Counties Manukau District Health Board Disability Support … · 2019-06-19 · Counties Manukau District Health Board – Disability Support Advisory Committee Agenda . Counties

Counties Manukau District Health Board – Disability Support Advisory Committee Agenda

Counties Manukau District Health Board Disability Support Advisory Committee Meeting Agenda Wednesday, 20th August 2014 at 3.30pm – 4.30pm, Manukau Board Room, Lambie Drive Time Item Page No

3.30pm 1.0 Welcome

3.30pm – 3.35pm 2.0 Governance 2.1 Attendance & Apologies 2.2 Disclosure of Interests/Specific Interests 2.3 Acronyms 2.4 Confirmation of Previous Minutes (16 July 2014) 2.5 Action Items Register

2 3-6 7 8-11 12-13

3.35pm – 4.00pm

3.0 Disability Support Update 3.1 Waitemata DHB Disability Strategy Coordinator –

Samantha Dalwood

verbal

4.00pm -4.15pm

4.0 Information 4.1 Bed Rails/Restraint Minimisation & Safe Practice

Policy – Mr Martin Chadwick

14-20

Next Meeting: Wednesday 24th September 2014, Lambie Drive

2

BOARD MEMBER ATTENDANCE SCHEDULE 2014 – DiSAC Name

Jan 26 Feb 26 Mar 16 Apr 21 May 18 June 16 July 20 Aug 24 Sept 22 Oct 26 Nov 17 Dec

Lee Mathias

No

Mee

ting

X

Colleen Brown (Chair)

Sandra Alofivae

X X

David Collings

X X X X X X

George Ngatai

X X

Dianne Glenn

Reece Autagavaia

X

Mr Sefita Hao’uli

X X

Ms Wendy Bremner

Mr Ezekiel Robson

X

3

BOARD MEMBERS’

DISCLOSURE OF INTERESTS

20 August 2014

Member Disclosure of Interest

Dr Lee Mathias • MD Lee Mathias Limited

• Trustee, Lee Mathias Family Trust

• Trustee, Awamoana Family Trust

• Chair Health Promotion Agency

• Deputy Chair Auckland District Health Board

• Director, Pictor Limited

• Director, iAC Limited

• Advisory Chair, Company of Women Limited

• Director, John Seabrook Holdings Limited

• Chairman, Unitec

Sandra Alofivae

• Chair of the Auckland South Community Response

Forum (MSD appointment)

• MSD Member, Auckland Social Policy Forum,

Auckland Council

• Member, Fonua Ola Board

• Appointed to the Ministerial Forum on Alcohol

Advertising & Sponsorship

• Board member Pacifica Futures

David Collings

• Chair, Howick Local Board of Auckland Council

• Member Auckland Council Southern Initiative

Colleen Brown • Chair Parent and Family Resource Centre Board

(Auckland Metropolitan Area)

• Member of Advisory Committee for Disability

Programme Manukau Institute of Technology

• Member NZ Down Syndrome Association

• Husband, Determination Referee for Department of

Building and Housing

• Chair, Early Childhood Education Taskforce for

COMET

• Member, Manurewa Advisory Group

• Member, Child Advocacy Group – Manukau

• MSD Member, Auckland Social Policy Forum,

Auckland Council

• Deputy Chair, Auckland City Council Disability

Strategic Advisory Group

• Chair ECE Implementation Team Auckland South

• Chair 11Much Trust

4

George Ngatai • Arthritis NZ – Kaiwhakahaere

• Chair Safer Aotearoa Family Violence Prevention

Network

• Director Transitioning Out Aotearoa

• Director BDO Marketing

• Board member Manurewa Marae

Dianne Glenn • Member – NZ Institute of Directors

• Member – District Licensing Committee of Auckland

Council

• Life Member – Business and Professional Women

Franklin

• President – National Council of Women

Papakura/Franklin Branch

• Member – UN Women Aotearoa/NZ

• Vice President – Friends of Auckland Botanic Gardens

and Member of the Friends Trust

• Member – Friends of Regional Parks

• Life Member – Ambury Park Centre for Riding

Therapy Inc.

• CMDHB Representative - Franklin Health

Forum/Franklin Locality Clinical Partnership

Reece Autagavaia • Member, Pacific Lawyers’ Association

• Member, Labour Party

• Member, Auckland Council Pacific Peoples Advisory

Panel

• Board Member, United Otara Market

Sefita Hao’uli

• Trustee Te Papapa Pre-school Trust Board

• Deputy Chair: Anau Ako Pasifika Inc. (Pacific ECE

provider)

• Member Tufungalea Tonga Inc. (Promoting and

Growing Lea Tonga)

• Member Tonga Business Association & Tonga

Business Council Advisory roles:

• Counties Manukau District Health Board

• Toko Suicide Prevention Project (Ministry of Health)

• Tala Pasifika (NZ Heart Foundation Pacific Tobacco

Control)

• (On short-list for the Pacific Advisory Board, Auckland

Council)

• Primary ITO & MBIE: Ola e Fonua Project. Consultant:

• Government of Tonga: Manage RSE scheme in NZ

• Alliance Health: Community Engagement &

Communication Advice.

5

• Ministry of Business Innovation and Employment:

Policy Advice and Leadership Training

• Pacific Perspectives/Auckland University: Health

research projects

• NZ Heart Foundation (Tala): Communication Strategy

and Advice.

• NZ Translation Centre: Translates government and

health provider documents.

• Mana Trust: Advice on health literacy collaboration

between Maori and Pacific providers.

• Member Pacific Advisory Panel of the Auckland

Council.

Ezekiel Robson • Auckland Council Disability Strategic Advisory Group

• Department of Internal Affairs Community

Organisation Grants Scheme Papakura/Franklin Local

Distribution Committee

• Be.Institute/Be.Accessible ‘Be.Leadership 2011’

Alumni

Wendy Bremner • CEO Age Concern Counties Manukau Inc

• Member of Auckland Social Policy Forum

• Member of Health Promotion Advisory Group (7 Age

Concerns funded by MOH)

6

DISABILITY SUPPORT ADVISORY MEMBERS’ REGISTER OF DISCLOSURE OF SPECIFIC INTERESTS Specific disclosures (to be regarded as having a specific interest in the following transactions) as at 20 August 2014 Director having interest Interest in Particulars of interest Disclosure date Board Action Mr Ezekiel Robson

Be.Institute

Mr Robson had a past interest with the Be.Accessible Leadership Alumi.

18th June 2014

That Mr Robson’s specific interest is noted and the Committee agree that he may remain in the room and participate in any deliberations or decisions.

7

Glossary ACC Accident Compensation Commission

ADU Assessment and Diagnostic Unit

ARDS Auckland Regional Dental Service

BT Business Transformation

CADS Community Alcohol, Drug and Addictions Service

CAMHS Child, Adolescent Mental Health Service

CNM Charge Nurse Manager

CT Computerised Tomography

CW&F Child, Women and Family service

DNA Did not attend

ESPI Elective Services Performance Indicators

FSA First Specialist Assessment (outpatients)

FTE Full Time Equivalent

ICU Intensive Care Unit

iFOBT Immuno Faecal Occult Blood Test

MHSG Mental Health service group

MoH Ministry of Health

MTD Month To Date

MOSS Medical Officer Special Scale

OHBC Oral health business case

ORL Otorhinolaryngology (ear, nose, and throat)

PACU Post-operative Acute Care Unit

PHO Primary Health Organisation

PoC Point of Care

SCBU Special care baby unit

SMO Senior Medical Officer

SSU Sterile Services Unit

TLA Territorial Locality Areas

WIES Weighted Inlier Equivalent Separations

YTD Year To Date

8

Minutes of the meeting of the Counties Manukau District Health Board

Disability Support Advisory Group

Wednesday 16 July 2014

held at Counties Manukau Health Boardroom, 19 Lambie Drive, Manukau

commencing 3.45pm

COMMITTEE MEMBERS PRESENT:

Ms Colleen Brown (Committee Chair)

Ms Dianne Glen

Ms Wendy Bremner

Mr Ezekiel Robson

Mr Apulu Reece Autagavaia

ALSO PRESENT:

Mr Martin Chadwick (Director Allied Health)

APOLOGIES: Apologies were received and accepted from Dr Lee Mathias, Mr George Ngatai,

Mr David Collings, Ms Sandra Alofivae and Mr Sefita Hao’uli.

WELCOME The Committee Chair welcomed all those present.

2.2 DISCLOSURE OF INTERESTS

The Disclosures of Interest were noted with no amendments.

2.2 SPECIFIC INTERESTS

There were no specific interests to note with regard to the agenda for this meeting.

2.3 ACRONYMS

The acronym list was noted.

2.4 CONFIRMATION OF PREVIOUS MINUTES

Confirmation of the Minutes of the Counties Manukau Health Disability Support Advisory

Committee meeting held 18 June (agenda pages 7-9).

Resolution (Moved Ms Colleen Brown/Seconded Ms Wendy Bremner)

That the minutes of the Counties Manukau Health Disability Support Advisory Committee

meeting held 18 June 2014 be approved.

Carried

9

Matters Arising from the Minutes:

Item 4.3 (page 9) –Noted that the Health Passport contains non-medical information as well as

medical information and tells a whole range of things that the medical health system would not.

Item 4.2 Be.Accessible Proposal - Agreed that the Resolution be amended to read:

Resolution

That the Board accept the quote from Be.Institute to assess the accessibility of the Manukau

Super Clinic for our patients and their families.

Carried

2.5 ACTION ITEMS REGISTER

Resolution (Moved Ms Colleen Brown/Seconded Ms Wendy Bremner)

That the Action Items Register of the Counties Manukau Disability Support Advisory Committee

be received (agenda pages 10-11).

Carried

3. PRESENTATION

3.1 Implementing the Whaanau Ora System in CMH

Ms Angie Tangaere , National Hauora Coalition provided a powerpoint presentation (agenda

pages 12-38). A copy of the presentation is available on the CMDHB website.

Three key areas of work:

1. Maaori service integration – investing in services that will improve Maaori Health gain

2. Whaanau Ora networks and social innovation hubs – networks and social innovation to

support health and social service integration in Mangere and Manukau

3. Maatua Pepi Tamariki pilot project – targeting underserved Maaori mothers in CMH

What has been achieved:

• Consolidated contracts into 5 service specifications.

• Focus on a high quality skilled Whaanau ora workforce.

• Targeting of the limited resources to Maaori Whaanau.

• Targeting areas of DHB priority for population outcomes.

• Outcomes based performance measurement framework that will clearly demonstrate the

impact of the services on health gain for these populations.

As a follow up to this presentation, Ms Colleen Brown undertook to engage with Ms Tania Kingi,

Manawhenua to discuss where she sees Whaanau Ora sitting with whaanau who have disabilities.

The Chair thanked Ms Tangaere for her presentation.

10

4. DISCUSSION PAPERS

4.1 Stroke Service Update

Mr Martin Chadwick took the Committee through the paper (agenda pages 39-40)

More than 600 people in the Counties Manukau area suffer from a stroke event per annum. The

long term impact of stroke on patients and their families can be significant due to loss of mobility

and function across many facets of daily life.

Stroke services are provided across acute and rehabilitation environments, including community

settings.

The DHB is working well to improve stroke services, including the provision of a 24/7 thrombolysis

service, working with ambulance services for timely access, education and training for a stroke

interdisciplinary team, improving radiology services in ED, stroke beds and a dedicated

rehabilitation area.

It was agreed that the Committee would keep a watching brief on this.

4.2 Over 65’s Living with Disabilities

Mr Martin Chadwick took the Committee through the proposal (agenda pages 41-42).

A person receiving Disability Support Services does not automatically transition to Health of Older

People Services on turning 65. The key factor is whether the person has an age related disability,

not just on chronological age.

It is important to identify the reason behind the support needs of a person over 65 who has a

physical, sensory or intellectual disability and has not been previously assessed. If that person has

been managing independently up until after they turn 65, the onset of an additional age related

disability will be the key factor for that person’s needs changing and them seeking assessment

and supports. This would be the responsibility of DHB NASC.

It is also important to identify the reason behind changes in the support needs of a person over 65

with a physical, sensory or intellectual disability, who has been already assessed by a DSS NASC

and is living at home with minimal DSS support. If the person requires additional support because

of their base DSS disability, the DSS NASC will assess and provide additional supports. If the key

factor to the change in the person’s need is the onset of an additional age related disability the

person will transition to DHB NASC.

Noted that the GM ARHoP has a monthly meeting with Taikura Trust. Ms Bremner to contact Ms

Dana Ralph-Smith in relation to any specific older person having difficulty accessing services

through Taikura Trust.

The Committee requested that Mr Chadwick pass on their special thanks to Ms Dana Ralph-Smith

for the information provided in this paper.

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5. FOR INFORMATION

5.1 NZ Statistics Data

Mr Ezekiel Robson took the Committee through the key findings from the 2013 NZ Disability

Survey (agenda pages 43-55).

In 2013, 24% of the NZ population were identified as disabled, a total of 1.1m people. The

increase from 2001 (20%) is partly explained by our ageing population.

Maaori & Pacific people had higher than average disability rates, after adjusting for differences in

ethnic population age profiles.

For adults, physical limitations were the most common type of impairment. For children, learning

difficulty was the most common impairment.

The most common cause of disability for adults was disease or illness (42%). For children, the

most common cause was a condition that existed at birth (49%).

5.2 WHDB Disability Coordinator Job Description

The paper was taken as read (agenda pages 56-64).

6.0 OTHER BUSINESS

Noted that the Disabled Persons Assembly is taking a partition to Parliament next week about

repealing the NZ Public Health & Disability Amendment Act which has outlawed disabled from

taking the Government to court about family carers, deciding which family members can be carers

and deciding that they should be paid less than other carers. The Committee asked Mr Ezekiel

Robson to circulate the petition to the members.

The Committee requested a presentation in September from the Interpreting Service.

Ms Dianne Glenn closed the meeting with some poignant thoughts.

The meeting concluded at 5.02pm.

Signed as a correct record of a meeting of Counties Manukau Health‘s Disability Support Advisory

Committee meeting held 16 July 2014.

Chair

Ms Colleen Brown Date

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Disability Support Advisory Group Meeting Summary of Action Items as at 20 August 2014

DATE ITEM ADDED

ITEM DETAIL RESPONSIBILITY (GM/ADVISORY COMMITTEE)

COMMENTS/ UPDATES

WHEN COMPLETE

Aug 2011 Policies That policies need to be sent for

review to DiSAC before implementation of policy and the Committee to receive a brief analysis to be put in papers for following meeting.

Mr Chadwick Ongoing

February 2012 Dignified Patient Handling Further update including information on staff training including the policy for use of bed rails.

Mr Chadwick (Denise Kivell) July/August

21 May 2014 Health Literacy Updated presentation from Dr Sinclair & Alan Kuyper

Mr Chadwick November

21 May 2014 Disability Support Update Samantha Dalwood, WDHB Disability Strategy Coordinator is invited to talk about her role at WDHB. Obtain copies of the Auckland Council disability coordinator job descriptions.

Mr Chadwick

Ms Brown/Mr Robson

June/July/August July

21 May 2014 CPHAC Director’s Report Mr Robson to seek a written report from Mr Hefford in relation to items from his 21 May CPHAC Director’s Report.

Mr Ezekiel Robson

TBC

18 June 2014 Action Items Register Follow up with Janine Bycroft, ADHB to get an updated presentation from Health Navigator.

Mr Chadwick

TBC

18 June 2014 Be.Institute Proposal Mr Chadwick to table a paper for the Board to accept the quote from Be.Institute to assess the accessibility of the Manukau Super Clinic for our patients and their whaanau.

Mr Chadwick

Paper tabled at 5th August ELT meeting and proposal approved to proceed

13

DATE ITEM ADDED

ITEM DETAIL RESPONSIBILITY (GM/ADVISORY COMMITTEE)

COMMENTS/ UPDATES

WHEN COMPLETE

18 June 2014 Health Passport Discuss with the Franklin Health Forum

a potential trial of the Health Passport and to ascertain much a small case study would cost.

Mr Chadwick TBC

16 July 2014 Interpreting Service Presentation from the Interpreting Service

Mr Chadwick September

16 July 2014 Whaanau Ora As a follow up to the NHS presentation, Ms Brown to engage with Ms Tania Kingi, Manawhenua to discuss where she sees Whaanau Ora sitting with whaanau who have disabilities.

Ms Brown

September

14

Counties Manukau Health

Bed Rails

Recommendations

It is recommended that DiSAC:

• Note the update with regards to bed rail use at CMH

• Note the policy with regards to Restraint Minimisation and Safe Practice which is

currently under review.

Prepared and submitted by: Martin Chadwick, Director Allied Health

Purpose

To present the Restraint Minimisation and Safe Practice policy to DiSAC for review. To update

with regards to the use of bed rails aligned with the roll-out of new bed stock in CMH.

Background

At the February DiSAC meeting an action item for DiSAC was entered for an update on the

work that has been undertaken around dignified patient handling of which the use of bed

rails is an integral part, and a specific update was requested. DiSAC also has a standing

action item pertaining to policies that relate to the remit of DiSAC be presented for review.

Policy:

• Is currently being updated with the De-escalation and Restraint Minimisation

Operational Group (DRMOG) members submitting suggested updates and

changes. These are being collated now. Any feedback from DiSAC can be

integrated into this process.

Education:

• All wards at Middlemore hospital, Manukau Super Clinic, Spinal Unit, Pukekohe

Rehab & Care and Franklin Memorial Hospital have received a teaching session

on Restraint Minimisation and Safe Practice.

• All of these wards have a folder (bright orange for ease of identification) with

relevant information and forms. It includes the Enabler Record for when using

Enablers (Bed-rails or Specialised Seating). It is important to note that use of bed

rails is not the norm, unless specifically indicated and noted due to the potential

confusion and miss-use of bed rails which aligns with international best practice.

• Twice monthly audits of bed-rail use in each area are being completed with staff

being informed if Enabler Forms have not been completed.

• Regular ward visits are being carried out to check on bed-rail use and

assist/educate staff on completing the Enabler Assessment.

15

Note: We were achieving 80% compliancy with Enabler Assessments and

Enabler Record for bed-rail use up until November 2013.

• For Personal Restraint, a template has been designed for Security to complete

which prompts follow up with staff members to complete Incident Reports

which is CM Health’s Restraint Register.

• Ko Awatea Learn (our e-learning platform) have a Restraint Minimisation and

Safe Practice module as an e-learning package.

Bed-Rail Review:

• Compliancy for bed-rail use was achieved if a patient is using a bed-rail, the

Assessment and Record were completed and if a patient was in a bed and not

requiring bed-rails, then these were removed to prevent the misuse.

• In October 2013, 104 new beds arrived that had attached bed-rails. This went

against CM Health’s current practice of removing rails that weren’t in use.

• This has caused confusion as patients or family members as well as orderlies are

putting rails up without appropriate assessment.

• When bed-rails are required, they are ordered through Task Manager and an

Orderly would bring them up and attach them to a bed.

• A new process for Enabler Use for Middlemore site has been proposed for using

Bed-rails.

• Instead of rails being ordered, the new beds with attached rails will become the

Enabler Beds. The bed will be ordered through Task Manager.

• Once this process has been agreed to, more intensive education will be provided

to ward and Allied Health staff.

• A Resource Nurse will be appointed from each ward to ensure the safe transition

of the new improved, user friendly process.

Page 1 of 5Restraint Minimisation and Safe Practice Policy

Document ID: A17357 Version: 2.0

Department: De-escalation & Restraint Minimisation Organisational Group (DRMOG) Last Updated: 29/06/2011

Document Owner: Chair DRMOG Next Review Date: 29/06/2013

Approved by: Clinical Management Executive Committee Date First Issued: 14/09/2010

Counties Manukau District Health Board

Policy: Restraint Minimisation and Safe Practice

PurposeCounties Manukau District Health Board is dedicated to serving our patients and communities by ensuring quality focussed health care.

The District Health Board takes the health, safety and welfare of all patients and staff extremely seriously.

The District Health Board will ensure that patients receive and experience services in the least restrictive manner whilst recognising that all staff have the right to perform their duties without tolerating abuse or acts of aggression.

Philosophy

It is the philosophy of CMDHB, in line with the values of the organisation, to support health professionals and support staff to achieve the intent of the Health and Disability Services (Restraint Minimisation) Standard NZS 8134. 2008: which is that restraint should only be used in the context of ensuring, maintaining, or enhancing the safety of the patient, service providers, or others.

ScopeThis policy is applicable to

All CMDHB employees, including contractors, visiting health professionals and students working in any CMDHB Facility.

Specific clinical areas must have procedures, consistent with this policy, that reflect the contextual issues in a particular setting.

Policy Restraint is a serious intervention that requires clinical rationale and

oversight. It is used based on sound clinical judgement with clear justification for use.

Restraint shall be perceived in the wider context of risk management; it is not a treatment within itself but one of a number of strategies used by service providers to limit or eliminate a clinical risk.

Restraint should only be used as a last resort after alternative less restrictive interventions have been attempted. e.g. de-escalation, interpreters, cultural support. It will be used for the shortest time possible.

Approval of Restraints and Enablers

All restraints and enablers used ay CMDHB require to be approved through the De-escalation and Restraint Minimisation Operational Group (DRMOG).

CMDHB Approval Procedure (Forthcoming)

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Initiation

Restraint use will be initiated after assessment and discussion by the MDT team. They will consider treatment of underlying cause, previous trauma or abuse history and any advance directives in place. They will consider whether the patient has been restrained in the past and if so, an evaluation of these episodes. They will consider alternatives and the risk to the patient, staff and others during the restraint period. All considerations, including cultural considerations will be in partnership with the patient and family/whanau. Exceptional circumstances will require emergency personal restraint.

The decision making process is clearly documented in the clinical notes and an individualised care plan developed to ensure all the patient’s needs are met whilst restraint is being used.

A patient centred goal will be developed in the patient’s care plan outlining the use, monitoring and evaluation of restraint use.

Wherever possible discussion and consent process will include the patient and family/whanau.

Restraint will be initiated only when the environment is safe and appropriate for initiation and when adequate resources are in place for safe initiation

Monitoring

All episodes of restraint use will be monitored while in place and a record of that monitoring will be documented.

The frequency of monitoring will be documented in the care plan.

Discontinuation

Restraint will be used for the shortest time possible.

Desired outcome and criteria for ending restraint is explicit and where practicable is shared with the patient.

The decision to discontinue restraint may be made by a registered staff member after careful assessment that the criteria for discontinuation have been met.

Evaluation

An evaluation of the effectiveness of the use of restraint will be undertaken and documented.

De-escalation and Restraint Minimisation Training Framework available from DRMOG

Education

All CMDHB will receive information/training related to restraint minimisation at a level that supports safe practice in their role, discipline, service.

Documentation

All episodes of restraint use require clear documentation of

Initiation

Monitoring

Discontinuation

Evaluation

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Restraint use will be documented in patient clinical notes, the service held register and reported on the Incident Reporting System.

Audit

Restraint use will be recorded in a service record which will be available for audit. Information to be recorded with include patients name, date and time restraint commence and discontinued, type of restraint and adverse events related to the use of restraint.

The use of restraint and enablers will be subjected to rigorous internal review by the DRMOG and externally through certification and accreditation.

Review

A register of approved restraints and enablers will be maintained by DRMOG with specified review dates.

All reported incidents of aggression, de-escalation and restraint will be monitored by staff Occupational Health and Safety and DRMOG to inform education, staff support and safety procedures.

Following incidents requiring restraint or de-escalation, the organisation will offer support to all staff members.

NZ Legislation NZ Crimes Act 1961NZ Bill of Right Act , 1990Health and Disability Act 2001 Code of Health and Disability Services Rights 1996Protection of Personal and Property Right Act 1988Mental Health (Compulsory Assessment and Treatment) Act 1992.Human Rights Acts 1993Health and Safety in Employment Act 1992

CMDHB Clinical Board Policies A Brief Guide to Delirium (guideline)Falls risk assessment Tikanga Best practice (policy) Cultural safety – linguistic interpreters (guideline)Informed consent (policy)Management of aggressive behaviour in the workplace (policy) Visitors (policy) Security (policy)Approval procedure (forthcoming)

NZ Standards Restraint Minimisation and Safe Practice Standard NZS 8134.2 :2008 Health and Disability Services (general) Standard NZS 8134. 0: 2008. Health and Disability Services (core) standards NZS 8134.1: 2008.

Organisational Procedures Vision and Values of the CMDHBOther related documents Nil

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DefinitionsTerms and abbreviations used in this document are described below:

Term Definition

Restraint The use of any intervention by a service provider that limits a patient’s normal freedom of movement.

Type of Restraint:

Personal RestraintWhere a service provider uses their own body to intentionally limit the movement of a consumer e.g. holding a patient.

Type of Restraint:

Physical RestraintWhere a service provider uses equipment, devices or furniture that limits a patients normal freedom of movement e.g. fixed trays, belts.

Type of Restraint:

EnvironmentalWhere a service provider intentionally restricts a patients normal access to their environment. e.g. locking devices on doors, removing mobility aids e.g. wheelchair.

Seclusion Where a consumer is placed alone in a designated room or area, at any time and for any duration, from which they cannot freely exit.

Seclusion only occurs in the inpatient Mental Health Services at CMDHB

Enablers Equipment, devices or furniture, voluntarily used by a patient following appropriate assessment by a health professional, that limits normal freedom of movement. The least restrictive option is used with the intent of promoting independence, comfort and or safety (consented to by the patient or their legal representative).

Chemical Restraint

CMDHB does not support the use of Chemical Restraint

NZS 8134: 2008 Health & Disability Standard.“All Medicines should be prescribed and used for valid therapeutic indications. Appropriate health professional advice is important to ensure that the relevant intervention is appropriately used for therapeutic purposes only.”

Chemical restraint is defined as the intentional use of medication to control a person’s behaviour when no medically identified condition is being treated,

or where the treatment is not necessary for the identified condition

or amounts to excessive treatment for the identified condition

or where the intended effect of the drug is to sedate the person for convenience sake or purposes of punishmentUse of medication as a form of ‘chemical restraint’ is in breach of this standard.

Bedrails

CMDHB does not support the use of Bedrails as a

Bedrails can be used as an enabler in specificcircumstances. The inappropriate use of bedrails is associated with significant risks to the patient.

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method of restraint Staff must be familiar with the enabler guideline and bed rail criteria before using this equipment as an enabler.

Technical positioning and planned safe holding

Is not considered to be restraint

Adults, children and young persons are often held or their ability to move is limited while an investigation or procedure occurs. This is referred to as technical positioning and planned safe holding. It is expected that the need for this will be essential to the procedure, included in the relevant procedure along with safety requirements, education needed to ensure patient safety and informed consent requirements will be met.

Transportation of patients

The temporary use of bed rails or safety belts for patient safety when a patient is in transit from one place to another is not considered restraint as long as a staff member is present. When transporting a patient vehicle land transport requirements must be met e.g. the wearing of seat belts.

Non Clinical Intervention Use of restraint recommended and applied by law enforcement officers i.e. police/prison officers, for reasons other than clinical treatment, is not covered by this policy. Police/prison officer have full responsibility for safe law enforcement restraint. These situations are governed by Criminal Law including Trespass ACT and Crimes Act.

Locked Units: In a locked unit the locked exit is a permanent aspect of service delivery to meet the safety needs of consumers who have been assessed as needing that level of containment. Although by definition the locking of exits constitutes environmental restraint the requirements of NZS8134.2 are not intended to apply to designated locked units that have entry and exit criteria and can ensure any consumer who does not meet the criteria has the means to independently exit at any time.

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Counties Manukau District Health Board Disability Support … · 2019-06-19 · Counties Manukau District Health Board – Disability Support Advisory Committee Agenda . Counties