Report raises concern about use of physical restraints in Galway mental health unit

The Mental Health Commission has raised concerns about aspects of the use of physical restraints at a mental health unit in Galway.

The concerns followed an inspection of the 50-bed acute adult mental health unit at University Hospital Galway which took place last November.

Inspectors found the next of kin of a resident in the unit was not informed about two episodes of physical restraint.

The report also said there was no record to indicate two residents had received a medical exam at all by a registered medical practitioner within three hours after the start of an episode of physical restraint.

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The clinical files of three residents who had been physically restrained were inspected. Residents were not informed of the reasons for, duration of, and circumstances leading to discontinuation of physical restraint during two episodes.

The reasons for not informing them was not documented in either case, according to the inspection report.

“In two episodes of physical restraint, the resident’s next of kin was not informed about the physical restraint and the reasons for not informing them was not documented in two cases,” it added.

“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 multidisciplinary team and documented in the clinical file within two working days after the episode.”

The report said in all cases physical restraint was initiated by an appropriately qualified health professional and used in rare and exceptional circumstances “only when the resident posed an immediate threat of serious harm to themselves or others”.

The centre had four high-risk ratings for non-compliance with staffing, register of residents, the use of physical restraint and admission, transfer and discharge.

Dr Susan Finnerty, inspector of Mental Health Services, said the commission's Code of Practice on physical restraint states that it should be used by staff only when no other option will work.

“A patient can only be restrained for a maximum of 30 minutes at first, after which a doctor must review. The doctor may decide that further restraint is necessary and at this stage they must make a renewal order that allows the patient to be restrained for up to another 30 minutes,” she said.

“Being restrained is a very serious action and if a patient is restrained, staff must tell the patient why they are being restrained, for how long and what needs to happen before physical restraint will end.

“In addition, if a patient agrees, the staff will contact the patient’s relatives and inform them. Staff will end physical restraint when a doctor or nurse decides that the patient is no longer a serious threat to themselves or others. Afterwards, they must provide an opportunity for the patient to discuss the restraint if requested.”

Mater hospital

A separate inspection at St Aloysius Ward, a 15-bed unit in the Mater Misericordiae University Hospital, Dublin, found four high-risk non-compliances for searches, privacy, premises and use of seclusion.

In relation to privacy, beds in the six-bedded room were “too close together which compromised residents’ privacy and dignity”.

“There was no programme of routine maintenance and decorative maintenance,” the report said.

It said a separate visitors’ room or visiting area was not provided where residents could meet visitors in private. At the time of the inspection the visitors’ room operated as a “thoroughfare between two areas”.

Inspectors also noted a noticeboard in the nurses’ office, which was visible from the ward corridor window, displayed resident names. “This was resolved at the time of the inspection,” the inspectors added.