Mental ward strain

A confidential report detailing day-to-day operations at Latrobe Regional Hospital’s acute care units has given rare insight into a mental health system under pressure.

The internal review of nursing practices in LRH’s Macalister aged care ward and the Flynn adult psychiatric ward, completed in February this year, depicts an uncoordinated and sometimes apathetic working environment, lacking leadership and chain of command.

Authored by LRH’s then senior discipline nurse, the IPU Mental Health Observation Study – End Report, seen by The Express, also expressed concern about poor staff adherence to medication management and administration protocols in the Macalister ward.

“The clinic is untidy, practices were not in line with LRH policy. Certain aspects of nursing practice were unsafe,” the report stated.

“These had to be addressed immediately. (However) the concern is that the staff will slip back in to ‘sloppy practices’ because it’s quicker and easier, and as one member of staff said, ‘who would know?’.

“It appears that some staff within the ward is (sic) simply giving a drug at the prescribed time regardless of the safety factors around spacing of drugs and the true efficacy of the drug.”

The report also identified numerous potential breaches of patient privacy, poor hygiene provisions across both wards, and limited access to diversional therapy, noting a sense of “mindless monotony” where televisions were running all day.

“Stark and drab are two adjectives that describe fully the initial entry into Flynn. The ward looks tired and unattended to. As one enters the ward the feeling is one of uncertainty; lack of comfort, and a lack of coordination for patients and one would suspect some staff.”

However in handing down its conclusion, the report stopped short of demanding “radical reorganisation” of work practices, instead requiring reemphasis on a list of key parameters such as protocol compliance, transparency, and leadership.

“There must be no tolerance of staff deciding to opt out of (patient care)… frontline staff must be empowered with responsibility and freedom to act in this way under strong and stable leadership,” it concluded.

LRH mental health director Cayte Hoppner said the report contained significant factual errors and omissions “which was not surprising given it was a ‘snapshot’ in time”.

“LRH has a focus on continuous improvement and I asked (for) a review of nursing practice in the adult and aged inpatient units to identify areas of nursing practice that worked well and areas that required further development,” Ms Hoppner said.

She said patient centred care and involvement in care planning and collaboration with the community teams had been “working well” in the wards.

However Ms Hoppner said medication management, clinical review processes such as handover of patient information between shifts and the use of communication tools were highlighted as areas for improvement.

“An action plan was developed and a number of strategies were put in place to address the practice issues identified. A new practice development nurse position for the bed-based units has also been created to provide enhanced education and leadership “LRH has undergone successful external accreditation by Australian Council on Healthcare Standards and the Aged Care Standards Agency in the last two years.”

An LRH mental health worker, who wished to remain anonymous for fear of employer retribution, said she found the report’s findings an accurate representation of ward operations.

“Staff were very angry (about the report) at first because (the author) actually said she would be recording people’s registration numbers – people thought they would be losing their jobs over this,” the mental health worker said.

“But when you’ve got a turning door syndrome, with clients being prematurely ejected (due to bed shortages) and readmitted, all you are providing is band-aid psychiatry, so something has to give.”

Last fortnight The Express reported on patient turnover statistics, as published in the Community Visitors Annual Report 2012-2013, which found a continued shortage of mental health beds at LRH, with the average length of stay in its active unit between 10 and 11 days, less than the statewide 14-day target.

“It’s very difficult to work in those conditions; there’s a lot of people taking sick leave, and there’s lots of low morale. Staff are continuously being forced to work outside their field of practice, but they are hesitant to come forward and speak out for fear of being targeted and retribution,” the health worker said.

The health worker estimated as many as 20 psychiatrists had been through mental health positions at LRH over the past four years, however Ms Hoppner rejected that figure as incorrect.