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Fiona Stanley Hospital told to improve how it reports and monitors the use of restraints on patients

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Josh ZimmermanThe West Australian
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Four inquiries have been raised relating to the use of restraint with Fiona Stanley Hospital.
Camera IconFour inquiries have been raised relating to the use of restraint with Fiona Stanley Hospital. Credit: Peter Bennetts/Peter Bennetts

Perth’s biggest hospital has been directed to improve the way it reports and monitors the use of restraints on patients in “non-mental health areas” after failing to meet the required standard as part of an ongoing assessment process.

Use of both physical and chemical restraints in hospital emergency departments has been on the rise in recent years as a result of long waits — sometimes lasting multiple days — for beds for mental health patients.

The worrying trend has been a focus of WA’s Chief Mental Health Advocate Sarah Pollock, who revealed her agency had raised four inquiries relating to the use of restraint with Fiona Stanley Hospital (FSH) in 2021-22.

“Each of them referred to female (patients) with eating disorders on medical wards,” Dr Pollock said.

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“In summary, the sort of themes across those four inquiries were around the excessive use of force in restraint, how security guards were deployed… communications between security guards and clinical staff and also how distress is managed.”

The failure to meet standards were reported as part of an initial accreditation assessment earlier this year and Dr Pollock stressed she had been “very pleased” with FSH’s response after meeting with hospital management in March — resulting in a number of changes.

“They’ve changed the status of some of the beds in the particular medical ward that we were concerned about so that they’re now high dependency beds, which means that they get a higher level of resourcing,” she said.

“They acknowledged that they needed to do some upskilling for nursing staff and security guards in de-escalation and in trauma informed care.

“They improved their mental health liaison nursing for medical units and they improved their security governance.

You cannot effectively address these issues if you are not monitoring them, and clearly such issues get dropped when you have a health system which is under resourced and struggling to keep up

Libby Mettam

“So they looked at some of the issues of communication between clinical and security and made sure that restraints are clinically led, so that a clinical person will direct the restraint and the security guard will follow the clinical direction.”

FSH is currently undergoing an accreditation process against new national standards being administered by the Australian Commission on Safety and Quality in Health Care (ACSQHC).

As part of the initial assessment, FSH was also told to brush up in three other areas — governance of open disclosure in the wake of adverse events, medical record and clinical alert IT systems and the legibility of prescriber details on medication requests – ahead of a final review in October.

Responding to the failure to meet all of the required actions, Fiona Stanley Fremantle Hospitals Group executive director Kellie Blyth said it was not uncommon for hospitals to “have recommendations made at the initial assessment phase”.

“FSFHG is well on track to deliver on the four priority areas before final assessment in October,” she said.

Dr Pollock said the use of restraints — which can include all four limbs being chained to a bed – on patients with eating disorders was a growing area of concern for the Mental Health Advocacy Service at multiple different hospitals.

She said in most cases the patients were young women and they were almost always being restrained by male security guards, which sometimes led to injuries.

Dr Pollock added that a reliance on restraint in hospitals more generally – including chemical sedation – was directly linked to resourcing.

“This is a system wide problem — COVID has really battered the nursing workforce,” she said.

Shadow Health Minister Libby Mettam said use of restraint was a “consistent issue” for hospitals and it was a concerning FSH had been directed to improve in the area.

“You cannot effectively address these issues if you are not monitoring them, and clearly such issues get dropped when you have a health system which is under resourced and struggling to keep up,” Ms Mettam said.

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