CITY TRIBUNE
Commission slams mental health facility at UHG
An independent report into the running of the new adult mental health unit at UHG has raised concerns about physical restraints being used on patients, as well as the use of seclusion and delays in informing GPs of discharges.
Two patients were not told why they were being restrained or for how long, and there was no record to indicate if they had been medically examined within three hours of being restrained.
‘High risk’ failings were also recorded relating to the discharge of a patient – their GP was not given a discharge summary within the required three days and full information was not sent to relevant personnel for 23 days, rather than within the required 14-day timeframe.
During an inspection of the 50-bed Acute Adult Mental Health Unit (AAMHU) by the Mental Health Commission – the independent watchdog which oversees standards and practices – two patients had not been told why they were being physically restrained or how long the restraints would be used for.
The unannounced inspection was carried out at the €20 million UHG unit from November 27th to 30th last and the Commission published its findings last week.
Areas of inspection were deemed to be either compliant or non-compliant – where non-compliant, risk is rated as low, moderate, high or critical.
High-risk non-compliance was recorded in four areas: The Code of Practice on the use of physical restraint; the Code of Practice on admission, transfer and discharge and on regulations relating to staffing and the register of residents.
Dr Susan Finnerty of the Mental Health Commission said in her report that the inspection had looked at the clinical files of three residents who had been physically restrained.
“In two episodes of physical restraint, there was no record to indicate that the resident had received a medical exam at all by a registered medical practitioner within three hours after the start of an episode of physical restraint.
“In one case, while a medical exam did take place, there was no time record to show that it took place within three hours after the start of the physical restraint episodes.
“In two physical restraint episodes, residents were not informed of the reasons for, duration of, and circumstances leading to discontinuation of physical restraint. The reasons for not informing them was not documented in either case.
“In [each of] two episodes of physical restraint the residents’ next-of-kin was not informed about the physical restraint and the reasons for not informing them was not documented in two cases,
“In all three physical restraint episodes, there was no documented record to indicate that each episode of physical restraint was reviewed by members of the multi-disciplinary team and documented in the clinical file within two working days after the episode.”
The report also noted that: “In all cases, physical restraint was initiated by an appropriately qualified health professional. Physical restraint was used in rare and exceptional circumstances only when the resident posed an immediate threat of serious harm to themselves or others. Cultural awareness and gender sensitivity were demonstrated when considering the use of and when using physical restraint.”
The MHC’s report also found that not all staff had signed a log to indicate they had read and understood the policy in relation to using physical restraints.
In its response, the HSE said its corrective action would include a training schedule for medical staff and a checklist to be completed ‘post restraint’ to ensure regulations were met.
The inspection noted ‘high risk’ non-compliance in terms of regulations on staffing, which was due to the fact that not all staff had up-to-date mandatory training in basic life support; fire safety; management of violence and aggression and in the Mental Health Act. The HSE responded that training needs would be assessed and staff would complete mandatory training. The unit was also non-compliant (high-risk) with the Code of Practice on admission, transfer and discharge – one resident’s discharge plan did not include documented communication with the GP.
The preliminary discharge summary was not sent to the patient’s GP within three days and comprehensive discharge summaries were not sent to relevant personnel within the required timeframe of 14 days – instead, it was 23 days after the resident had been discharged.
Discharge summaries did not include details of prognosis and a follow-up appointment was not arranged within one week of discharge.
A memo has since been sent to all staff to ensure the discharge plan for patients complies with regulations, and a new ‘initial discharge book’ is being developed to send to GPs on the day of discharge.
‘High risk’ non-compliance was also noted for regulations governing the register of residents, which was found not to be up-to-date, while residents’ names were not consistently recorded. The HSE said a new computerised database was being developed to keep all information and staff have been reminded to input all data.
‘Moderate risk’ non-compliance with rules governing the use of seclusion was also recorded.
“In two seclusion episodes, the resident was not informed of the reasons, duration, and circumstances leading to discontinuation of seclusion. In two seclusion episodes, the resident was not informed of the ending of an episode of seclusion, and in one seclusion episode, the reason for ending seclusion was not recorded in the clinical file.” The HSE said a training schedule would be arranged for staff and a checklist for when seclusion of a patient is discontinued.
The ’moderate risk’ non-compliance for use of CCTV relates to the equipment being capable of recording the image of a resident who was under observation. According to the HSE, the system is no longer capable of recorded and this is checked monthly.
The Commission’s report found ‘low risk’ non-compliance with regulations on maintenance of records – these contained loose pages and notes were out of logical sequence, while one resident’s record contained multiple different dates of admission. The HSE said a memo was sent to all staff to file notes in keeping with regulations and audits of records would be undertaken every three months.
Overall, the inspection found the centre was compliant with 81% of regulations, rules and codes of practice.
Areas of compliance with regulations which were rated as ‘excellent’ included the identification of residents; food and nutrition; food safety; clothing; residents’ personal property; religion; communication and searches of patients and their belongings.
From this week’s City Tribune: Investment of €1.8 billion is needed to deliver on the potential for more than 6,000 new housing units identified by the Land Development Agency in Galway City.
The LDA’s Report on Relevant Public Land identified eight sites in Galway which it claims can deliver up to 6,050 affordable and social houses, if planning and other constraints are overcome.
It identified potential for up to 2,240 homes on HSE land at Merlin Park Hospital; up to 1,010 homes at Renmore Barracks; and up to 950 homes at Galway Harbour.
The report conceded these sites are on complex land with “numerous constraints” and are longer-term possibilities requiring masterplans.
The other six sites include: Ballymoneen Road; Terryland Waterworks on Dyke Road; Brothers of Charity Services on Old Dublin Road; City Hall at College Road; and Sandy Road.
Galway’s sites are among 83 State-owned landbanks the LDA has assessed as having development potential for up to 67,000 homes.
Only Ballymoneen Road and Dyke Road are in what the LDA terms Class 1, which can deliver a maximum of 420 within five-ten years.
This includes between 140-200 homes on Ballymoneen Road, and between 160-220 homes at Terryland Waterworks on Dyke Road.
The cost for the development of Ballymoneen Road, on a site opposite Coláiste na Coiribe, would be between €41.2m-€50.7m.
The total cost of delivering up to 220 homes on the Teryland site is between €78.5m and €101m
The remaining 93% of the total city target face greater constraints, and longer timeframes.
Almost 70% of the target, or 4,200 units, is earmarked for sites that are ‘Class 3’, which are lands that have potential for residential but face more constraints and are longer-term possibilities requiring masterplans.
The LDA carried out an assessment on the eight sites in the city, which had an “indicative yield” of between 4,330 and 6,050 new housing units.
John Coleman, LDA Chief Executive said his organisation was “committed to working closely with the public bodies to find common ground for the release of land for affordable housing purposes and for the common good”.
This was a first step that “will lead to the identification of locations where new affordable homes can be built”, he added.
(Image: Lands at Galway Harbour identified by the LDA for up to 950 homes).
This is a shortened preview version of this story. To read extensive coverage of the LDA report and for indicative maps of the lands, see the March 31 edition of the Galway City Tribune. You can support our journalism and buy a digital edition HERE.
From this week’s City Tribune: Galway City Council has sought further information from the applicants proposing to develop 227 apartments in seven high-rise blocks at the entrance to Gateway Retail Park in Knocknacarra.
In what is the second application for the site at Gort na Bró, Glenveagh Living Ltd is seeking to develop five blocks ranging in height from three to five storeys – with 85 one-bed units, 139 two-bed units; and three three-bed units.
In a Further Information request, the Council noted that Transport Infrastructure Ireland (TII) expressed concerns that the development “is located in close proximity to the preferred and/or approved route” of the N6 Galway City Ring Road.
“The authority is of the opinion that insufficient data has been submitted with the planning application to demonstrate that the proposed development will not have a detrimental impact on the capacity, safety or operational efficiency of the national road network in the vicinity of the site”.
Planners state that the creation of a “fifth arm” on the roundabout from the Western Distributor Road into Gateway Shopping Park and the site proposed for development was not discussed at pre-planning meetings and “is not permitted”.
Cycling facilities have been identified as concerning, as the two-way cycling lane on the WDR “ends abruptly”, bringing cyclists into the path of oncoming traffic.
Bicycle parking included in the application would be “difficult and inconvenient” to access and would not store non-standard bikes with cargo elements, it is outlined.
(Photo: Cllr John Connolly meets with residents to discuss the Glenveagh apartments proposal).
This is a shortened preview version of this story. To read the rest of the article, see the March 31 edition of the Galway City Tribune. You can support our journalism and buy a digital edition HERE.
From this week’s Galway City Tribune: An underpass to facilitate pedestrians and cyclists to negotiate the Briarhill junction is regularly flooded with up to three feet of water discommoding the most vulnerable road users.
The popular ‘line’ walkway connecting Renmore to the heart of the city is also often deluged with water.
The two routes are used by hundreds of people to get around without cars but are an example of how Galway City Council are slow to address active travel issues, according to newly co-opted Social Democrats Councillor Alan Curran.
Cllr Curran had to warn off four people from walking through the underpass when he passed through last week.
“It’s like that for a few weeks. This happens regularly. I understand from the Council it’s a drainage issue. They’re aware of it and they have cleaned it out but it keeps returning in heavy rain,” he explained.
“The impression I got was it will take a while to get fixed. It may require some heavy engineering solution. My concern is the longer these things go on, the less people use them. Their only other option is wait ten minutes or longer at the begging buttons to cross four sets of lights.
“The entrances are dark and narrow and don’t give the illusion of safety for those using it, especially during the dark winter months. There was a pedestrian and cycling tunnel recently built in Amsterdam and the difference is stark – they know how to do it right.”
Head of Transport at Galway City Council, Uinsinn Finn, said the underpass was constructed as part of the original N6 Link, in the mid-90s when a roundabout operated.
When the roundabout was replaced with a signalised junction, with pedestrian crossing facilities and cycling lanes across the junction, the underpass worked more as a secondary option for pedestrians and cyclists.
“Underpasses – and overpasses – are not ideal and not considered in the city as we put pedestrians and cyclist generally ahead of motorised traffic and accommodate them at junctions with at-grade crossings,” the engineer stated.
This is a shortened preview version of this story. To read the rest of the article, see the March 31 edition of the Galway City Tribune. You can support our journalism and buy a digital edition HERE.
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