A REPORT INTO an acute psychiatric unit in Tralee has found a number of areas where it was not compliant – including multiple hazards being found in a seclusion room and some residents having to share six-bed, dorm-style rooms.

The report into Sliabh Mis, was the acute psychiatric unit in University Hospital Kerry, Tralee, was released by the Mental Health Commission  this week.

‘Drab and dirty’

Sliabh Mis had two acute admission wards, Reask and Valentia, and one high observation ward, Brandon, which was not in use at the time of the inspection.

Valentia ward had recently been refurbished and was described as “bright and modern in its appearance”. However, Reask ward, was described as “drab, dirty, rundown and in need of urgent refurbishment”.

The report found there was no significant improvement in overall compliance with regulations, rules and  codes of practice from 2016 (58%) to 2018 (61%). The report found that in total, 43% of non compliances were rated high risk.

It also stated that he approved centre were unable to provide any quality improvements undertaken since the inspection in 2017. “There were no quality initiatives available from the approved centre,” it said.

Sliabh Mis did have a risk management policy, but this did not contain arrangements for response to emergencies. Brandon unit, the high observation area was not open, which the report said meant that seriously mentally ill residents did not have access to an appropriate safe area.

According to the report, ligature points had not been minimised to the lowest practicable level of risk on Reask ward, where numerous potential ligature points were identified.

It also found:

• There were errors in the prescribing and administration of medication. The controlled drug balance did not correspond with the balance recorded in the controlled drug book.
• Not all staff were trained in fire safety, basic life support, prevention and management of aggression and violence and the Mental Health Act 2001.
• Furniture and fittings in the seclusion room were not of a design and quality to ensure patient safety, and multiple hazards were observed in the seclusion room, said the report.

It detailed one episode of physical restraint, where it said “it was not possible to determine whether physical restraint was initiated in rare and exceptional circumstances and in the best interests of the resident, and it could not be determined whether physical restraint was only used after alternative interventions to manage the resident’s unsafe behaviour had been considered”.

In two episodes, the use of physical restraint was not based on a risk assessment.

Each resident had a multidisciplinary individual care plan, into which they had input, it was found. There was also good provision of therapeutic services and programmes available which met the assessed needs of residents.

Staff members were observed to interact with residents in a respectful manner and sought permission before entering residents’ rooms. Meanwhile, all bathrooms, showers, toilets, and single bedrooms had locks on the inside of their doors.

Personal space

In shared bedrooms appropriate bed screening was in place to ensure that resident privacy was not compromised.

However, the report states that not all observation panels on doors of bedrooms were appropriately screened.

Not all residents had access to personal space. Some residents on Reask ward were required to share sixbed, dorm-style rooms, which were not appropriately sized to address residents’ needs.

The report also found:

There was episodic overcrowding in the dormitories in Reask and consequent lack of privacy and dignity for residents. A notice on the computer at the nurses’ station in Valentia ward displayed detailed visitor information for one resident, which could be seen by people passing by. A clinical file was observed unattended at the desk
in Valentia ward, which was on a main public thoroughfare. Residents could make private phone calls using the portable phone on Valentia ward.

It found that the dignity and privacy of residents in seclusion “were not respected in the approved centre”.

Residents in seclusion had to cross the main corridor to access toilets and had to go further along the corridor to access the shower area, which was in a poor state of repair, with missing tiles and rusty pipes. The seclusion room had chipped paint, chipped skirting boards, and stained windows.

In addition, the approved centre breached its registered capacity of 34 residents on a number of occasions.

Vulnerable citizens

This report was one of a number which were published this week. Commenting on the publications Dr Susan Finnerty, Inspector of Mental Health Services, said:

Some of our most vulnerable citizens are looked after in these approved centres and they are failing in a number of key areas.

She said they have raised a number of concerns, including how in one case, Teach Aisling in Co Mayo, there were restrictions to access to water and fluids.

“There was no free access to fresh drinking water in one of the locked areas and fluid restrictions were imposed as a punishment for challenging behaviour as part of a behavioural programme for one resident,” said Dr Finnerty. “Residents were observed banging on the window of the nurses’ station, which had closed blinds, to request a drink of water. There was no other way of attracting nursing staff attention. This was not conducive to residents’ dignity.”

All of the reports can be read on the Mental Health Commission’s website.