Published: 02/02/2014 08:30 - Updated: 31/01/2014 11:41

Dr Gray's given areas of improvement

MORAY’S main hospital has been told by inspectors that it must do better.

Healthcare Improvement Scotland raised a number of concerns surrounding their visit to Dr Gray’s in November.

While 100% of patients surveyed said they had received good care, an array of problems were raised.

A poor filing system in one ward led to fears medical records could be lost; staff did not always use the correct admission documentation; and some ‘Do Not Resuscitate’ documentation (DNACPR) was inaccurately filled out.

“Staff’s awareness of, and ability to recognise, delirium was varied and not all staff were aware of any guidelines or protocol that guide management and care,” the report continued.

Inspectors found that the majority of patients were treated with compassion and spoke highly about staff and their care.

Evidence of good leadership was found and NHS Grampian’s partnership working with the voluntary sector to support patient discharge was hailed.

“However, we identified a significant number of areas where NHS Grampian needs to improve the care provided to older people,” said Jacqueline Macrae, head of quality and care.

“We found an inconsistent approach to the completion of patient documentation, including do not attempt cardiopulmonary resuscitation forms, nutritional assessments and personalised care plans.

“As a result, we could not be assured that care given was appropriate to individual patient needs.

“Wards were not dementia friendly and patient mealtimes were poorly managed.”

Inspectors found one area of strength, 14 areas for improvement and three areas for continuing improvement.

NHS Grampian said it would address the issues as a “matter of urgency”, with an action plan already in place.

A spokesperson said: “We are pleased the report found that patients were treated with compassion, dignity and respect, and that there was evidence of good leadership on the wards.

“The inspectors also noted the positive feedback from patients. All patients surveyed said that the quality of care was good, and staff will be pleased to know they were described as caring, kind and friendly.

“However, the report did find areas for improvement. It highlighted the maintenance of certain patient documentation, planning and staff awareness of care protocols and called for better patient flow through the hospital. This is disappointing for a hospital with a good record in the care of older people, and these issues are being addressed as a matter of urgency.”

Staff “consistently” raised concerns about patient flow and capacity impacting on their work, and inspectors said they were aware of 18 patients whose discharge had been delayed – eight waiting for social work care, six waiting for transfer to other hospitals, and four waiting for long term care.

The NHS spokesman said steps were already in place to improve the situation.

“The staff in Dr Gray’s work hard to maintain patient flows, and the discharge process which is key to maintaining patient flows has speeded up as a result of closer working with community health and social work colleagues,” he said.

The spokesman confirmed that inconsistencies in the completion of DNACPR forms would be quickly rectified.

He said: “Patients who have a DNACPR order are well known to ward staff. There is always significant clinical discussion and conversations with family, which are documented in case notes before a DNACPR is confirmed. If there is any doubt the team will always start resuscitation. Every attempt is made to save and sustain life.

“The recommendation in the report relates to inconsistencies in the way documentation was completed. An audit of completed paperwork will be carried out and all the issues identified by the inspectors will be addressed.”

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