COMPLIANCE levels at University Hospital Waterford’s (UHW) Department of Psychiatry (DOP) have risen to 86 per cent, a 29 per cent increase on the previous figure according to the Mental Health Commission’s (MHC) 2020 Inspection Report.
The latest MHC inspection, conducted by Lead Inspector Carol Brennan-Forsyth, Noeleen Byrne and Susan O’Neill, took place from August 4 to 7 of last year. The previous inspection was conducted from April 15 to 18, 2019, following which a disappointing 57 per cent compliance rating was arrived at.
For the record, the DOP compliance levels recorded for the 2016, 2017 and 2018 annual report came in at 49, 64 and 68 per cent respectively.
The report notes that “certain activities within approved centres were not able to take place” due to public health restrictions brought about by the ongoing pandemic.
The DOP has 44 beds and is situated on the lower ground floor at UHW. At the time of the inspection, it has a 14-bed acute unit (the Brandon Unit) and a 30-bed sub-acute unit (the Comeragh Unit). Accommodation within the centre us a mixture of single and two, four, and six-bedded shared bedrooms.
“Residents were admitted to the approved centre by 13 teams: eight general adult teams, two rehabilitation teams and three psychiatry of old age teams. To deal with issues of overcapacity (which this newspaper has previously reported on) the approved centre had introduced a daily bed management meeting which was proving to be very beneficial at the time of inspection.”
The marked improvement in compliance was welcomed by Mary Butler (FF), the Minister for Mental Health and Older People, who stressed that full compliance, as sought by the MHC, remained the ultimate objective.
“In recent years I (have) consistently raised concerns, with respect to the challenges presenting within the DOP at UHW and in particular, on issues of overcrowding,” she said on Friday last.
Progress at the DOP
“I visited the centre recently and very much welcome the progress made by the DOP at UHW, including the introduction of a daily bed management system to deal with issues of overcapacity. The report noted the individual care plan (ICP) in place for each resident, with a daily programme of therapeutic activities for both units, including “input over the week from all health and social care professional groups and nurses”. The general health needs of residents “were monitored and assessed by the residents’ specific needs”.
However, the report noted the following:
* “One ICP was not developed by relevant members of the multi-disciplinary team (MDT);
* Two ICPs were not reviewed by relevant members of the MDT;
* Three ICPs did not identify appropriate goals for residents;
* Three ICPs did not identify appropriate care and treatment for each resident and
* Three ICPs did not identify appropriate resources to provide care and treatment.”
In reaction, Minister Butler said: “the area of high risk non-compliance identified in the latest inspection report on individual care plans must be addressed going forward to ensure that people accessing the centre have real, meaningful involvement in their own care and treatment. Similarly, further work is needed to redress high risk non-compliance on the code of practice on the admission of children.”
Insufficient resident privacy
While the layout, furnishing and maintenance levels of the DOP “were conducive to resident privacy and dignity”, the Comeragh Unit’s garden overlooks the main hospital building “and therefore did not offer sufficient resident privacy. At the time of inspection, funding had not been secured to rectify the issue”.
The report also noted: “Access to safes was overseen by nursing staff and, where money was deposited or withdrawn, this was supposed to be documented on a log sheet contained within the safe. Balance checks were undertaken once a week by nursing staff; however, it was found that the balance sheets were incorrect and had not been updated when money was withdrawn. The same finding was made during the 2019 annual inspection.”
The inspection team concluded that the DOP staff was satisfactorily responding to the needs of residents.
* Residents were provided “with a variety of wholesome and nutritious food” and had two (dietitian-approved) choices for meals;
* Recreational activities included gym, exercise groups, music, arts and crafts, in addition to access to newspapers, books, board games, television and individual recreational resource packs;
* A separate visitors’ room/visiting area was provided “where residents could meet
visitors in private once visitations restarted after the Covid-19 restrictions were lifted”.
* Written information on diagnosis and medications were provided to the inspectors while “complaints procedures and implementation was satisfactory”.
The inspection team’s report, which runs to 80 pages, also identified eight quality initiatives implemented at the DOP:
* The centre has introduced a compliance team which included members from the multi-disciplinary team. “The aim of introducing this team was to encourage interdisciplinary involvement in compliance within the DOP.”
* The centre had commenced a daily bed management meeting to deal with over capacity issues.
* Processes were in place for residents to receive essential and comfort items from the local supermarket and from family members during the pandemic.
* “The approved centre had introduced individual daily menu cards to assist residents with meal choices.”
* The DOP’s recreation and recovery service (the ‘Move Your Mood’ initiative) had submitted a presentation to the ‘National Get Up Get Dressed and Get Moving Conference’ in the Royal College of Surgeons, Dublin to share the positive outcomes of their work.
* The DOP’s Men’s and women’s health groups were designed by the recreation and recovery service following consultation with residents.
* “An advocacy ‘Zoom’ hub for residents was established in the approved centre to ensure access to the Irish Advocacy Network” while
* The centre had also introduced a child admission resource pack “which informed the younger people of the services available within the unit”.