Mental Health Unit - Intensive Patient Care (IPC) suite

Transcription

1 MEMO To: From: Board Members Christine Nolan, GM Secondary Services Date: 17 January 2013 Re: Mental Health Unit - Intensive Patient Care (IPC) suite In early May of 2009 a Telarc Quality Health Ltd certification audit of South Canterbury District Health Board and clinical services contained corrective actions requiring the Mental Health Service to upgrade the acute inpatient unit, in order to meet certification standards. The audit of the service noted several issues relating to environmental safety: ligature points, duress alarm access, restraint standards, and smoke free compliance Following receipt of the audit report corrective action, an internal facility audit Risk Assessment of the Mental Health Inpatient Unit was completed in late May This audit identified a significant number of environmental risks within the facility. All the listed safety compliance issues were addressed at that time by SCDHB. The report also recommended prioritising an upgrade of the seclusion area, including the development of a dedicated deescalation space adjacent to the seclusion rooms. These recommendations confirmed the need to upgrade the environment which would support the development of a best practice clinically focused Intensive Patient Care programme. The report noted the recommendation of a facility upgrade that will improve the delivery of safer patient care; and that there are two complementary elements of the programme that required attention: The facility upgrade to create an integrated acute and intensive care environment with a de-escalation lounge, and two seclusion rooms with ensuite, and Establish an Intensive Patient Care programme which consists of risk assessment, de-escalation programme inclusive of a sensory modulation environment As background to this Board report and associated recommendations there is a summary of scope and purpose of seclusion described in Appendix One. The summary is an extract from the 2011 Annual Report - Office of the Director of Mental Health (DoMH). The establishment of an evidence based Intensive Patient Care programme is of significance as there was a concern regarding the high utilisation of seclusion in the SCDHB 12-1 Page

2 mental health inpatient unit. The Annual Report - Office of the Director of Mental Health in 2010 and 2011 reported that SCDHB was second and third highest in the measure people secluded per 100,000 population this has subsequently decreased to 9 th of DHBs in the 2012 report. There was a further report prepared by Service Manager Mental Health on use of seclusion and associated factors was request by SCDHB Clinical Risk Management Committee and presented to the committee in February 2011 as a result of high seclusion hours and duration of seclusion episodes reported in late In March 2011 senior members of the MHS attended the national MH key performance indicator (KPI) workshop in Wellington. It was clear from the workshop that SCDHB MHS was not actively developing the level of quality improvement activity it should in response to the SCDHB results in the national KPI measures reported through the PRIMHD 1 project. Apart from higher than expected seclusion hours the other KPI measures that required attention by the MHS were lower than targeted levels of access to services, average length of stay (ALOS) in the inpatient unit (too short), timely community follow post discharge and readmission within 28 days ( linked to ALOS result). In June 2011 the MHS commenced the local MHS KPI project that encompassed all the areas listed above such as the requirement to improve timely access to service. By example this KPI measure has been improved through the introduction of the choice and partnership approach (CAPA) process in all teams of the MHS by April Further to the initiatives listed above a capital expenditure request of $200K was included in the 2011/12 capital programme to upgrade the MHS impatient unit seclusion rooms. The business case to advance this capex project was well underway by October This resulted in considerable planning to achieve an optimal Intensive Patient Care environment within the agreed capex budget. This project work included the development of a fully integrated Intensive Patient Care programme to ensure evidence based best practice in deescalation and minimal utilisation of seclusion within the inpatient unit; that business case activity also purposely coincided with the MHS KPI project activity. The work on improving the utilisation of seclusion has been addressed through; Introduction of the sensory modulation programme to manage patients heightened anxiety and aggression, Converted a office room to a sensory modulation room, Reviewed the crisis plan format to clearly identify with the patient and their family stress triggers and personalised therapeutic responses to stress, Involving families to identify when and how to use de-escalation skills and techniques, Coexisting problems training for staff, Increased use of phased level of observations all clinical associates trained in specialling, 1 Programme for Integration of Mental Health Data (PRIMHD) - PRIMHD data is used to report on what services are being provided, who is providing the services, and what outcomes are being achieved for health consumers across New Zealand s mental health sector. These reports enable better quality service planning and decision-making by mental health and addiction service providers, at the local, regional and national levels 12-2 Page

3 All staff trained in evidence based calming and restraint techniques As a result of this work the number of seclusion events has dropped in the past 12 months and the duration by average hours per seclusion events has also reduced. There have been some months with no or little seclusion events although other months have and will continue to record seclusion use dependent on patient need. Separately there was a further external audit conducted on 6th April This was an unannounced site visit by the Chief Ombudsman s office to conduct an audit of SCDHB MH Inpatient Unit under the Crimes of Torture Act The Chief Ombudsman s office reported that The Visiting Team found the seclusion rooms unsuitable for their intended purpose. The report made the recommendations that: a) Work should press ahead on the modernisation of the seclusion area. This should include, as a minimum, rooms that have toilet/washing facilities, natural light and heating and ventilation, and a means of raising the alarm with staff. Clients should also have daily access to fresh air/exercise. b) The Unit needs modernising to bring it up to date. This should include all communal areas, clients bedrooms, bathrooms and offices In the recent certification audit conducted in May 2012 the state of the seclusion rooms was again identified as an issue along with the antiquated facility design; specific comment was made on the continued use of four bed bedrooms when this is no longer considered as best practice in MHS inpatient units for the reasons of patient safety and privacy. In previous upgrade planning it has been assessed that six single bedrooms may be created out of three adjacent four bed bedrooms. This will have the impact of reducing the number of physical bed spaces from 14 to 12 as one large bedroom is currently used as a lounge space. The inpatient unit does gain two rooms that may be used as open bedrooms once the seclusion room upgrade is complete. The MHS inpatient unit is resourced for an average occupancy of eight patients. Based on the finding of the various audit reports and concerns on the quality of services it has been the priority for the MHS in the past two years to improve the patient centred outcome measure results. The MHS KPI project has been the vehicle to achieve the favourable results over the past 12 months. This local DHB initiative has also complemented the implementation of the national project to improve services for people with coexisting problems (aka CEP project) such as problems with alcohol and other drug addictions along with mental illness. The business case in relation to the MHS inpatient unit upgrade has been put on hold since November This was due to unforeseen developments as a result of the impact of the Canterbury earthquakes as well as the SCDHB site redevelopment planning process. The delay was justified as it was assessed that with the proposed site development options for the MHS as a whole (community and inpatient services) could and should be successfully incorporated into the body of all new facility development plans. With the decision made in 12-3 Page

4 late 2012 to defer the wider redevelopment plans (i.e. the Facility Master Plan preferred option) for at least the next decade, and to focus on strengthening (and demolishing) the current building stock on site, and addressing some more immediate issues such as ED / Outpatients, Day Patient Services and Mental Health it is timely now progress the immediate Mental Health facility issues. This does not preclude the possibility that the MHS will in the future be incorporated into the main clinical services building/s on the Timaru hospital site. The scope of work proposed for the Mental Health facility upgrade includes: Remodelling and fitting out two seclusion rooms including a secure lounge attached to each of the seclusion rooms Remodelling the four bedded rooms to leave an end result of having 12 single bedrooms within the Mental Health Unit (excluding the seclusion area) Installation of privacy locks on all of the bedrooms which provide patient privacy whilst maintaining immediate staff access Addressing any further critical safety issues associated with the inpatient unit of the Mental Health Service Please note this upgrade is not a full refurbishment of the Mental Health Unit, it simply provides appropriate facilities to meet immediate safety concerns, allowing the service to meet certification and safety issues. A full refurbishment would include a significantly greater capital investment which is not proposed given the longer term Facility Master Planning Direction. Given the total capital being proposed is only $300k it is recommended that this be kept outside of the wider project associated with the Seismic Strengthening of the CSB, and subsequent facility enhancements. It should be noted that the Mental Health Unit currently exceeds new building standard requirements for Seismic Strength. An area not included in this paper are the remaining facility issues associated with the relocation of the Child & Adolescent Psychiatric Services from Kohwhai House into the Mental Health Unit. The team have done well over the past year however there are some modifications required given that this will be their long term home. These issues will be worked up and brought back to the board in due course. Recommendation That the Board: receives this report notes that capital expenditure of $200K had previously been approved for 2011/12 to upgrade the inpatient unit seclusion to create an IPC suite. approves a total of $300k capital expenditure (capex), $100K of which is unbudgeted, to 12-4 Page

5 o Remodel and fit out two seclusion rooms including a secure lounge attached to each of the seclusion rooms o Remodel the four bedded rooms to leave an end result of having 12 single bedrooms within the Mental Health Unit (excluding the seclusion area) o Install privacy locks on all of the bedrooms which provide patient privacy whilst maintaining immediate staff access o Address any further critical safety issues associated with the inpatient unit of the Mental Health Service approves a closed Request for Tender (RFT) consistent with SCDHB Procurement Policy to seek bids to design and build the necessary facility changes within the approved capex budget. CHRISTINE NOLAN General Manager Secondary Services 12-5 Page

6 Attachments: Appendix 1 Seclusion 12-6 Page

7 12-7 Page