Mental Health Commission annual report 2005 Item Type Report Authors Mental Health Commission (MHC) Publisher Mental Health Commission (MHC) Download date 27/09/2021 21:13:45 Link to Item http://hdl.handle.net/10147/313459 Find this and similar works at - http://www.lenus.ie/hse MENTAL HEALTH COMMISSION • ANNUAL REPORT 2005 1 Book 3 - HSE: Dublin Mid-Leinster Mental Health Commission Coimisiún Meabhair-Shláinte ANNUAL REPORT | TUARASCÁIL BHLIANTÚIL including the Report of the Inspector of Mental Health Services 2005 2005 Book Three (of Six) 2 MENTAL HEALTH COMMISSION • ANNUAL REPORT 2005 Book 3 - HSE: Dublin Mid-Leinster Contents 3 Chapter 1 Laois/Offaly, Longford and Westmeath 49 Chapter 2 Dublin/Kildare 87 Chapter 3 Dublin/Wicklow MENTAL HEALTH COMMISSION • ANNUAL REPORT 2005 3 Book 3 - HSE: Dublin Mid-Leinster Chapter 1 Health Service Executive Laois/Offaly, Longford and Westmeath 4 MENTAL HEALTH COMMISSION • ANNUAL REPORT 2005 Book 3 - HSE: Dublin Mid-Leinster Laois/Offaly, Longford and Westmeath MIDLAND REGIONAL HOSPITAL, Adolescents up to the age of 16 years are referred to PORTLAOISE the Child and Adolescent Mental Health Service. There has been a recent overnight admission of a 16- DEPARTMENT OF PSYCHIATRY year-old in crisis. Community Care Services provide services for persons with intellectual disability. Date of inspection: 7th June 2005 Patients are reviewed by the consultant within 24 hours of admission. Number of beds: 50 beds. 26 male, 18 female, 6 beds for POLL CARE PLAN DESCRIPTION There is no formal multidisciplinary care planning process for in-patients. At the team meetings patients This is an acute unit for general adult and Psychiatry are referred using a specified referral form to the of Later Life (POLL). sector occupational therapist, psychologist and/or social worker as deemed appropriate. The occupational therapist, psychologist and social REFERRAL worker do not routinely attend review meetings for in-patients although they do so for outpatients. The Patients are usually referred by either the GP, the Tullamore sector has initiated multidisciplinary care sector medical team, a member of the sector planning for its outpatients. Families and care givers multidisciplinary team following discussion with the regularly attend the weekly team meetings and are sector medical team, the Midland Regional Hospitals involved in the discharge planning. at Portlaoise and Tullamore following discussion with the sector medical team or by a consultant from another hospital. Occasionally patients may self-refer. NURSING PROCESS A patient who self-refers is assessed by the sector NCHD or the NCHD on call and their management is The nursing model used is described as an integrated discussed with the sector consultant or consultant on care plan and is an adaptation of the Orem and call. There is a detailed referral and admission policy Roper models. This care plan is completed by the key that outlines the procedure for referral both during nurse, who is assigned on a sector basis. It involves normal working hours and out of hours. collaboration with the patient who completes a section of it. There are set review dates. There is a policy on observation: the observation levels are PROCESS OF ADMISSION general, high observation, and special nursing. All nursing staff wear name badges and there is a dress Key admission criteria are identified in the admission code. policy which, in addition, specifies steps to be taken for involuntary detention. Individuals referred to the Department of Psychiatry for an uncomplicated ACCESS TO THERAPY AND TREATMENT alcohol detoxification programme are not admitted. Persons with substance misuse problems are not Each sector team has a social worker, occupational admitted but are referred to the community services. therapist and psychologist. Access is by referral only. If there is co-morbid psychiatric illness, such persons There is currently no psychologist on the POLL team may require admission to the unit once deemed although the team can access psychologist input medically fit by the referring agency. from the sector team. A record of all assessments made is kept in the Addiction counsellors visit the unit for assessments. admission unit. The referrer is notified immediately if The sector team cognitive therapists come to the the patient is not admitted. unit. There is regular consultant psychiatrist review. There is excellent medical and surgical back-up if MENTAL HEALTH COMMISSION • ANNUAL REPORT 2005 5 Book 3 - HSE: Dublin Mid-Leinster Laois/Offaly, Longford and Westmeath required and many of the other services from the searches, the management of violent incidents, general hospital will come to the ward. Phlebotomy is administering injections against resistance, and performed by the NCHDs or by nursing staff who are absconding. Staff are regularly trained and updated appropriately trained. in managing violent episodes. There is also regular training in cardio-pulmonary resuscitation. There are two defibrillators on the unit and immediate access to the CRASH team when required. ECT ECT is provided on the unit in a designated suite that includes a waiting area, dressing room, treatment UNIT MANAGEMENT room and a recovery room. There is a designated ECT consultant psychiatrist. Patients receiving ECT are Since the unit opened there has been no shortage of usually accompanied by their key nurse. beds, which means that patients have not been moved out to create vacancies. When patients have been transferred from St. Fintan’s Hospital they have been documented as discharges and admissions ACCESS TO ACTIVITIES rather than transfers. This has the effect of raising There is an activation programme conducted by two the admission rate in the catchment area. There are nursing staff from 0900h to 1700h five days a week. plans to develop a 4-bed step down unit as part of The programme is drawn up each week and includes the rehabilitation service, which means that patients management of stress, anxiety and money. Many of not able to be discharged home may be moved on the patients attend the programme. The occupational when ready. therapist runs a group twice a week and undertakes The unit is open. If it needs to be locked for any assessments as required. In addition there is access to reason the Director of Nursing must be informed in the local advocacy service, GROW, yoga, art therapy writing. However, both the male and female and literacy services as required. There is a hairdresser admissions may be locked off from time to time and available on a regular basis. this is not documented. Patients usually inform staff if they wish to leave the ward. A central rostering system is in place with a CNM3 on duty day and CLINICAL RISK MANAGEMENT night. In addition there is a CNM2 and four staff nurses on both the male and female sides during the The nursing care plan does not contain a formal risk day and three nurses on the male side at night and assessment although it enquires about any history of two nurses on the female side at night. There is a violence and risk to others and establishing a safe CNM2 and one staff nurse on duty during the day in environment. There is a Healthcare Risk Management the POLL and one nurse at night. Policy available on the unit, which is part of the Corporate Safety Statement. All near misses and As part of the pilot programme, there is also a care untoward incidents are reported on incident report assistant assigned to the male, female, POLL and forms and health risk management forms, which are activation units. There are two porters working in the investigated and managed by the health care risk unit and a number of household staff. There is a management office. receptionist who also functions as a ward clerk. The staff are very satisfied with their access to all the Seclusion is used in this unit and there are policies hospital services including maintenance and and checklists in relation to that. Refractory clothing switchboard. There are set visiting times although is never used. The seclusion register documented the these are flexible. date and time of initiation of seclusion and the reason for seclusion. CCTV is used in this ward for Meal times are at 0830h, 1300h and 1700h. monitoring the entrances and reception area and seclusion rooms. There is a pinpoint alarm system with alarms for staff and official visitors. There are policies on alcohol and illegal drugs, conducting 6 MENTAL HEALTH COMMISSION • ANNUAL REPORT 2005 Book 3 - HSE: Dublin Mid-Leinster Laois/Offaly, Longford and Westmeath SERVICE USER INVOLVEMENT was not always used. Prescriptions were dated and signed but, on a number of occasions, There are lots of information boards, leaflets and discontinuation of medication was not signed by the notices available. There are forms for opinions, doctor. At present, there is no signature bank in use, comments and complaints available throughout the but the nursing officer interviewed intimated that unit along with suggestion boxes, which are one would be put in place shortly. monitored by the senior nursing staff. There are no formal community meetings with patients although staff report that they have regular informal discussions about the service with patients. There are ENVIRONMENT plans to conduct a formal survey of patients and their The Department of Psychiatry is a separate unit families regarding their view of the new unit and the within the Midland Regional Hospital, Portlaoise. service provided. The advocacy service visits the unit Access is through the main reception of the hospital each week. There is a formal complaints policy. but the unit has its own reception area, where the receptionist/ward clerk is stationed. This area was bright and clean and had comfortable seating and RECORDS access to a toilet. A large array of useful information leaflets were contained in leaflet pockets on the wall.