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Grantham and District Hospital Good

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Inspection report

Date of Inspection: 24, 25 February 2014
Date of Publication: 2 April 2014
Inspection Report published 02 April 2014 PDF | 94.14 KB

Before people are given any examination, care, treatment or support, they should be asked if they agree to it (outcome 2)

Meeting this standard

We checked that people who use this service

  • Where they are able, give valid consent to the examination, care, treatment and support they receive.
  • Understand and know how to change any decisions about examination, care, treatment and support that has been previously agreed.
  • Can be confident that their human rights are respected and taken into account.

How this check was done

We looked at the personal care or treatment records of people who use the service, carried out a visit on 24 February 2014 and 25 February 2014, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service, talked with carers and / or family members, talked with staff and reviewed information given to us by the provider.

We were supported on this inspection by an expert-by-experience. This is a person who has personal experience of using or caring for someone who uses this type of care service.

Our judgement

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

Reasons for our judgement

The patients we spoke with during our visit had been in the hospital between one and twenty-four days. Most patients spoken with in the outpatients department and day ward told us they had been given choices about their care and had been able to make decisions about their care themselves We observed staff, in both areas, explaining processes to patients and ensuring each person had the correct information before moving on to a new topic.

Patients on the ward areas told us they sometimes received confusing information about their treatment and care as so many people appeared to be involved in the delivery of care to them. But on the whole patients were pleased with the attitude of all staff and the way they had been treated.

One patient told us, "It has been very reassuring because I was very frightened." Another patient said, "I was told what would happen the day before my tests commenced and then staff went over it again on the day."

During our visit we looked at 25 sets of patient notes. Each set of notes had recorded preferences of patients, such as the name they would like to be known as, their next of kin and their home address.

The trust has an outstanding action at two other hospital sites regarding the policy on Do Not Attempt Cardiopulmonary Resuscitation (DNACPR), which impacts on this hospital site. However the revised policy was approved by the trust board in August 2013 and due for renewal in August 2015. This sets out processes for staff to follow and how to complete the necessary documentation.

Each of the wards and departments visited were able to show us the folder which contained the up to date policy and the signatures of staff stating they had read the policy. The provider may wish to note the majority of signatures were of nursing staff. We asked two consultants how they had informed their medical staff of the new policy and they told us this was either on a one to one basis or within team meetings. We saw one consultant asking their team to ensure they had signed the information folder, after we had informed them. Another consultant told us this would be reiterating again with their team that day. A member of the nursing team had been allocated on each ward and department to ensure learning was put in place about the new policy.

The policy clearly sets out what staff should do if people cannot make decisions for themselves and whether they already had an advanced decision recorded about their wishes to be resuscitated or not. The forms seen were not always clear about what type of Mental Capacity Assessment had been completed prior to a decision being reached. We were informed update training in the Mental Capacity Act 2005 would be taking place in the next week, for those staff who required an update on that topic.

The majority of sets of patient notes we looked at contained all the information which had been gathered prior to a DNACPR form being completed. Nursing and medical staff had written in patients history sheets when the topic had been discussed with the patient and included details of when relatives had been present. When a person could not, due to their medical condition, make a decision for themselves, this was generally recorded. When relatives or other named next of kin had been spoken with, this was also recorded.

The provider may wish to note that where the form indicated a reason to be recorded of the decision made the relevant box was ticked but sometimes there was no record made of the decision process. For example on one form the box was ticked for CPR is unlikely to be successful. The form then asked the question - because - this part was not always completed. In another section, if the decision had been discussed with relatives/carers/those with power of attorney or others, the box was ticked for yes but no names or relationships of relatives etc had been added. Therefore we had no means of knowing whether the process had been discussed with anyone.

On one ward we were inf