"Do not resuscitate" forms for patients were completed inconsistently at a hospital, inspectors have found.

The Healthcare Improvement Scotland (HIS) inspectors noted issues with the documentation when they visited Inverclyde Royal Hospital (IRH) in August.

They have asked NHS Greater Glasgow and Clyde (NHSGGC) to make improvements in 14 areas following the report, which the health board must address "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 some areas of strength at the hospital, in Greenock.

During their visit the 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 and resuscitate a patient, and may decide not to share this information as they feel it may cause too much distress for the patient and their families.

Three of the eight forms the inspectors reviewed did not document whether the decision had been discussed with the patient or relatives, meaning they could not be sure the patient or their relatives were aware of the decision.

Two forms had no date for review while another two had not been reviewed in the time-scale identified in the document.

Inspectors have now asked the health board to ensure clinical staff "consistently comply with the national policy on do not attempt cardiopulmonary resuscitation".

The inspectors found patients' intake of food and fluid was often not accurately recorded and monitored, and there was a lack of information in 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 training appropriate to their role.

Jacqui Macrae, head of quality of care at HIS, 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.

"This inspection resulted in 14 areas for improvement which NHS Greater Glasgow and Clyde must address as a matter of priority."

The inspectors also noted areas of strength at the hospital, such as that patient care was carried out in a way which maintained patient dignity and was compassionate and respectful.

They said the meal times they saw were well managed and co-ordinated and psychiatric liaison services, specifically for older people, are embedded in the hospital, supporting the patient's journey.

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."