The Division of Mental Health FMC provides three allocated beds to treat and care for patients who require close observation in a safe, low stimulus environment. These beds are utilised by Rural and Remote and Inner South Mental Health Services as the need arises. This area will facilitate specialist care for patients who require a higher level of nursing and medical care. The area will have no provision for seclusion nor is it intended as an intensive care facility.

The following is a nursing protocol and should be viewed in conjunction with the Medical and Allied Health protocols being developed for the area.

The criteria for nursing management of a patient in the special observation area include the following:

1. Must be under detention or an appropriate Guardianship Board order
2. Would benefit from the low stimulus environment while mental state improves
3. At risk to themselves due to:

1. Not volatile, hostile or physically aggressive
2. Not actively homicidal

Patients who do not meet the above criteria will either be managed in an Intensive Care Unit or in the open ward setting.

It is anticipated that special support beds will be utilised for the short-term management of patients for up to a period of approximately 72 hours, however it is recognised that in some circumstances certain patients my need to stay longer. It is acknowledged that some patients may also benefit from short therapeutic periods in the special observation area as "time out". Where it is deemed the duration of observation will possibly be less than 24-hours, the patient’s allocated bed will be retained, this will prevent the creation of an internal "bottle neck" when the patient is ready to be transferred out of the Special Observation area.

Prior to allocation of a Special Support Bed, the patient will undergo a risk assessment and mental state examination to determine suitability. The decision of suitability is to be negotiated between the inpatient areas of Rural and Remote and Southern Mental Health.

Patients managed in Special Support Beds will have a specific nursing care plan based on the Risk Assessment and the determined Nursing Observation Category.

There will be a joint nursing review of each patient by the Clinical Nurse/Senior Nurse of the respective unit on a daily basis.

Nursing staff of both units can negotiate transfer into and out of the unit of patients who require short term management of less than twenty-four hours and who are not likely to require medical intervention. These patients will be reviewed on a regular basis by nursing staff to determine appropriateness for return to the original unit.

The environment will be maintained as normally as possible. The safety of patients will be assured by increased nursing supervision rather than restricting patient property or free movement of the patient.

The rights of patients particularly in regards to privacy and dignity will always be maintained as a matter of utmost importance.

Patients cared for in Special Observation Beds should be integrated into the normal ward environment as soon as practicable.

Once the decision has been made to care for a patient in a Special Support Bed, the Clinical Nurse or Senior Nurse is responsible for:

• Allocation of staff to care for the patient in the Special Support Bed. This will be commensurate with the identified Nursing Observation Category.
• Ensuring staff are aware of their role in caring for a patient in a Special Support Bed and familiar with the patients planned care and expected outcome.
• Initiating management of the patient in the area.
• Physical sighting of staff and patients in the area at commensurate with the Nursing Observation Category.

The following guidelines have been formulated to promote a comfortable, safe and secure environment, all staff are required to familiarise themselves with the guidelines.

1. The Clinical Nurse/Senior Nurse is responsible for the management/supervision of the area.
2. All staff must wear a duress alarm at all times.
3. When operating as a closed area, at least one nurse must be present in the area at all times.
4. Nurses will rotate through the area.
5. When operating as a closed area, student nurses may not be alone in the observation area.
6. Patients are to be observed at least half-hourly (or more often), depending on individual patients’ risk factor assessment.
7. Extra nurses will be allocated at all times when a patient is required to leave the area, eg. showering, meals, ward activities etc.
8. Patients may not be taken out of the area without prior discussion with the Clinical Nurse.
9. Whenever the Special Support Beds are in use the Clinical Nurse or Senior Nurse will plan staffing in conjunction with the Clinical Nurse Manager for both the current shift and the next shift.
10. All patients in a Special Support Bed are to be reviewed by the Clinical Nurse and medical officer daily (Monday to Friday). On weekends the review is to occur between the Clinical Nurse or Senior Nurse and patient’s allocated nurse.
11. Unless deemed absolutely essential, patients in a Special Support Bed will not be taken on escorts for tests etc.
12. Patients may have unlimited access to their bedrooms.
13. Meals will be provided to the area when deemed necessary in lieu of patients attending the dining room. Provision will also be made for a patient to receive their meal at other than set times if it is appropriate for their management.
14. Cleaning of the area will be negotiated with the Clinical Nurse/Senior Nurse and will occur on a needs basis, rather than as a routine, in line with infection control and OHS&W Standards.