A Scottish hospital was ordered to carry out an immediate review of its care of elderly people after inspectors highlighted concerns to staff.
Healthcare Improvement Scotland (HIS) said it had worries about nutritional care and hydration in the wards inspected at Victoria Hospital in Kirkcaldy, despite warnings in a report earlier this year that improvements needed to be made.
As a result, inspectors asked NHS Fife to carry out an immediate review of all patients in one ward to ensure that the correct care was in place.
Earlier this year a previous inspection at the site identified one patient who received no food for ten days because hospital staff could not fit a feeding tube.
The follow-up inspection at the Victoria in June, which followed the last inspection in March, found that was still “an inconsistent approach to nutritional care and hydration across the wards inspected”.
In particular, inspectors found issues with nutritional screening, calculating patients’ body mass index and with the completion of food and fluid balance charts.
Their report also found delays in screening patients for nutritional needs to identify those at risk of weight loss and problems eating.
Out of 14 patient health records reviewed, only four patients had received nutritional screening within 24 hours of admission to hospital.
One patient’s health record stated that they were “unable to weigh” on admission to hospital and the nutritional screening was not conducted until 17 days later. Later screening showed they had lost 6kg in weight.
Another patient was admitted to hospital with reduced appetite and confusion but there were delays in nutritional screening and information on weight missing from their record.
The report noted: “There was no nutritional care plan in place for this patient. At the request of medical staff, the patient was seen by a dietitian five days later, 24 days after they had been admitted to hospital. A 19 per cent weight loss was calculated.”
Inspectors found that food and fluid balance charts were still not well completed at the Victoria. In one case a patient had no documented fluid intake between 12pm and 9pm.
Jacqui Macrae, HIS head of quality of care, said: “The purpose of this inspection was to assess the progress made by NHS Fife towards addressing four areas for improvement identified at our previous inspection.
“During this follow-up inspection, we found evidence that NHS Fife was working towards addressing our recommendations. However, while we saw that one recommendation has been met three remain.”
She added: “We had particular concerns about nutritional care and hydration across the wards inspected. As a result, we asked NHS Fife to carry-out an immediate review of all patients in one ward to provide assurance that the correct care was in place.
“NHS Fife carried out this review and provided us with an action plan of how these issues will be addressed.
“We will follow-up this action plan at a future date. NHS Fife must address these areas for improvement as a matter of priority.”
Heather Knox, director of acute services at NHS Fife, said: “NHS Fife has been working hard to address the issues raised and progress is being made.
“We are pleased that the report highlights the improvements made to the management of patient mealtimes, the calm and organised manner of lunchtimes on our wards, and the positive input of our dietetic services and speech and language therapists.
“We acknowledge that at the time of the inspection there were inconsistencies of approach in certain areas - these are being actively addressed through a number of initiatives.
“We are committed as an organisation to building further on the work currently under way and I am grateful to our staff for their tireless efforts.”