Compliance rat­ing falls af­ter in­spec­tion


Wicklow People (West Edition) - - NEWS - By MYLES BUCHANAN

NEW­CAS­TLE Hospi­tal’s compliance rat­ing has fallen by 8 per cent from last year fol­low­ing a Men­tal Health Com­mis­sion (MHC) in­spec­tion car­ried out over four days in Fe­bru­ary.

Compliance with reg­u­la­tions, rules and codes of prac­tice had de­creased from 77 per cent in 2018 to 69 per cent in this year’s in­spec­tion.

The in­spec­tion was car­ried out on the Glen­cree Ward, the acute ad­mis­sion unit with ca­pac­ity for 26 res­i­dents, and the Avon­more Ward pro­vid­ing con­tin­u­ing care and a long stay fa­cil­ity, with ca­pac­ity for 26 res­i­dents.

Eleven in­stances of non compliance reg­u­la­tions were recorded in the in­spec­tion re­port. There were ‘High’ risk rat­ings for food safety, in­di­vid­ual care plan, ther­a­peu­tic ser­vices and pro­grammes, staffing, reg­is­ter of res­i­dents, rules gov­ern­ing the use of seclu­sion and Part 4 of the Men­tal Health Act 2001 - con­sent to treat­ment.

There were mod­er­ate risk rat­ings for gen­eral health, rules gov­ern­ing the use of me­chan­i­cal means of bod­ily re­straint and code of prac­tice on the use of phys­i­cal re­straint in ap­proved cen­tres. There were low risk rat­ings for reg­u­la­tions on premises,

New­cas­tle Hospi­tal was com­pli­ant with 24 other reg­u­la­tions.

There were a num­ber of good safety prac­tices in op­er­a­tion but the food fridge in the Avon­more unit was rarely above 4 de­grees Cel­sius. At the time of the in­spec­tion, the gauge showed that the fridge tem­per­a­ture was 8 de­grees Cel­sius. This was con­sid­ered an un­safe method of food stor­age.

Rooms were cen­trally heated, but pipes and ra­di­a­tors were not guarded and were ex­posed. Works were due to be­gin two weeks af­ter this in­spec­tion time to rec­tify this.

In one seclu­sion episode, there was no doc­u­men­tary ev­i­dence that the res­i­dent was as­sessed to in­clude a risk as­sess­ment prior to seclu­sion tak­ing place.

There were some ar­eas of ap­pro­pri­ate care and treat­ment pro­vided for res­i­dents but there was no oc­cu­pa­tional ther­apy in­put into ther­a­peu­tic pro­grammes. So­cial work­ers and psy­chol­o­gists did not de­liver any group work but at­tended Multi-Dis­ci­plinary Team meet­ings and met with res­i­dents as re­quired on a one to one ba­sis. Not all res­i­dents from the ap­proved cen­tre could at­tend the Kil­mullen En­ter­prise Cen­tre and so had no ac­cess to ther­a­peu­tic pro­grammes. The in­di­vid­ual care plans (ICPs) of res­i­dents were of very poor qual­ity and showed a lack of train­ing.

Res­i­dents’ pri­vacy, dig­nity and au­ton­omy were re­spected in some ar­eas but other ar­eas needed im­prove­ment, ac­cord­ing to the re­port.

Ac­com­mo­da­tion was mainly dor­mi­tory style with only one sin­gle room avail­able. Suit­able fur­nish­ings weren’t pro­vided to sup­port res­i­dent independen­ce, dig­nity and com­fort. In Avon­more unit, four arm­chairs in the res­i­dents sit­ting room were in a poor state of re­pair.

None of the bed­rooms in Avon­more or Glen­cree units had bed­side lock­ers for res­i­dents in which to store their per­sonal items, or for their own com­fort.

The seclu­sion room had been used as a bed­room reg­u­larly since the last in­spec­tion. Seclu­sion rooms are not con­sid­ered suit­able for use as bed­rooms and such use is in con­tra­ven­tion of the Rules Gov­ern­ing the Use of Seclu­sion and Me­chan­i­cal Re­straint.

In the case of one pa­tient who had been de­tained in hospi­tal for more than three months there was no ev­i­dence that the pa­tient had pro­vided con­sent for the con­tin­u­ing ad­min­is­tra­tion of med­i­ca­tion or if there had been a ca­pac­ity as­sess­ment done to show that he/she had ca­pac­ity or not to con­sent to treat­ment.

There also was no doc­u­mented ev­i­dence to in­di­cate that me­chan­i­cal re­straint was only prac­ticed when the res­i­dents posed an en­dur­ing risk of harm to them­selves or to oth­ers.

There was good gov­er­nance of the cen­tre, how­ever, the num­ber and skill mix of staffing was in­suf­fi­cient to meet res­i­dent needs

Not all health care staff re­ceived manda­tory train­ing in fire safety, Ba­sic Life Sup­port, The Pro­fes­sional Man­age­ment of Vi­o­lence and Ag­gres­sion, (PMAV) and the Men­tal Health Act 2001.

New­cas­tle Hospi­tal was found to be re­spon­sive to res­i­dents’ needs and a num­ber of qual­ity ini­tia­tives were iden­ti­fied dur­ing the in­spec­tion.

A sur­vey was car­ried out to bet­ter un­der­stand the needs and in­ter­ests of the ser­vice users while they were res­i­dents. Two rep­re­sen­ta­tives from the lo­cal Wick­low men­tal health fo­rum had joined New­cas­tle’s op­er­a­tional man­age­ment meet­ing which was held monthly.

Fol­low­ing an anal­y­sis of risk man­age­ment and in­ci­dent re­view pro­cesses, all Na­tional In­ci­dent Man­age­ment sys­tem (NIMs) re­views are com­pleted by the re­spec­tive Multi- Dis­ci­plinary Team (MDT) prior to dis­sem­i­na­tion to the Risk Ad­vi­sor and Qual­ity and Pa­tient Safety Com­mit­tee.

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