increased nursing patient care and or supervision · web viewa request to increase patient...
TRANSCRIPT
CHHS18/106
Canberra Hospital and Health ServicesOperational Procedure Increased Nursing Patient Care and/or Supervision Contents
Contents....................................................................................................................................1
Purpose.....................................................................................................................................3
Alerts.........................................................................................................................................3
Scope........................................................................................................................................ 4
Section 1 – Request Process......................................................................................................4
Section 2 – Staff Responsibilities: Clinical.................................................................................5
The MO is responsible for:....................................................................................................5
The respective CNC/CMC is responsible for:.........................................................................5
The Divisional ADON/M is responsible for:...........................................................................5
The DON/M is responsible for:..............................................................................................6
The NMRO (in business hours) is responsible for:.................................................................6
The AIN/EN/RN/RM is responsible for working within their scope of clinical practice and will:........................................................................................................................................6
Section 3 – Staff Responsibilities: Operational..........................................................................7
The respective TL is responsible for:.....................................................................................7
The Wardsperson (Wardsperson Operations Manager / Supervisor) is responsible for:......7
Section 4 – Staff Responsibilities After Hours...........................................................................7
The AH-CNC is responsible for:.............................................................................................7
The AHHM is responsible for:...............................................................................................7
Section 5 – Other Considerations..............................................................................................8
Section 6 – Risk Matrix to be used............................................................................................8
Related Policies, Procedures, Guidelines and Legislation.......................................................10
Search Terms.......................................................................................................................... 11
Attachments............................................................................................................................11
Attachment 1 – Patient Care and or Supervision Request Form.........................................12
Attachment 2 – Patient Care and or Supervision Business Hours Flow chart......................14
Attachment 3 – Patient Care and or Supervision Afterhours Flow Chart..........................15
Doc Number Version Issued Review Date Area Responsible PageCHHS18/106 1 16/03/2018 01/04/2022 CSS - Nursing
Clinical Support1 of 14
Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register
CHHS18/106
Purpose
The purpose of this Procedure is to: Ensure patients who are assessed as requiring an increase nursing in care and or
supervision will receive additional and appropriate levels of support and nursing/midwifery care
Ensure identified risks are managed in a way that minimises the likelihood of adverse incidents/events and promotes safe health outcomes
Promote timely communication to ensure the allocation of appropriately trained nursing/midwifery staff in accordance with the staff members’ scope of practice and the patient safety and clinical requirements
Ensure the patient, and where appropriate, the patient’s family/carer or Enduring Power of Attorney receive an explanation as to the nature and reasons for the increased level of care and or supervision.
This procedure provides clinicians with best practice information for assessment and management of patients whom have been assessed as requiring an increase in nursing care and or supervision.
When providing a patient with a diagnosed mental health condition on a medical/surgical ward, please refer to the Adult Mental Health Unit Operational Procedure (MHJHADS). When providing a patient who is subject to Section 309, please refer to the Management of People Subject to Section 309 of the Crimes Act 1900 Transferred to the Canberra Hospital (MHJHADS).
Back to Table of Contents
Alerts
A request to increase patient care/supervision must only be undertaken when the patient requires an increase in the frequency of observations and/or supervision for safety or clinical intervention, inclusive of risks associated with misadventure, vulnerability and/or risk of absconding. Please refer to the Increased Patient Care/Supervision Request Form (Attachment 1) for additional reasons for requesting increased patient care/supervision.
Relevant qualified and trained staff must be allocated to the patient.
Back to Table of Contents
Scope
Doc Number Version Issued Review Date Area Responsible PageCHHS18/106 1 16/03/2018 01/04/2022 CSS - Nursing
Clinical Support2 of 14
Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register
CHHS18/106
The care and/or supervision of patients requiring increased supervision is a multidisciplinary approach, therefore the scope of this procedure applies to: Nurses and Midwives working within their scope of practice Clinical Nurse/Midwife Consultant (CN/MC) Nurse Manager (NM) Team Leader (TL) After Hours Hospital Manager (AHHM) After Hours Clinical Nurse Consultant (AH-CNC) Assistant Director of Nursing/Midwifery (ADON/M) Director of Nursing/Midwifery (DON/M) Wardsperson Operations Manager / Supervisor Wardsperson Registered Nurse/Midwife(RN/RM) Enrolled Nurse (EN) Assistant in Nursing (AIN) Medical Officers (MOs)
Back to Table of Contents
Section 1 – Request Process
A request to the Nursing and Midwifery Resource office (NMRO) and/or the After Hours Hospital Manager (AHHM) office for an increase in nursing/midwifery staffing for Patient Care and/or Supervision must be scheduled as below:
Shift and staff request Time request needs to made by
Cancellation
Morning 04.55 04.55Evening 10:30 10:30Night 18:30 18:30
If the NMRO and/or AHHM office does not receive a request for an increase in Patient Care/Supervision the additional staff member allocation may not be provided.
The request process requires multidisciplinary input and the following should be adhered to.
All requests are to be:1. Documented in the patient’s progress notes2. Completed on the Patients Requiring Increased Care and/or Supervision Request Form
(Attachment 1) which is not an official clinical record and is a working document only. This should be filed with the NMRO/AHHM. Please note, if an area currently has an AIN rostered on duty for the shift in which the patient requires Increased Care and/or Supervision, this request is still required to be completed by the unit
3. Approved by the area DON/M in business hours
Doc Number Version Issued Review Date Area Responsible PageCHHS18/106 1 16/03/2018 01/04/2022 CSS - Nursing
Clinical Support3 of 14
Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register
CHHS18/106
4. Endorsed by the AH-CNC after hours (Monday – Friday 17:00-07:30 hours and 24 hours during weekends and public holidays) and
5. Approved by the AHHM after hours (Monday – Friday 17:00-08:00 hours and 24 hours during weekends and public holidays).
Back to Table of Contents
Section 2 – Staff Responsibilities: Clinical
The MO is responsible for: Reviewing the patient’s clinical, mental health and safety requirements on a daily basis Documenting patient reviews in the patient’s progress notes and completing
appropriate documentation on the patient care and/or supervision request form Completing Referrals to Psychiatry where appropriate for ’review/advice Working collaboratively with nursing staff to provide a safe work area and
minimise/prevent harm to the patient.
The respective CNC/CMC is responsible for: Ensuring patients who are assessed as requiring an increase in care / supervision are
identified Ensuring patients who are assessed as requiring constant supervision are provided with
the appropriate staffing resource at all times Completing the patients requiring increased care and/or supervision request form and
ensuring an appropriate rationale has been entered in the patients’ progress notes. Contacting the respective Divisional ADON/M for escalation to Divisional DON/M for
approval Reassessing the patient each day to determine the continued requirement for an
increase in patient care / supervision Ensuring all meal, tea and rest breaks are provided to the staff attending the increased
care/supervision. All breaks will be covered within existing staff resources by appropriately trained staff.
The Divisional ADON/M is responsible for: Contacting the Divisional DON/M for approval of request Contacting the NMRO/ AHHM / respective NM to source appropriate staff Ensuring all request forms for an increase in patient care/supervision are complete, and
where appropriate, have been signed by an appropriate medical officer Ensuring the request form is faxed or delivered to the NMRO/AHHM Office Reassessing the patient each day to determine the continued requirement for an
increase in patient care / supervision.
The DON/M is responsible for: The approval or decline of the request for an increase in patient care/supervision in line
with patient safety requirements The financial/budgetary management in relation to their respective cost centres
Doc Number Version Issued Review Date Area Responsible PageCHHS18/106 1 16/03/2018 01/04/2022 CSS - Nursing
Clinical Support4 of 14
Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register
CHHS18/106
Overseeing, on a daily basis, and within business hours, the approval process for the provision and continuation of increased patient supervision within their respective Division
Monitoring all after hours request forms within their respective Division.
The NMRO (in business hours) is responsible for: Liaising with the NM/CNC/CNM/ADON/M to ensure the appropriate process has been
followed before endorsing the approval and engagement of additional staff Ensuring the DON/M or their delegate is provided with timely notification of all requests
for increased patient supervision within their respective Division.
The AIN/EN/RN/RM is responsible for working within their scope of clinical practice and will: Interact and engage with the patient where appropriate Provide patient care including increased supervision and treatment Escalate any concerns related to the patient’s condition to the most appropriate Team
leader / CNC member on shift Document the care provided to the patient for the shift in the patients progress notes.
AIN’s are to have the care they provide and the documentation they enter in the patients’ progress notes supervised by the allocated staff member
Document any changes in the patients’ progress notes including the patients’ observations, level of consciousness, mental state, and behaviour, levels of agitation or expressions of suicidal thoughts/ideation/intent in the patients’ progress notes
Provide increased supervision, visually sighting the patient regularly and ensuring the patient is safe at the specified frequency of that observation level as per the risk matrix action (which may be at 15, 30 or 60 minutes, if not more often) on the Increased Patient Supervision Request Form (Attachment 1)
Adhere to all safety and infection precautions specified for increased supervision Provide handover of the patient to another nurse before going on meal breaks or
leaving the ward and provide a comprehensive handover with each change of shift Notify the CNC/MC, TL, and Security immediately if the patient is unable to be located
on the ward.
Back to Table of Contents
Section 3 – Staff Responsibilities: Operational
The respective TL is responsible for: Completing appropriate documentation on the patient care and or supervision request
form. Contacting the AH-CNC to clinically review the patient, and if deemed appropriate,
ensuring the request form is endorsed Ensuring patients who are assessed as requiring constant supervision are provided with
the appropriate staffing resource at all times
Doc Number Version Issued Review Date Area Responsible PageCHHS18/106 1 16/03/2018 01/04/2022 CSS - Nursing
Clinical Support5 of 14
Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register
CHHS18/106
Ensuring all meal, tea and rest breaks are provided to the staff attending the increased care/supervision. All breaks will be covered within existing staff resources by appropriately trained staff.
The Wardsperson (Wardsperson Operations Manager / Supervisor) is responsible for: Providing support to the RN/M’s, EN’s and AIN’s in circumstances where the patient
under increased supervision becomes violent, agitated and aggressive with a potential for compromising the safety of staff/patients within close proximity
Working collaboratively with nursing staff to provide a safe work area and minimise/prevent harm to the patient
Undertaking Professional Assault Response Training (PART) and demonstrating compliancy with the training requirements
Advising the AHHM as soon as possible of the availability of a Wardsperson for patient supervision
Booking a Wardsperson for the requested duration required for supervision.
Back to Table of Contents
Section 4 – Staff Responsibilities After Hours
The AH-CNC is responsible for: Clinically reviewing the patient and making a clinical determination in consultation with
the appropriate stakeholders as to whether the patient requires increased care / supervision
Completing appropriate documentation on the patient care and or supervision request form
If endorsed, providing the AHHM with the endorsed request form Reassessing the patient each day (weekends and after hours) to determine the
continued requirement for an increase in patient care / supervision.
The AHHM is responsible for: Ensuring the AH-CNC has undertaken an appropriate clinical review of the patient prior
to endorsing the approval and engagement of additional staff Reviewing existing staffing, activity, acuity and models of care delivery prior to the
approval and engagement process of additional staff Sourcing appropriate staff as per request Completing the AHHM report located in the Q Drive/TCH/Nursing Services Folder so that
the DON/M and the ADON/M can access up to date information pertaining to ‘Special’ requests within their respective Divisions
Providing a rationale for decision making Sending a copy of all request forms to the relevant ADON/M via internal mail. Completing appropriate documentation on the patient care and or supervision request
form.Back to Table of Contents
Section 5 – Other ConsiderationsDoc Number Version Issued Review Date Area Responsible PageCHHS18/106 1 16/03/2018 01/04/2022 CSS - Nursing
Clinical Support6 of 14
Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register
CHHS18/106
If there is more than one patient on a ward who has been assessed as requiring increased care/supervision, and if deemed appropriate, consideration should be given to co-locating more than one patient under the care/supervision of an appropriate staff member
Due to operational demands, patients that require increased care/supervision with different genders may be co-located together. This can occur after appropriate consideration and discussion
In the event that an additional staff member is unable to be provided, the CNC/MC, TL, AHHM/AH-CNC will discuss alternative solutions inclusive of changes in Models of Care to meet this requirement.
Back to Table of Contents
Section 6 – Risk Matrix to be used
Risk MatrixThe risk matrix must be used to aid in the decision to support the request for increased supervision, noting potential patient and organisational risks. Once the risk rating is completed the corresponding action is determined which facilitates the required level of increased supervision.
The risk matrix is to be completed on the Increased Patient Supervision Request Form (Attachment 1).
Doc Number Version Issued Review Date Area Responsible PageCHHS18/106 1 16/03/2018 01/04/2022 CSS - Nursing
Clinical Support7 of 14
Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register
CHHS18/106
RISK MATRIX
LIKELIHOOD
CONSEQUENCE
1 2 3 4 5
A LOW MODERATE HIGH EXTREME EXTREME
B LOW MODERATE MODERATE HIGH EXTREME
C LOW MODERATE MODERATE HIGH HIGH
D LOW LOW MODERATE MODERATE HIGH
E LOW LOW LOW MODERATE MODERATE
LIKELIHOODLEVEL LIKELIHOOD FURTHER DESCRIPTION
E Rare Patient is cooperative
D Unlikely Patient may be verbally loud, may have aggressive body language has not yet physically confronted others or attempted to abscond / challenging behaviour is exhibited
C Possible Patient is verbally aggressive and may have aggressive body language. Patient may have a history of violence but has not demonstrated intent/ability to physically hurt self, others or abscond
B Likely Patient has a history of dementia, confusion. Patient demonstrates anger and aggression toward self and/or others. Patient has intent/ability to injure, may have identified potential victim/s. Where measures of containment are insufficient.
A Almost Certain Patient has a history of dementia, confusion, hostility and demonstrates the intent/ability to physically injure self or others. Where measures of containment are insufficient.
CONSEQUENCELevel Consequence Further description
1 Insignificant No injuries
2 Minor First aid treatment3 Moderate No immediate professional medical attention required
4 Major Immediate professional medical attention required, extensive injuries, financial risk
5 Catastrophic Severe injury to self or others , extreme financial risk
RISK RATING
Doc Number Version Issued Review Date Area Responsible PageCHHS18/106 1 16/03/2018 01/04/2022 CSS - Nursing
Clinical Support8 of 14
Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register
CHHS18/106
RISK RATING
DESCRIPTION ACTION
Low Patient requires routine supervision Routine supervision with regular reassessment
Moderate
Patient requires more frequent supervision by nursing staff and may be restrained using containment (secure ward area/ stable doors)
More frequent supervision option with regular (hourly) reassessment
High Patient requires close supervision by at least one staff member. Ward persons may be required to assist with physical aggression/ restraint
Close supervision with patient being continually monitored with a (half hourly) reassessment
Extreme Patient requires constant supervision by one or more staff members. Ward persons and Security staff will need to be present on request from ward CNC/ AHHM.
Close supervision with patient being continually monitored with regular (quarter hour) reassessment
Back to Table of Contents
Related Policies, Procedures, Guidelines and Legislation
Policies ACT Health Work Health and Safety Policy Incident Management Policy Violence and Aggression by Patients Consumers or Visitors Policy ACT Health Protective Security Policy
Procedures AMHU Operational Procedures Emergency Detention in the Inpatient Setting and a Persons Rights under the Mental
Health Act Falls Prevention and Management Prisoners/Detainees as Patients Management of People Subject to Section 309 of the Crimes Act 1900 Transferred to the
Canberra Hospital (MHJHADS)
Standards Australian Charter of Healthcare Rights Australian Commission on Safety and Quality in Health Care.
Legislation Mental Health Act 2015 Crimes Act 1900 Human Rights Act 2004 Health Records (Privacy & Access) Act 1997 Work Health and Safety Act 2011
Back to Table of Contents
Search Terms
Doc Number Version Issued Review Date Area Responsible PageCHHS18/106 1 16/03/2018 01/04/2022 CSS - Nursing
Clinical Support9 of 14
Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register
CHHS18/106
Special, Patient Increase Risk, Increased Care, Increased Supervision, Patient Special
Back to Table of Contents
Attachments
Attachment 1 - Patient Care and or Supervision Request FormAttachment 2 - Patient Care and or Supervision Business Hours Flow chartAttachment 3 - Patient Care and or Supervision Afterhours Flow Chart
Disclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Services specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.
Policy Team ONLY to complete the following:Date Amended Section Amended Divisional Approval Final Approval 16/03/2018 Complete Review Lisa Gilmore, ED, CSS CHHS Policy Committee
This document supersedes the following: Document Number Document NameCHHS13/634 Increased Patient Care Supervision SOP
Doc Number Version Issued Review Date Area Responsible PageCHHS18/106 1 16/03/2018 01/04/2022 CSS - Nursing
Clinical Support10 of 14
Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register
CHHS18/106
Attachment 1 – Patient Care and or Supervision Request Form
Doc Number Version Issued Review Date Area Responsible PageCHHS18/106 1 16/03/2018 01/04/2022 CSS - Nursing
Clinical Support11 of 14
Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register
CHHS18/106
Attachment 2 – Patient Care and or Supervision Business Hours Flow chart
Doc Number Version Issued Review Date Area Responsible PageCHHS18/106 1 16/03/2018 01/04/2022 CSS - Nursing
Clinical Support12 of 14
Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register
Process for increased patient care and or supervision requests during business hours
(Monday – Friday 0800- 1700 hours).
CHHS18/106
Doc Number Version Issued Review Date Area Responsible PageCHHS18/106 1 16/03/2018 01/04/2022 CSS - Nursing
Clinical Support13 of 14
Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register
Identified requirement for increased care /supervision
CNC/M to contact ADON/M for escalation to DON/M for approval of care /supervision and complete request form, include patient’s condition and rationale for care/supervision
ADON/M to inform NMRO of request and provide NMRO with completed request form
ADON/M to inform CNC/M
Not EndorsedEndorsed
NMRO to attend morning weekday Access meeting & provide a brief on hospital staffing status to ADON/M and DON/M attendees. In collaboration with NM’s, the NMRO will source appropriate staffing in accordance with patient safety & operational requirements. CNC/M to allocate patient
care
All staffing requests will be reviewed on a shift by shift basis during business hours by the CNC/MC and ADON/M. Rationale for decision making will be provided to the DON/M
CHHS18/106
Attachment 3 – Patient Care and or Supervision Afterhours Flow Chart
Doc Number Version Issued Review Date Area Responsible PageCHHS18/106 1 16/03/2018 01/04/2022 CSS - Nursing
Clinical Support14 of 14
Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register
Process for increased patient care and or supervision requestsAfter hours (Monday – Friday 1700-0800 hours and 24 hours during
weekends and public holidays).
Identified requirement for increase in patient care /supervision
TL to complete care /supervision request form, include patient’s condition and rationale for increase in care/supervision
TL to contact AH-CNC to review request
AH-CNC to inform AHHM of request and provide AHHM with completed request form.
AH- CNC to inform TL. AH CNC will discuss alternative Models of Care of delivery with TL.
Not EndorsedEndorsed
TL to allocate patient careAHHM to provide appropriate staffing in accordance with patient safety and operational requirements. AHHM to complete AHHM report located in the Q Drive/TCH/Nursing Services Folder.
All afterhours staffing requests will be reviewed on a shift basis during non-business hours by the AH-CNC/ AHHM.