HEALTH watchdogs warned hospital chiefs over record keeping after dementia patients on a psychiatric ward were treated under the Mental Health Act despite their detainment orders having expired.
A report published by the Mental Welfare Commission for Scotland after a spot check found two patients at the Royal Alexandra Hospital in Paisley were affected by the admin issue.
The hospital was also been cited in the report over the issuing of medications and the “dismal” environment of the ward.
READ MORE: Analysis: Dementia patient detention errors - what went wrong?
The care of nine patients was assessed during the unannounced visit to the short-stay 20-bed dementia ward in April. A review of files showed a number of patient records were 'incomplete' and copies of detention papers could not be found in their audit.
Staff were reported to be “unaware” of the errors. Health chiefs, who don't dispute the report, last moved to reassure that no patients were treated without the appropriate consents.
However Mike Diamond, executive director of Social Work at MWC said holding patients when their detention orders had lapsed was “potentially a deprivation of their liberty”.
He added: “The issue is they might have chosen to leave had they so desired. We can’t say that for sure because these patients might have consented to carry on their stay in the ward, but the point is that they were not given the chance to make that decision.”
“There should be processes in place. You really don’t want people to be detained unless there’s legal authority to do so.”
The MWC report recommended managers ensure copies of current detention papers are held in patients’ care files and start and end dates of detentions are recorded. The report also flagged up how one patient deemed not to have the capacity to consent to treatment was given medication without the appropriate authorisation, while another had two conflicting treatment authorisations.
Mr Diamond said patients being given treatment that “has not been properly authorised” did not necessarily mean they were receiving the wrong treatment.
Concerns were noted about patients’ washing facilities which did not “meet the needs of frail and confused older adult patients.” The decor of the communal areas were said to be “dismal” with an “odour of urine”.
“Disorientated” male patients were observed entering female dormitory areas, something that was noted in the previous year’s report, carried out in January 2018.
There was found to be little evidence of life story information and patients’ likes and dislikes being recorded in the latest report, despite recommendations made last year, while none of the cases reviewed included care plans for stress and distress, despite some patients being prescribed medication for “agitation”.
Dementia expert, Professor June Andrews said: “The report makes dreadful reading.
"Patients’ human and legal rights are ignored because staff think patients are in detention when they are not, and doctors assume patients have given consent to be treated when they haven’t.
"You can be sure that individual staff are doing their best, but this is not good enough.”
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A spokeswoman for NHS Greater Glasgow and Clyde said: “The Mental Health Act is sometimes used to give staff the power to guide patients back to the ward if they should deliberately or inadvertently seek to leave.
"It is not unusual for a detention under the Mental Health Act to be stopped or to be allowed to lapse, if those powers are no longer thought to be required.
"At the time of the visit, the ward was moving from paper based systems, to electronic systems and this would include patients’ detention certificates.
"No patients remained on the ward without the appropriate paperwork or their consent.
"All case notes have been reviewed and all legal documentation and procedures are now correct.
"Nursing staff should be aware of the legal status of patients on the ward at all times, and immediate action will be taken to remind them of this responsibility, and prevent a recurrence of this situation.”
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