Focussed visit summary: Visits to older people in hospital
Number of visits 17
Number of recommendations 82
Recurring themes and areas for improvement
1.Environments
We made several recommendations aimed at improving care environments to meet people's right to privacy and dignity. These included:
- Making living areas more homely
- Providing more signs and environmental cues to help people with dementia
- Making best use of outside space
Example of improvements following our visit:
Our recommendation where we found that only part of a ward for people with dementia was well-designed
We would like to see the benefits of the obvious planning and work, that has gone into making the main body of the ward dementia friendly and homely, being applied to the bedroom and bedroom corridor area.
The hospital's response:
Bedroom area sectioned off with three colour schemes to support orientation and way-finding for patient,
Land marks set up in corridorincluding purchases of lamps, cushions, pictures, clocks, vases etc
Bottom windows painted with murals to aid way-finding and orientation
Doors leading to patient roomshave prompts/way-finding support including numbers, pictures & life story images
Bedroom doors colourcoordinated to zoneswith top panels blocked with coloured squares
2.Care plans
Principles of mental health and incapacity legislation include ensuring benefit, taking account of people's past and present wishes and providing appropriate services. We found several care wards where care plans were not individualised or did not appear to us to cover all the person's needs. In particular, we made recommendations where care plans:
- Did not contain information about people's life story, like, dislikes and interests
- Did not contain information about the need for activity or its benefit for the person
- Did not address appropriate use of people's own money to provide extra activity to improve their quality of life.
Example of improvements following our visit:
Our recommendation where we thought activity available on one ward was insufficient:
Activity programmes should be individualised and based on the patients' interests and wishes. Evidence of the effectiveness of activities should be recorded in individual case records as recommended in the Mental Welfare Commission report "Where do I go from here?"
The hospital's response:
A programme of OT activities does take place on the ward. The nursing staff also engage with the patients and an activity schedule has been introduced. An individualised activity recording system is to be introduced. The range of activities in this programme will be increased to include more patients.
3.Compliance with incapacity legislation
Many of the people we visited lacked capacity to make decisions about their welfare, treatment or finances. We wanted to ensure they were being treated in accordance with the Adults with Incapacity (Scotland) Act 2000. We made recommendations if they were not. Areas of recommendation addressed:
- Poor compliance with part 5 of the 2000 Act (medical treatment)
- Inadequate recording of the powers of attorneys and guardians
- Poorstaff knowledge of relevant legislation
Example of improvements following our visit
Our recommendation where we found that medical treatment was not being properly authorised by a "section 47" certificate of incapacity as required by the 2000 Act:
The files of all residents are to be reviewed to ensure that Section 47 certificates with treatment plans attached to them are in place where relevant.
The hospital's response:
All S47 certificates, treatment orders, certificates of guardianship and interlocutors are now to be stored consistently in the individual's file with the personal plans relating to mental state and cognition. Treatment plans given to GP for completion
