Inspectors have raised “serious concerns” about the nutritional care provided to three patients in one hospital.
One patient at Borders General Hospital in Melrose had lost more than 10% of their body weight in 17 days, and was scored as being at “high risk of malnutrition”, Healthcare Improvement Scotland (HIS) said.
It visited the 274-bed facility in June this year and found another patient had lost 6.15kg in weight since being admitted.
Inspectors also said a third patient had seen their weight fall by 4kg since admission, while their food record charts were “poorly completed”.
The HIS report said: “We have concerns about the leadership and management of food, fluid and nutrition in this hospital.”
Inspectors added they believed the issues with food and nutrition “were a result of the lack of senior leadership”, adding there was a “lack of governance”.
In their report they said: “We found no nutritional policy, no evidence of reporting to the NHS Borders’ Board, no strategic implementation plan and no evidence of an annual report. The current nutritional group meeting is on an operational level rather than a strategic level.
“We identified three patients whose care gave us serious concerns. We brought this to the attention of Borders General Hospital senior managers and asked for a review of the care of these patients.”
When a patient is admitted to hospital, a nutritional care assessment should be carried out with screening for any risk of malnutrition done on an ongoing basis.
But inspectors said there were concerns about the accuracy of malnutrition screening, saying there was “no place on the majority of documentation in use to enter a patient’s usual weight or any unplanned weight loss”.
Nineteen patients should have undergone weekly screening but this was only completed for seven, the report added.
HIS has now recommended NHS Borders make sure its staff have the “knowledge and skills required to meet patients’ food, fluid and nutritional care needs”.
The health board has also been told to “ensure there is governance and leadership for nutritional care in order to provide assurance to the NHS Borders’ Board that the provision of food, fluid and nutritional care meets the required national standards for safe and effective patient care”.
NHS Borders medical director Dr Cliff Sharp said the health board had developed an action plan to address the areas for improvement identified in the report.
He stated: "Most areas for improvement relate to documentation and highlighted instances where we have not yet embedded all aspects of the food, fluid and nutritional care standards.
"Our new director of nursing, midwifery and acute services, Claire Pearce launched a 'Back to Basics' improvement programme earlier this month.
"This is a focused effort to ensure that the improvements we make are embedded and sustained, and includes an important piece of work to reduce the burden of documentation for clinical staff, so that they have more time for patient care.
"We have asked Healthcare Improvement Scotland to support this improvement work.
"Under the leadership of myself and Claire we have already changed our documentation to take account of the learning from the inspection, commenced a staff training programme with a focus on assessing patients' nutritional needs and introduced a new method of providing ongoing assurance relating to food, fluid and nutrition."
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