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# hiqa inspection
'High-risk' physical and chemical restraint still in use at Limerick care centre
Hiqa said that the procedures at a daughters of Charity care centre continued to present “a risk to residents’ health and safety”.

A HIQA REPORT has found a Limerick centre for adults with disabilities non-compliant over issues to do with residents’ privacy and restraint procedures.

In a report published yesterday, the healthcare watchdog said that the use of “a high-risk physical restraint” at St Vincent’s Residential Services in Limerick had decreased, but was still approved and continued to present “a risk to residents’ health and safety”.

The report noted that:

A review of physical restraint indicated an incremental decrease in high-risk restraint techniques over the previous two years with a particularly high risk technique (prone or face-down restraint) being used once so far this year (once in a seven month period).

“This was a significant decrease from previous years,” the report said.

There were however well-documented difficulties with carrying out a health examination of any individual resident involved following any such episodes with only visual monitoring being possible.

It said that as a result, “despite the safeguards in place, the on-going use of such a high-risk technique coupled with the difficulties examining residents following any such episode remains a cause for concern for Hiqa in terms of residents’ health and safety”.

It added that a previous recommendation of how to use a chemical restraints had not been followed by the centre.

In a previous inspection, the centre was advised to improve its record keeping of the administration of PRN medicine usage (medication only taken as the need arises).

The centre was found to not have adequately documented any adverse effects of the medicines, or the efficacy of the medication.

In addition, improvement was required to ensure that the reasons for administering chemical restraint were recorded clearly and consistently as general terms such as ’agitation’ were being recorded as the rationale.

In another case, the consultant psychiatrist had indicated that the use of the chemical restraint in one particular circumstance was inappropriate, but the practice had not changed.

This was discussed with the person in charge and representative of the provider, who after the inspection arranged for a clinical meeting to take place to review their practices in the centre.

The administration of chemical restraint usage at the centre was reviewed on a weekly basis by a psychiatrist and service-wide oversight was taken by a drugs and therapeutics committee.

The Daughters of Charity-owned centre provides support and accommodation for adults with intellectual disabilities. Currently, the centre has seven residents.

Between two Hiqa inspections of the centre in May and July of this year, a report of an alleged breach of one resident’s human rights, in relation to their right to liberty, had been reported.

In response, a “safeguarding plan” was implemented at the Limerick centre, which included reducing restrictions and support from a speech and language therapist in communicating options and choices to residents.

The inspection report also found that the environment in which patients lived was unacceptable:

The failings identified at previous inspections found that “adequate private accommodation was not provided for all residents”.

The privacy and dignity of four residents was compromised due to the fact that partitions between sleeping areas were taller than head height but did not extend the full height of the room.
There was a gap between the top of the partitions and the ceiling of the room. As a result, bedroom areas were not fully private. Inspectors observed that windows in five bedrooms were above head height with limited natural light. Curtains were also at ceiling height

These had since been solved, the report acknowledged:

The staff team had made further efforts to decorate and personalise the centre with pictures, photographs, soft furnishings and other homely touches. Bedrooms were personalised and some residents chose to show inspectors their rooms, which they said they liked.

It was acknowledged that some positive actions had been taken at the centre. The centre arranged for two external reviews of the service of one part of the centre, and showed that they were implementing recommendations from those reviews.

The Hiqa inspector also found that “the building was not provided with construction capable of containing a fire where required” and that “a funded plan was not yet in place to address the failing that the environment” at the centre which was having an impact on residents.

Read: Children ‘subjected to atmosphere of fear’ due to issues at residential centre

Read: How many HSE doctors does Navan hospital’s emergency department have? None

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