A health watchdog has twice raised “significant concerns” after finding children are being treated in an adult ward in Stornoway.
Healthcare Improvement Scotland (HIS) said the situation could leave children without adults accompanying them when adult patients are confused.
The watchdog said there were incidents when adult patients could become distressed, confused and aggressive while children were being nursed on the ward.
Children accompanied ‘most times’ in adult ward
HIS said it was told children were accompanied by staff “most times” during their stay in an adult ward.
But there were times when children were unaccompanied on the adult ward.
The health board told the watchdog it would take adult patients off the ward who were showing signs of confusion and aggression.
HIS carried out an unannounced inspection of the 68-bed hospital on September 3, and 4.
Inspectors said they observed staff working hard to provide compassionate and responsive care.
But HIS twice wrote to NHS Western Isles during the inspection to raise “significant concerns” about paediatric or children’s care and fire safety in the hospital.
In a report, HIS said: “…Significant concerns were raised in relation to mandatory staff training, particularly paediatric training and fire safety.
“Due to these significant concerns, we wrote to the board twice to raise our concerns about this. There remains a lack of assurance in this area.”
The watchdog said that as a “matter of urgency” all staff must complete children and adults immediate life support training to carry out their roles.
The hospital is one of three on the islands and is by far the largest in the Western Isles.
The report said: “We were advised that paediatric patients were accompanied by an adult at most times during their hospital stay.
“We found that children are cared for in a dedicated bay or within single rooms in an adult ward.
“Through several incident reports, we observed occasions where adult patients within the ward have become distressed, confused and aggressive.
“Although we were told that children were accompanied by an adult at most times during their hospital stay, there may be occasions that children are unaccompanied.
‘No visible leadership’ at Western Isles Hospital
“Hospital managers told us that when an adult patient becomes confused and shows signs of aggression, they would move them to another ward to ensure children are not cared for in the same area.
“Some of the areas visited were calm and well organised with visible leaders.
“However, within one ward we visited there were no visible leadership and staff reported feeling stressed.”
Concerns about mandatory fire safety training were also raised as an urgent issue.
In addition, medicine was found on patients’ bedside tables, and medicine cupboards and preparation rooms were left unlocked.
The watchdog continued: “This may increase the risk of errors such as medicine being missed or being taken by the wrong person.”
Concerns were also raised about the lack of buzzers in the emergency department.
The watchdog said: “In the emergency department we also saw no patients have access to a call bell and in the side rooms there was only an emergency buzzer.
One shower for 22 patients
“There are times when the door may be closed, and it may be more difficult for patients to get help.”
In one ward, the watchdog found: “There was one shower and no bath for 22 patients, managers advised that there are plans to upgrade the facilities within this ward.”
Patients were instead offered a basin to wash at their bedside.
In all HIS made 22 requirements for the hospital, saying “NHS Western Isles must make sure these are all met”.
Routinely health boards are expected to provide an action plan at 18 weeks however due to significant concerns raised throughout the inspection process HIS has asked NHS Western Isles to provide updates at 6, 10, 14 and 18 weeks.
In a statement, NHS Western Isles said it was consistently being challenged in its efforts to recruit registered children’s nurses but had successfully increased its total complement from four to five.
It said a clinical support nurse was always on duty to support staff, along with 24-hour availability of a consultant paediatrician and consultant anaesthetist.
Testament to care that patients received
The health board said concerns around fire safety were also being addressed.
Chief executive Gordon Jamieson said: “There are a number of points in the report that demonstrate the excellent care provided by our staff to the local population.
“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.”
A spokeswoman confirmed that training was already underway.
She said: “Fire extinguishers servicing was completed on October 21.
“Paediatric Immediate Life Support (PILS) training has been completed for all Medical Ward 1 nurses. One exception of a member of staff absent, who will complete it next month. Medical 1 is the ward where children are cared for.
“At the hospital huddles, staff are now asked if there have been any staff wellbeing concerns in the preceding 24 hours or anticipated for that shift (none have been raised thus far).
“Compliance with Real Time Staffing assessment has improved across all teams and is monitored and shared monthly.”
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