increased nursing patient care and or supervision · web viewa request to increase patient...

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

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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).

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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.


Scope




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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)


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




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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).


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




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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.


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




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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.


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



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.


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).




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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




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


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


Search Terms




CHHS18/106

Special, Patient Increase Risk, Increased Care, Increased Supervision, Patient Special


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




CHHS18/106

Attachment 1 – Patient Care and or Supervision Request Form




CHHS18/106

Attachment 2 – Patient Care and or Supervision Business Hours Flow chart




Process for increased patient care and or supervision requests during business hours

(Monday – Friday 0800- 1700 hours).

CHHS18/106




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

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Attachment 3 – Patient Care and or Supervision Afterhours Flow Chart




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.

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