Transfer of Care – Medical Services Liaison.

Issues and points raised by the Reading group on 27/ 09/ 2010:

·      The policy referred to the Department of Health (1999) “Modern Standards and Service Models. Mental Health National Service Framework”, so the readers felt that this document should have also been included or incorporated within this document.

·      Under the section entitled assessment of clinical environment the group felt that when the policy refers to issues relating to poor hydration it states that the nursing staff can consider more robust basic nursing interventions, with regards to this issue the group felt that this should have been explained as the group could not understood what this meant in practice.

·      Section 4B refers to the assessment of staffs clinical capacity and competency, this section raises a few questions which are good but the group felt that it would be very worrying if the staff on the wards answered no to any of these, more so the group felt that a policy should not really pose any questions as the purpose of the policy is to answer any questions.

·      The first line on page 4 has a spelling mistake; it refers to revenant when it should have referred to relevant.

Section 4.3A refers to AHP, the group could not understand what this meant, so they believed there should have been an abbreviations sheet which would have explained them.

·      Section 4.5C refers to each service communicating relevant information about a patient to other services, the group felt that this should have been done with the patients knowledge and if they disagreed to this happening then the clinical staff would need to explain and document why they felt the need to overrule what the patient wanted.

·      Section 4.5D refers to DNR, this also needed to be clarified.

·      Section 4.6C refers to the named nurse liaising with acute trust every 48 hours unless otherwise agreed. The group wanted to know how the trust decided on a period of 48 hours as they felt that this was a long time to leave a vulnerable person as they could have had significant changes over this period of time. The group also wanted to know what else would be in place over the 48 hours for patients.

·      The overall response from the group with regards to this policy was that it was a user friendly policy to follow, however they felt that this was more so a discussion document rather than a formal policy that would help staff in practice.

Bathing and Showering: Safety Guidance.

·      The principle statement was liked by the group because they felt that it was very much patient centred.

The group felt that the personal hygiene needs of patients should be part of the initial assessment. Also the group felt that whoever carries out this assessment should be sensitive to the cultural needs of the patient, for example having same sex staff to carry out this assessment.

With regards to the section entitled assessment of physical risk the group felt that not everyone is included within this section. The group specifically talked about individuals who had prosthetic limbs and that they were at a greater risk of falling within the shower or bath, also the group mentioned those patients who were on specific medications for their mental ill health and the effect that the medication had on those individuals with regards to the ability to firstly identify that they needed to use the WC and then try to get to the WC in time.

·      The group made suggestions about what would happen to patients who refused to be directly supervised within the showers. Also the group felt that it would have been beneficial to the trust if they included an example within the policy.

The group wanted to look at what practice or procedure was in place at the moment for patients who were being supervised? The group wanted to know what procedure was being followed by staff who were monitoring an individual, the group suggested that with staffing levels being cut how would a practitioner ensure that an individual is being monitored regularly and secondly how can practitioners ensure that there is another professional to take over monitoring should the original professional need to take a break etc.

·      Within the policy there were abbreviations used which we did not know what was meant by them. CPPSG The group felt this needed to be elaborated on.

The table used within the policy document was good as the readers felt that it took into consideration the needs of various groups, the group felt that bathing rituals could be different within differing cultures and dependent on age, gender and ethnicity.

The group also wanted to know what was meant by a stage 2 full assessment and that there should have been an example within the policy.

The group suggested that within the policy document it makes references to guidance notes and that these should have been included within the policy document so it would be easier for professionals to follow.

 

Safeguarding Children Policy.

·      The group felt that the introduction was precise, concise and educative, they also felt that the policy sounded inclusive.

The group felt that it was very positive that recognition be given to children living with and caring for parents who have mental health problems.

·      The group expressed the fact that there was not any page numbers on the document, which made it hard to follow.

·      With reference to the Safeguarding Committee the group felt that it was essential for the trust to have working practices such as the Safeguarding Children practice that is effective and that these are monitored, as this is the procedure that makes sure that the best possible service is given to the user.

·      With reference to the section entitled Admission of young people into Psychiatric wards the group felt that this was totally inappropriate for young people to be on adult wards alongside it being very frightening for the young people.

With regards to section 5.5 the group felt that the policy referred to young people staying on the wards at a psychiatric unit for a long time, the group wanted to know what provisions have been made on adult wards for young people who have had to stay for an extended period of time.

·      Within section 3.7 the group felt that this section was very good but needed the inclusion of cultural differences and sensitivities that the professionals should be aware of.

·      Section 5.8 refers to ECT, the group felt that it was good that young people could refuse ECT, but worried that the emergency exemption to refuse ECT could be used as a back up by the professionals. The group also questioned what was meant by the word emergency within this context? Also the group seemed concerned about what determines whether a young person has the capacity to refuse ECT.

·      Section 5.9 refers to supervision and Child Protection advice, the group felt that there was no mention of different cultural needs of young people and that this could have been included within this section.

·      The group felt that all the information on these pages was written in a smaller font compared to the rest of the document and that some people might find it difficult to read.

·      The flowchart contained within this section of the policy in relation to dealing with allegations, the group felt was very useful for the professional staff.