Psychiatric hospital staff seen ‘focusing’ on mobile phones rather than patients

Staff in a psychiatric hospital were seen by inspectors “focusing” on their mobile phones when they should have been monitoring patients being cared for in “non-standard” areas because of pressure on beds.

Healthcare Improvement Scotland said the “majority of interview rooms and quiet rooms” at the Royal Edinburgh Hospital were being used to accommodate patients when inspectors visited, despite these rooms having furniture which “presented a ligature risk” if patients were suicidal.

While hospital workers should have been carrying out “continuous interventions” with patients being cared for in these additional beds, HIS inspectors said the majority of staff were seen “sitting outside the patient’s room”.

A new report for HIS added: “A few of these staff were also observed by inspectors to be focusing on their mobile phones at times.

“In some instances, inspectors observed that the bedroom door and blinds were closed, making it difficult for the member of staff to observe or interact with the patient.”

HIS inspectors said they “raised this immediately as a serious concern” with senior managers at NHS Lothian, adding they then “took action to ensure this was addressed immediately”.

However the report is the second by HIS to criticise NHS Lothian in just over two weeks – with a report in October raising “serious concerns” about maternity care in the area.

HIS carried out an unannounced inspection at the Royal Edinburgh Hospital in June this year, with inspectors finding 21 areas where it failed to meet the required standards.

Managers told inspectors the “non-standard care areas” were “not designed to be bedrooms”, and these were “only planned to be used as a short-term response to increased demand for inpatient beds”.

While those working in the wards said they had “good support” from senior staff, the inspectors said those in one ward “felt there is a lack of leadership”.

The report added: “Staff in the ward described feeling isolated with low morale and that they were concerned that continuous interventions are not always facilitated due to a lack of available staff.”

HIS chief inspector Donna Maclean said during the visit to the Royal Edinburgh Hospital they saw “good multidisciplinary team working to provide person-centred care and treatment and kind and respectful interactions between staff and patients”.

She added: “Staff were open and transparent about the current challenges they face in relation to the use of non-standard care areas throughout the hospital.

“During our inspection we raised several concerns with senior managers relating to the care of patients within non-standard care areas.”

Ms Maclean added concerns were also raised with senior managers at NHS Lothian about risk assessments, the lack of an approved process to support staff decision making, and the lack of privacy for patients in non-standard care areas – with the report noting one patient used a picture to cover a window in their room as “they had no blinds or curtains”.

She said: “Several requirements have been given in relation to a lack of effective systems in place to support the delivery of safe care within non-standard care areas.

“We will return to carry out a follow-up inspection to assess and monitor improvement in response to these concerns.”

Jim Crombie, deputy chief executive at NHS Lothian, said the health board takes the issue of patient safety “extremely seriously”, adding it “took immediate action to address many of the concerns raised in the report”.

Mr Crombie said a “structured plan to reconfigure wards to add extra permanent beds” is almost complete, adding this “will end the use of temporary, non-standard areas”.

He said: “Additional leadership oversight and staff training are in place to improve the quality and consistency of ligature inspections, assessments and observations to further reduce the risk of patient self-harm or suicide.

“We have also recently recruited 97 newly qualified nurses, and 30 healthcare support workers. This will allow us to meet increasing service demand and provide more resilience, while significantly reducing the use of bank and agency staff.

“We are committed to providing safe, effective care for patients and ensuring staff are well supported. We are grateful to HIS for their guidance and will continue to work with them and other professional bodies to improve our services.”