Visit highlights patient privacy and repairs

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The Mental Welfare Commission for Scotland found issues with patient privacy and building repairs at a ward in Ayr’s Ailsa Hospital.

The Commission is also looking into whether decreased staff and lack of activities is leading to incidents of aggression and distress for patients and staff at the hospital’s Dunure ward.

There were no issues found at the Croy and Lochranza wards, however the Commission heard that families of patients are concerned at plans to close Lochranza ward which looks after long-term rehabilitation patients.

Dunure Ward is a 15-bed ward designated for the assessment of organic mental illness in older adults. On the day of the visit there were 14 inpatients.

The report found that care plans have a good level of person-centred information and detail. It was very clear that the nurses know their patients, their preferences, and their carers. It was evident that relatives are encouraged to visit flexibly, with mealtimes protected. Patients were also positive about the care they receive. Efforts are made to help patients maintain links with their families, friends, and even with pets; these connections support the therapeutic work being done on the ward.

But the report found that activity provision is limited, with no dedicated activity coordinator or regularly scheduled programme of activities. Most activities are undertaken on a one to one basis.

Based on discussions with staff the Commission is interested in whether there is a correlation between incidents of aggression and distress in the evenings, with a smaller staff complement and decreased activity provision at those times.

The report stated: “On the day of our visit the ward appeared calm and clean. However, the ward is not ideal for the delivery of care and therapeutic services. The day room and dining room spaces are in the central core of the unit, have no windows and have little natural light. The décor of the ward is shabby and tired.

“Bedroom door windows do not have privacy blinds, and there are large windows at corridor ends that lack blinds. Lack of privacy screening compromises patient dignity. We were shown broken railings, loose radiator guards, curtains half off the rails, and signage pulled off walls. There is little dementia signage, particularly as some of what was previously provided has been removed by patients and has not been replaced. We were informed that there are problems getting maintenance issues addressed; all issues brought to our attention during the visit have been reported but not yet repaired.”

Recommendations included that the ward manager should conduct an audit of incidents of stressed and distressed behaviour. If a higher rate of stressed and distressed behaviour is identified in the evenings, consideration should be given to enhancing the staff compliment and/or activity provision at certain times in the evenings.

Managers should undertake a dementia environment assessment and implement the findings from this.

The ward manager should complete an audit of bedroom doors and windows, and take steps to ensure patient privacy and dignity is safeguarded.

Managers should ensure that outstanding repair and refurbishment work is undertaken as soon as practicable; a system should be implemented to ensure that maintenance requests are responded to within a reasonable timeframe.

The Commission was impressed by the four visitor rooms, which were created with funding contributions from relatives and fundraising efforts by staff. These rooms provide a comfortable and peaceful environment in which relatives and carers can meet with their loved ones. Positive mention was made of the liaison nurses who work between the ward and care homes in the community. According to staff, the liaison service has directly prevented hospital admissions and has served to support patients following discharge from the ward. The Commission requires a response to these recommendations within three months of the date of the report.

Croy Ward is a fourteen-bed ward designated for the assessment of functional mental illness in older adults. On the day of the visit there were seven inpatients.

The intent of the visit to Croy Ward was to review previous recommendations and generally review the care and treatment being received by patients.

Care plans have a good level of person-centred information and detail. There is evidence that care plans are updated regularly and weekly multidisciplinary team meeting minutes are thorough and easily accessible on the electronic recording system. Records include evidence that families are kept informed of care and treatment – with patient consent – and are involved in decisions.

It was very clear that the nurses know their patients, their needs, and their carers. It was evident that relatives are encouraged to visit flexibly, with mealtimes protected.

Activity provision is limited though the Commission were satisfied that there were sufficient activities for patients, though for this to remain satisfactory staff must continue to prioritise the provision of meaningful and engaging activities for individuals.

Some patients can find the ward meals too restrictive. Due to amendments to the porter service, evening meals are served to Croy’s patients very early and cannot be reheated. While patients can bring in their own food, this is not an ideal alternative to receipt of hospital meals and is not a realistic option for everyone. No recommendations were made from the visit but the Commission would like an update on the issues raised regarding meal provision and would like to be informed of any significant changes to the provision of activities for patients.

Lochranza is a 14-bed long term rehabilitation ward for male and female adults on the Ailsa Hospital site. The nursing staff told us of the strong staff team they feel they have, which they believe contributes to the care and treatment received by patients.

The Commission heard that in anticipation of the closure of other wards on site, Lochranza’s staff team was increased and staff report feeling supported by each other. We were informed that Lochranza staff do not feel isolated on the Ailsa campus.

The report stated: “All relatives and patients with whom we spoke were anxious about the plans to re-provision the service and did not want the unit closed. They told us that patients concerned had a long history, some over decades, of community and hospital placements; we were told of several failed placements when individual needs were not met. They told us that Lochranza staff had been able to manage the complexity of these needs and improve the quality of life for those individuals, while promoting independence.”

There is a high level of attention paid to the physical healthcare of patients. The ward employs a ‘health and well-being advisor’ who is a nurse with a focus on physical care and health improvement.

No recommendations were made following the visit.