Focussed visit summary: Visits to people in adult acute admission wards
Number of visits: 8
Number of recommendations: 24
Recurring themes and area for improvement
1. Access to staff
People who are acutely mentally unwell must be able to discuss their problems with nursing staff. This should include dedicate1:1 time with key members of staff.
Example of improvements following our visit:
Our recommendation where patients told us they did not have enough access to staff and often did not know who to approach
Staff should be proactive in providing 1:1 time for patients and this should be recorded. Patients should be clear which member of staff is allocated to them on each shift.
The hospital response:
Staff are allocated a client 'group' at the beginning of each shift. The staff described speaking to all of their group on an individual basis. The content of the interactions is recorded in care plans. All staff will inform their allocated patients that they are indeed allocated to them. Staff describe specific 1:1 interactions but often record this as a 'nursing note'. This has been discussed to ensure correct recording. The staff were also reminded that their client group felt they were not proactive enough in providing 1:1 interactions with their patients and ensure this time is protected.
2. Privacy and dignity
Adults admitted to admission wards in the acute phase of their illness are often temporarily unable to protect their own privacy and dignity and therefore it is incumbent upon staff to take extra care to ensure this fundamental human right is protected. We made a number of recommendations in relation to
- Improving privacy for individuals in dormitories
- Screening ofbedroom windows
Example of improvements following our visit:
Our recommendation where we were concerned that unscreened clear glass bedroom windows were causing patients' dignity to be compromised :
Recommend that hospital managers arrange, as a matter of urgency, for those windows into bedrooms which have clear glass to be screened effectively, to ensure that there is no breach of privacy for individuals using these bedrooms.
The hospital response;
In this situation, we did not receive a response despite several reminders. We are undertaking an unannounced visit and will escalate this matter to the Chief Executive of the NHS Board if we have not seen satisfactory progress.
3. Therapeutic activities and talking treatments
There should be an active presumption based on the principles of benefit and reciprocity that people admitted to an acute admission ward are offered appropriate care and treatment.A range of recovery focussed medical, nursing and psychological interventions should be available.
We made recommendations about:
- Need for a range of structured activities and therapies to aid recovery
- Lack of psychology provision
Example of improvements following our visit:
Our recommendation where we were concerned to find a lack of activities and therapies
We recommend provision of a range of activities, to develop and maintain skills, to build on other recovery focussed initiatives and therapies, and to relieve boredom, should be part of standard in-patient mental health care.
The hospital response ;
A system is now in place documenting activities undertaken by patients. The system is contained within the care plan and reviewed regularly.
With respect to time spent within bedrooms, a clear system of recording is now in place, including time spent in room and reason for time in room. In addition, a system has been put in place for the rooms with alarms where patients can call staff more discreetly.
