HIQA report slams short-staffed HSE Community Hospital

Simon Brouder

In a damning report HIQA has raised major concerns about staffing levels at the Tralee Community Hospital and the impact this is having on its elderly and vulnerable residents.

In the inspection report published last Thursday the Health Information and Quality Authority reported major areas of non compliance at the Community Nursing Unit in Killerisk which is currently home to 41 patients.

Due to the lack of staff the report reveals that there are too few activities for the residents and many residents spend hours alone in their rooms with nothing to occupy them.

The lack of staff means many patients are sent to bed in the late afternoon before staff finish duty or go on break at 5pm.

Patients that don't go to bed in the afternoon must often wait until after 10pm to be put to bed as the single nurse on duty - aided by only a single care assistant - was kept too busy checking and administering medicines

Several residents with specific dietary requirements are fed with frozen ready meals as the catering department at University Hospital Kerry (UHK) can't provide them with suitable meals.

Other patients have been moved out of their private rooms to make space for residents who are dying as there is no private room set aside for patients nearing the end of their lives.

Following the inspections on January 15 and 16 this year HIQA reported that there were issues of major non compliance at the unit relating to residents' "rights, choices and staffing levels".

There were also five cases of "moderate non compliance" relating to medication management; health and safety; food and nutrition; the premises in general and residents' personal property.

Though the concerns relate to various areas the vast majority are linked to a lack of staff at the unit.

While HIQA - and many patients and their relatives - praised the staff at the unit the inspection report makes clear that staffing levels at the unit are well below required levels.

The lack of activities for residents - particularly in the evening and at weekends - was severely criticised.

"Many residents were seen to spend long periods of the day sitting in their bedrooms," the report states.

"The impact of many residents spending long periods of time in their bedroom accommodation meant that residents had limited opportunities to meet, interact and engage with one another.

The inspector noted that at 4.30pm 23 of the 41 residents were already in bed while eight more were eating their dinner beside their beds.

The HIQA inspector also noted that "as there is no dedicated single room for end of life care, residents who occupied single bedrooms would have to vacate their bedrooms to facilitate this practice" a situation that damaged the "privacy and dignity" of those forced to move rooms.

The quality of food - which is prepared at UHK - provided to some residents was also criticised.

"Catering staff confirmed that residents who required 'texture A' modified diets were still not offered a choice at mealtimes. Catering staff also advised that it was difficult to facilitate residents who had specific requests for a particular food in that it had to be ordered from the hospital catering department and may take up to two days to be delivered".

When that food was provided many residents' relatives said the food was "often unappetising in appearance, lacked colour and offered little variety".

Despite these issues residents and their relatives, and the HIQA inspector, were highly complimentary about the staff of the unit.

"Some relatives spoken with told inspectors that they were not satisfied with staffing levels, commenting that staff were wonderful but always busy," the report states.

"Many residents spoken with praised the staff stating that they were kind, caring and treated them with respect," said the report.

The report adds that a number of staff at the unit had told the inspector "that they were worried about staffing levels".

"One relative had complained that a resident had been left in bed on a number of occasions due to staffing shortages and they had been advised by staff that it was safer to leave the resident in bed as they would be at risk of falling and injuring themselves," says the report.

In response to the report the unit's HSE management said that staff rostering arrangements would be changed but it refused to make any commitment on providing additional staff.

In addition, more activities will be provided; residents will no longer be forced out of their rooms to make way for the dying and "a plan is in place" to use the unit's own kitchen to prepare meals on site according to residents' needs.