Nourishment concerns for patients in Leitrim home raised

Some patients at a HSE-run nursing home in Co Leitrim may have gone without nourishment for periods of up to 15 hours due to limited food stocks in the hospital kitchenette, according to a new Hiqa report.

The report on St Patrick's Community Hospital in Carrick-on-Shannon also revealed concerns over choking risks, poor medication management, a lack of nutritional supports for patients and the use of chemical restraint methods in the facility.

Following an announced visit on October 9th last, inspectors cited grave concerns over the amount of time some patients were being confined to their beds. On one ward in particular, seven out of 13 patients were reported to be regularly bed-bound for entire days.

Constant referrals were made to an acute staff shortage suffered by the facility, which caters for 84 full-time patients, many of whom are elderly, along with another 30 day patients.

In one unit visited, inspectors found that over a two-week period, there were four days each week when no resident received a bath or a shower.

It was observed that trolleys containing medication were stored in communal areas accessible to residents and patients, and inspectors noted errors in medical administration records including omissions of what drugs were administered, and what dosage was given.

The report also identified the “excessive” levels of drugs that were stocked in the hospital, which was disproportionate to the frequency of orders made by patients.

Concerns were noted over the monitoring of patients’ nutritional needs and weight management. In one instance, a patient had lost 12kg in the space of two months without any staff realising or intervening until he was moved to a new ward, at which point he began to recover some of the lost weight.

The hospital’s dining area was described as “unattractive and institutional” in character, with many patients electing to have meals in bed.

The menus on offer didn’t satisfy nutritional needs, according to a review by inspectors, included chips four times a week, and failed to provide any hot food options for two evenings every week.

Health risks such as dysphagia and other difficulties with swallowing weren’t sufficiently flagged in patients’ records. This led to potential hazards around suffocation, especially at meal-times where locum staff who may have been unfamiliar with patients’ needs were involved.

The hospital also came in for criticism regarding its guidelines on the use of chemical restraint. Detailed records were not kept of instances when chemical restraint was used, and the effect it may have had on patients.

One resident who was receiving end of life care had two conflicting care plans in place, a situation which could lead to “confusions and risk of errors”, according to the report.

Previous inspections carried out at the hospital in July and October 2013 found it to be largely compliant with Hiqa criteria.