Since June 2018, the ANMF (SA Branch) has been consulting with the Northern Adelaide Local Health Network (NALHN) in a bid to overcome significant safety concerns about a new model of care planned for overnight implementation at the Aldgate Unit at James Nash House.
The Least Restrictive Practice (LRP) best practice model supports a person’s recovery and wellbeing by enhancing their autonomy and preserving their dignity, rights and individual worth as much as possible. In essence, it means providing James Nash House patients—a mix of prison and forensic patients—with the freedom to roam the hallways of the facility.
While the ANMF (SA Branch) supports LRP as a model of care, it opposed the plan to introduce it into a facility architecturally designed 30 years ago to treat prisoners on the basis it would be fundamentally unsafe and place staff and patients at significant risk of serious personal physical harm.
In July 2018, NALHN responded to the ANMF (SA Branch)’s safety concerns by initiating the establishment of an Expert Working Group to facilitate consultation among currently practicing clinicians to develop a revised model of care. A series of Open Nursing Staff Forums were also held at James Nash House around that time to foster further consultation around any updates to the service, innovations and general information sharing.
Since that time, numerous outcomes have been put in place to provide greater protection to staff and patients alike:
- CCTV cameras were installed in corridor adjacent to patient rooms.
- Overnight staffing levels increased from one to four nurses.
- A Registered Nurse Level 3 was rostered to night duty for four shifts to help staff with the transition to the new practice.
- Bolstered Management of Actual or Potential Aggression training
- Implementation of system to alert nurses’ station when a patient leaves their room.
- The requirement for patients only to be able to return to their rooms with staff intervention (as a safety measure for other patients).
Despite the above outcomes, the ANMF (SA Branch) has continued to voice its concerns around the absence of a dedicated seclusion suite to accommodate agitated or out of control patients who need to be contained in a safe and secure environment.
“Without a dedicated seclusion area, patients are having to be secluded in their room which is only accessible off the same corridor that is able to be freely accessed by numerous other patients in the facility,” says ANMF (SA Branch) CEO/Secretary Adj Associate Professor Elizabeth Dabars AM.
“Until NALHN completes the planned redevelopment of a separate seclusion suite, this poses a significant safety threat to staff and other patients,” Ms Dabars says.
Despite these concerns, NALHN introduced the new model to the night shift at the Aldgate Unit on 23 January and has since responded to member concerns about the framework on how staff will work under the new model. View NALHN’s response here.
The issue also attracted media attention recently, with Ms Dabars confirming the ANMF (SA Branch)’s position on ABC Radio: “We were opposed to the change, from both a staffing perspective and the physical restrictions of the facility.”
“We support Least Restrictive Practice, but we do not want to lose sight of the context. The individuals detained at James Nash House are in there for very serious issues.”
Listen to the ABC Radio interview below.
While NALHN has advised it will be undertaking a post-implementation review of the LRP project three months after implementation, if you have any issues or concerns on the meantime, please contact the ANMF (SA Branch) Duty Officer for immediate advice and support on 8334 1900.