Inspectors ask Inverclyde Royal Hospital to improve
Inspectors have found issues with documentation including "Do not resuscitate forms" in Inverclyde Royal Hospital (IRH).
During an August inspection Healthcare Improvement Scotland (HIS) found that forms were completed inconsistently.
NHS Greater Glasgow and Clyde (NHSGGC) have been asked to improve in 14 areas "as a matter of priority".
The visit was part of the HIS programme of inspections on the standard of care for older people in acute care.
The report also noted areas some of strength at the Greenock hospital.
Inspectors examined "Do not attempt cardiopulmonary resuscitation" (DNACPR) documentation, which relates to the emergency treatment given when a patient's heart stops or they stop breathing.
Sometimes medical staff will decide not to try to resuscitate a patient. They may not share this information as if they feel it will cause too much distress for the patient and their family.
Three of the eight forms the inspectors reviewed did not document whether the decision had been discussed with the patient or relatives, meaning it was unclear whether they knew about the decision.
Two forms had no date for review and another two had not been reviewed in the time scale specified in the document.
Inspectors have asked the health board to ensure clinical staff "consistently comply with the national policy on do not attempt cardiopulmonary resuscitation".
Inspectors also found patients' intake of food and fluid was not accurately recorded or monitored and there was a lack of information on the personalised care plans outlining the individual needs of older people.
They also noted poor awareness and a lack of understanding among staff of the Adults with Incapacity (Scotland) Act 2000, which protects the rights of patients who lack capacity.
HIS said all staff who have a professional role in implementing the legislation must receive appropriate training.
Areas for improvement
Head of Quality of Care at HIS Jacqui Macrae said: "Our inspection has highlighted areas where Inverclyde Royal Hospital is performing well in relation to the care provided to older people. We found meal times were well managed and observed caring and friendly interactions between staff and patients.
"However, we did identify areas where improvements must be made. Across the wards inspected, we found an inconsistent approach to the completion of patient documentation including DNACPR forms and food and fluid balance charts, and although we saw care plans in place, these and did not reflect individual patient needs.
"We also found poor awareness of the Adults with Incapacity Act among staff."
Other areas of strength at the hospital include patient care, which was carried out in a way which maintained patient dignity and was compassionate and respectful, and psychiatric liaison services specifically for older people.
Dignity and respect
Rosslyn Crocket, NHSGGC board nurse director, said: "We are pleased to note that the inspection team observed patients being cared for with dignity and respect by staff providing friendly and polite interactions with the patients.
"This was reinforced by the views of most of the patients and family members interviewed who spoke positively about the quality of care received.
"However, I am extremely disappointed that in a number of areas, particularly record keeping and care planning, we are still falling short of the standards expected.
"To address the improvements highlighted in the report we have developed a comprehensive action plan which is being monitored closely to ensure full implementation."