Inspection of Mohill Nursing Unit shows that unit is "substantially compliant"

An inspection carried out at Arus Carolan Nursing Unit in Mohill, Leitrim, which is HSE-run, during early April at on 'Restrictive Practice Thematic Inspection' stated that the unit was "substantially compliant" and that "residents received a good, safe service but their quality of life would be enhanced by improvements in the management and reduction of restrictive practices".

Restrictive practices may be physical or environmental in nature. Physical restraint commonly involves any manual or physical method of restricting a person’s movement while environmental restraint is the restriction of a person’s access to their surroundings etc.  

The report said that the local management team had effective systems in place to ensure they maintained oversight of restrictive practices monitored with regular audits.

It continued that a restrictive practice committee was established and met on a quarterly basis to "drive quality improvements and developed quality improvement plans, however, the records of these meetings did not clearly set out the actions or the timeframes for their implementation."

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The report stated that the person in charge ensured that all staff had attended up-to-date training on appropriate and safe use of restrictive equipment and practices and two restrictive practice link nurses were available to support staff with their practices adding that, three times daily, quality and safety talks were also convened with staff to review and discuss restrictive practices.

However, not all staff demonstrated adequate knowledge regarding minimising restrictive practices and with promoting residents’ rights and positive risk-taking, the report noted.

The report stated that sensor mats were in use in 18 residents’ beds and seven residents’ chairs during the day which sounded an audible alarm when residents got out of bed or stood up from their chairs.

Nine residents had sensor mats placed on the floor by their beds that sounded an audible alarm when residents stood on them. 

It was noted that residents consented to use of restrictive equipment but noted that the consent document did not "clearly reference the restrictive equipment that was being used" and "there was limited information available that the service had ensured the sound of the sensor alarm equipment did not restrict residents’ movements as they wished, and that alternative less invasive systems were considered."

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The report said the provider had ensured up-to-date policies and guidance were available on safeguarding residents from abuse, supporting and caring for residents with responsive behaviours and dementia and the National Restraint policy to support staff with providing person-centred care to residents that maximised their safety, independence, choice and autonomy.

However, it noted that the centre’s policy to support staff with effectively managing one residents’ responsive behaviours was not being implemented. For example, this resident’s behaviour support care plan was not reviewed and updated with the most effective strategies used by staff to de-escalate their increasing episodes of responsive behaviours.

The report said that information in residents’ bedrail and other restrictive equipment care plans was person-centered, and their preferences and usual routines were clearly described to guide staff on how they must care for residents using restrictive equipment.

However, a number of staff positions were vacant and were being backfilled by agency staff including to provide one-to-one staffing to meet two residents’ needs. This arrangement did not ensure continuity of staff for residents, it said. Furthermore, agency staff had not been facilitated to attend restrictive practice training or training to support them with managing residents’ responsive behaviours.

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