Staff advised on resuscitation plan

Hospital staff have been told they must consistently comply with the national policy when decisions are made not to resuscitate patients.

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Inspectors looking at the standard of care for the elderly at St John's Hospital in Livingston highlighted 15 areas where improvements should be made

Hospital staff have been told they must consistently comply with the national policy when decisions are made not to resuscitate patients.

Inspectors who visited St John's Hospital in Livingston, West Lothian, found there were cases where decisions were made in which the appropriate documentation and national policy was not followed.

The inspectors, who were looking at the standard of care for the elderly at the hospital, have now highlighted 15 areas where improvements should be made.

The team, from Healthcare Improvement Scotland (HIS), said that NHS Lothian "must ensure that clinical staff consistently comply with the national policy on do not attempt cardiopulmonary resuscitation (DNACPR)".

Medical staff sometimes decide not to attempt to resuscitate someone if their heart stops beating or they are no longer breathing.

Such decisions are made in cases where doctors believe intervention will not benefit the patient, for example if an underlying disease means they are not expected to live, but should be discussed with the patient and their family.

Hospital inspectors saw two DNACPR forms where it was noted there should be a discussion with the patients and their families about this, but they said neither of these discussions had taken place by the time of the inspection last month.

They also found one DNACPR form where no discussion with the patient or their family was noted either on the form itself or in the patient's health record.

In addition, NHS Lothian has been told it should ensure all older people who are admitted to St John's or treated in accident and emergency at the hospital should be assessed to see if they are suffering from any cognitive impairment, and that all affected patients should have a personal care plan in place.

The inspectors' report described cognitive screening as "poor", adding that from the records they had reviewed just over 27% had been screened for cognitive impairment.

There was said to be a " lack of understanding by staff of the need for cognitive screening" and how the results of this can then impact on patients' care.

Inspectors also found that one patient with a known history of Alzheimer's had 'happily confused' written in their patient health record, which they said was "not respectful language to use when describing a patient with dementia".

Regional inspector Ian Smith said: "In this inspection we noted areas where NHS Lothian was performing well in relation to the care provided to older people in St John's Hospital.

"We saw warm, caring and meaningful interactions between staff and patients, and care was carried out in a way that maintained patient dignity and was compassionate and respectful."

But he added: "We found that further improvement is required in the certain areas.

"For example, do not attempt cardiopulmonary resuscitation (DNACPR) documentation and national policy was not always followed, and screening for cognitive impairment was not routinely carried out in patients over 65 years when they were admitted to hospital."

He also said while some wards at the hospital had "dementia champions", their role was "unclear" and it was "not evident how they are improving dementia care throughout the hospital".

Sarah Ballard-Smith, nurse director at NHS Lothian, said that Healthcare Improvement Scotland had highlighted "a number of areas of strength" in the hospital's care for older people, stating: "It is pleasing to note that 95% of patients interviewed felt that the care they received was of a good standard.

"The inspectorate found that we are performing well in relation to the care provided to older people, with warm, caring and meaningful interactions between staff and patients.

"Other areas of good practice include that our staff were seen to be treating patients with dignity and that the care we provide is compassionate and respectful."

She added: " There were some areas which the inspectors felt could be improved upon and we have already addressed each of these issues.

"We are developing an education programme for staff to reinforce the national policy on do not attempt cardiopulmonary resuscitation (DNACPR).

"Over 100 individuals across NHS Lothian have been identified as vulnerable patient champions in order to ensure key information on the management of frail and elderly patients is disseminated across departments.

"Adding to this, we have rolled out a new assessment tool to ensure that older people are screened for cognitive impairment when being treated in the emergency department and for planned procedures.

"We have invested considerably in dementia training for large numbers of our staff and are also reviewing the excellent work our many dedicated volunteers can play in the care of patients with dementia.

"Assessing, developing and improving how we work are fundamental to NHS Lothian and we are committed to providing high-quality, safe and person-centred care for everyone."