Safety under the microscope

Union inspection follows threats to nurses

More than 50 security, occupational safety and other improvements, including safer ways of managing methadone patients, have been recommended for Inverell Hospital by a union inspection team.

The union visit follows threats to nurses, including one episode of verbal aggression which led police to charge a patient with intimidation.

The patient pleaded guilty to a charge of ‘stalk/intimidation with intent to cause fear of physical and/or mental harm’ and is awaiting sentencing.

The union’s occupational health and safety coordinator and an organiser inspected the hospital and sent a written report to management. Union General Secretary Brett Holmes asked management to provide an action plan within six weeks to fix the problems.

‘We strongly recommend that a comprehensive security audit be conducted by the Area Manager for Fire and Security or an external contractor with suitable qualifications and experience,’ Brett wrote.

He said particular areas of concern included perimeter security, duress response, ED security, aggression minimisation and other training, prevention and management of violence particularly from drug and alcohol clients, and non-compliance with security measures.

Management has since carried out a security audit and is working with nurses to fix the problems, said NSWNA Branch secretary Kylie Marquart.

The inspection report recommends measures to address security issues related to methadone dosing in the ED.

It notes: ‘Clients turn up at the ED whenever they please or with minimal warning despite appointment times. This includes arriving late at night on occasion.’

It says clients who arrive well outside appointment times should be turned away.

The report asks management, in consultation with nurses and drug and alcohol staff, to review the appropriateness of methadone dosing being done by the ED given its low staffing level.

Dosing should occur in a room with two exits, and the patient must not sit between the door and the nurse.

A security officer should be present during methadone dosing times, and should also be on-call in the event that an aggressive patient arrives at the ED.

Nurses should be directed to report all violent incidents and if necessary a simple form should be developed to encourage reporting.

The report points out that the emergency department treatment area is not secure: ‘Anyone can enter the ED once they are inside the hospital.’

Meanwhile the NSWNA branch at the hospital is pushing for a review of staffing in the emergency department.

The hospital at Inverell, on the western edge of the New England Tablelands, is a 52-bed acute care facility including a 29-bed medical ward, a six-bed maternity unit, eight surgical beds and a five-chair day surgery unit.

The three-bed ED has no clerical support and an on-call doctor only.

There is one RN and one EN on morning and afternoon shifts and just one RN on night shift. This nurse can be working alone and is also in-charge-of-hospital.

Branch secretary Kylie Marquart said the branch wanted two RNs, rather than one RN and one EN, rostered for the emergency department on weekends and public holidays.

‘The real workload issue in ED is the dual role of the one RN who has to carry a full clinical load while trying to adequately manage the hospital,’ she said.

‘Nurses feel they cannot provide adequate, safe care to ED patients during the busy times, and adequately oversee and support the staff in the rest of the hospital.’