​Inspectors highlight key concerns over Western Isles Hospital​​​​​​​

A team from Healthcare Inspectorate Scotland visited the hospital in September and while they observed “busy staff working hard to deliver care” there was a “disconnect between ward staff and senior management”.

They highlighted particular worries over paediatrics.

“Within evidence provided there were multiple incidents submitted by staff in relation to the care of paediatric patients including the lack of availability of registered children’s nurses,” the report said.

“During the onsite inspection, ward staff raised concerns in relation to caring for paediatric patients without having undergone further training, particularly in relation to the administration of medication including intravenous antibiotics.”

They said that “senior managers explained challenges in ensuring a children’s nurse is available during every shift”. Further clarification was required, said the inspectors, “regarding the conflicting evidence we had received”.

“We were told that a member of the nursing staff had raised concerns that they did not feel suitably trained to safely care for paediatric patients and it had been escalated to the senior executive on call, who attended the ward and felt this was the safest option for the patient.”

The report went on: “Paediatric inpatients are cared for in a dedicated bay or single rooms in an adult inpatient ward. Through several incident reports we observed occasions where adult patients within the ward have become distressed, confused and aggressive.

“During our virtual discussion with senior managers, we asked how any potential risks from both adult patients and paediatric patients being cared for in the same ward area are mitigated. We were advised that paediatric patients were accompanied by an adult at most times during their hospital stay.

“However, NHS Western Isles acknowledged that there may be occasions when the paediatric patients are unaccompanied.”

There was also, said the report, “no risk assessment in place to support the movement of patients displaying signs of confusion and aggression”.

In terms of advanced life support for adult patients, the clinical support nurse team are the “first point of contact for any staff member caring for a deteriorating patient”.

“We sought further assurance regarding the training of clinical support nurses in relation to adult immediate and advanced life support,” said the report.

“From the data provided we observed that although some of the clinical support nurse team had previously completed training, this qualification had expired. Therefore, currently no members of the team hold a valid immediate life support certificate and four clinical support nurses hold a valid advanced life support certificate. A requirement has been given to support improvement in this area.”

The report also detailed concerns over fire safety and fire safety training.

In terms of the general background, the inspectors recognised that “Western Isles Hospital was experiencing similar challenges to hospital boards in mainland Scotland including staffing shortages, high acuity of patients and increased patient numbers”.

Following publication of the report, NHS Western Isles Chief Executive Gordon Jamieson said: “We welcome all inspections and opportunities to address areas and issues to be improved so that we can provide the best care to patients that we possibly can, and to ensure that are staff are well supported.

“There are a number of points in the report that demonstrate the excellent care provided by our staff to the local population and it is testament to the staff delivering care that all patients spoke highly of the care received and would be happy if a loved one had to access care at Western Isles Hospital.

“As well as the positive findings, it is the purpose of an inspection to identify areas where improvements could be made. There were a number of areas identified for improvement and it is a priority for us to address these as quickly and comprehensively as possible.”

Mr Jamieson added: “Since the inspection, we have developed a detailed Improvement Action Plan to address the areas that Inspectors have identified.

“Ensuring all relevant staff are up to date with their annual paediatric immediate and advanced life support training is a priority for us, and ensuring that staff continue to be supported in terms of their wellbeing is key, in particular during these challenging times when hospital occupancy is so high and as recruitment remains one of the Board’s main challenges.”