CHHS17/220 Canberra Hospital and Health Services Clinical Guideline Transfer of Clinical Care between Adult Mental Health Inpatient Units and the Alcohol and Drug Services Withdrawal Unit Contents Contents..................................................... 1 Guideline Statement..........................................2 Scope........................................................ 2 Section 1 – Overview of inpatient units......................2 Section 2 – Assessment for the Transfer of Care..............4 Section 3 – Transfer Processes...............................5 Related Policies, Procedures, Guidelines and Legislation.....6 Search Terms................................................. 7 Attachments.................................................. 7 Attachment 1 – Transfer from AHMU/MHSSU to WU Flowchart.....8 Attachment 2 – Transfer from WU to AMHU/MHSSU Flowchart.....9 Doc Number Version Issued Review Date Area Responsible Page CHHS17/220 1 11/09/2017 01/09/2020 MHJHADS 1 of 12 Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register
Transcript
CHHS17/220
Canberra Hospital and Health ServicesClinical GuidelineTransfer of Clinical Care between Adult Mental Health Inpatient Units and the Alcohol and Drug Services Withdrawal UnitContents
Attachment 1 – Transfer from AHMU/MHSSU to WU Flowchart..........................................8
Attachment 2 – Transfer from WU to AMHU/MHSSU Flowchart..........................................9
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CHHS17/220
Guideline Statement
To provide guidance and support staff with the safe transfer of clinical care for people between the Adult Mental Health Unit (AMHU), the Mental Health Short Stay (MHSSU) and the Alcohol and Drug Withdrawal Unit (WU).
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Scope
This procedure applies to all Canberra Hospital and Health Services (CHHS) staff who may be involved in the clinical care for people admitted to AMHU, MHSSU and the WU and the transfer of this clinical care between those units.
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Section 1 – Overview of inpatient units
1.1 AMHU Admission Criteria The Adult Mental Health Unit is a 37 bed acute mental health inpatient unit. This unit has a purpose built High Dependency (HDU) and Low Dependency Unit (LDU) in addition to a Vulnerable Person’s Suite.
Inclusion: Admission for optimal management of an existing mental health diagnosis or identified
clinical risk. Admission for the assessment and stabilization of an emerging mental health diagnosis. Has been assessed as requiring a AMHU admission following face to face assessment by
a Psychiatry Registrar.
Exclusion: Children under the age of 17 years (unless accepted by the Consultant Psychiatrist in
discussion with the Operational Director or Mental Health Director on Call). Patients assessed as medically unstable. Patients exhibiting signs of delirium or overt confusion, or decreased level of
consciousness. Patients with a primary diagnosis of dementia, developmental disability or traumatic
brain injury unless there is a significant coexisting psychiatric disorder. Physical frailty that endangers the patient’s management in a Mental Health inpatient
environment. Patients who are acutely intoxicated.
1.2 MHSSU Admission Criteria
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MHSSU is a 6 bed mental health inpatient unit adjacent to the Emergency Department (ED). The majority of admissions to this unit occur through the ED although transfers from other units can be facilitated in some circumstances.
If a person has been assessed and deemed to require hospitalisation in a mental health inpatient bed, and this hospitalisation is expected to last less than 48 hours, they can be admitted or transferred directly to the MHSSU for short term admission, extended assessment or as a last resort to support bed pressure in the AMHU.
Inclusion: Short term admission for optimal management or assessment of an existing mental
health problem. Short term admission for the assessment and stabilization of an emerging mental health
problem. Has been assessed as requiring a MHSSU admission following face to face assessment by
a Psychiatry Registrar. Patients requiring greater than 48 hours admission may be accepted to MHSSU
according to operational demand.
Exclusion: Children under the age of 17 years (unless accepted by the Consultant Psychiatrist in
discussion with the Operational Director or Mental Health Director on Call). Patients assessed as medically unstable. Patients assessed as acutely behaviourally
disturbed, including aggression and or requiring At Risk Category (ARC) 3 or higher care are to be admitted AMHU.
Patients exhibiting signs of delirium or overt confusion, or decreased level of consciousness.
Acutely intoxicated patients. Patients with a primary diagnosis of dementia, developmental disability or traumatic
brain injury unless there is a significant coexisting psychiatric disorder. Physical frailty that endangers the patient’s management in a Mental Health inpatient
environment.
1.3 Withdrawal Unit (WU) Admission CriteriaThe WU is a 10 bed Unit. People admitted to this unit are voluntary. They are admitted for supervised medicated withdrawal under the care of addiction specialists, nurses and allied health. The model of care is provided utilising harm minimisation principles.
Inclusion: Admission for withdrawal management from alcohol and/or drugs. Admission for the assessment and stabilization of opiate treatment. Has been assessed as requiring a WU admission following a review at the WU
Multidisciplinary team meeting.
Exclusion:
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Children under the age of 17 years (unless accepted by the Consultant Alcohol and Drug Service [ADS] Specialist).
Patients assessed as medically unstable. Exhibiting signs of delirium or overt confusion, or decreased level of consciousness. Physical frailty that endangers the patient’s management in a Withdrawal Unit inpatient
environment. Acutely intoxicated. Current risk issues for aggression and violence. Admissions before 9am and after 3pm (preferably Mon-Thurs). Actively Suicidal. Actively Psychotic. Clients not willing or able to engage in treatment. Not self caring or ambulatory. Withdrawing from opiates unless a safe discharge plan is in place i.e. rehabilitation bed.
Please note: Clients need to be given the WU Client Agreement to read and agree to the unit’s
conditions of admission. The exclusion criteria may apply for weekends and after hours, however, the ADS
Medical Consultant and Senior Nurse on shift need to agree to the transfer with a requirement by the ADS Consultant to admit the client onto the unit.
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Section 2 – Assessment for the Transfer of Care
2.1 Transfer from WU to AMHU / MHSSU A person requiring transfer to must be reviewed by the Mental Health Consultation
Liaison Team (Business Hours) or the on call Psychiatry Registrar (After Hours). The MH CL / on call Registrar or Consultant is to discuss admission to the AMHU / MHSSU with the AMHU / MHSSU Consultant Psychiatrist or on call Psychiatrist.
The person must meet at least one of the AMHU / MHSSU admission criteria and none of the exclusion criteria.
Legal documentation is to be completed in accordance with the requirements under the Mental Health Act 2015 and faxed to the Public Advocate and ACT Civil & Administrative Tribunal (ACAT).
A suicide vulnerability assessment tool (SVAT) and medication chart is to be completed prior to the person being transferred.
With the consent of the admitted person, the nominated family, friends and/or carer are notified of the plan for admission to the AMHU / MHSSU.
WU nursing staff to provide a clinical handover to the Mental Health nursing staff. ADS Medical staff to provide a clinical handover to the Psychiatry Registrar.
2.2 Transfer of a Person from AMHU/MHSSU to the WU
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A person requiring transfer to WU must be reviewed by the ADS Consultation Liaison (CL) Team. The ADS CL Consultant will discuss admission to the WU with the CNC of WU or RN in charge Afterhours if ADS CL is not rostered on duty.
ADS CL Service is available:o Sunday to Wednesday 0900 – 1700hrso Thursday to Saturday 0900 – 2100hrs
After Hours the afterhours Psychiatry Registrar to contact the on call ADS Consultant to discuss and coordinate.
The person must meet at least one of the ADS admission criteria and none of the exclusion criteria.
The clients’ next of kin (NOK) is to be notified of the plan for transfer to the WU.
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Section 3 – Transfer Processes
3.1 CommunicationAll staff must be familiar with the CHHS Clinical Handover Procedure. When transferring clinical care from one unit to another, ISBAR and ISOAP principles must be adopted by all staff, and as a minimum, the handing over clinician should provide the following: a summary of the presentation and other relevant issues (especially relating to risk of
harm to the patient or others) a contact number for the unit so that further information can be obtained if required updated electronic clinical record documentation, including information about this
presentation, medication regime and medications given prior to presentation issues of physical concern or related to withdrawal
3.2 Transfer of care3.2.1 Transfer from AMHU / MHSSU to WU Contact ADS CL team to assess the client – 0409 772 734 AMHU/MHSSU Consultant to contact WU Consultant (via switch as per roster) or
6244 2591 AMHU/MHSSU CNC to contact WU CNC – 6174 7047, if WU CNC is unavailable, contact
Manager of Clinical Services BH on 6174 7966 or AH Nurse in charge of shift – 6174 7047 If all parties agree, then the transfer of the person via the AMHU van should be
facilitated, accompanied by a Nurse and the client file. A Clinical Handover is to be given.
3.2.2 Transfer from WU to AMHU/MHSSU Contact MH Consultation Liaison team to assess the person – 6244 3204 (BH) or the on
call Psychiatry Registrar (AH) – via switch If deemed suitable for transfer, WU CNC to contact AMHU CNC ext 45444 or
0434601263 (BH) or Shift Team Leader on 45455 (AH), MHSSU CNC 48271 (CNC) or 0466481161 (BH) or ext 45679 (AH or unable to contact CNC)
The AMHU / MHSSU CNC will provide advice to the WU CNC with regards the correct admitting Psychiatrist (depending on demographics).
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The WU Consultant to Liaise with the AMHU/MHSSU Consultant and provide clinical handover.
If all parties agree, then the transfer of the person via the AMHU van should be facilitated, accompanied by a Nurse and the client file. A Clinical Handover to be given. If after hours, WU Nurses are unable to accompany client as only 2 staff are rostered on then the WU Nurse in charge is to liaise with AMHU/MHSSU CNC or Team Leader to determine whether MH can send a Nurse to assist in the patient transfer.
If there is no agreement to transfer the person then the person will remain in the WU and will be seen by MH CL team daily.
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Related Policies, Procedures, Guidelines and Legislation
Policies and Procedures CHHS Admission Discharge – Adults, Pregnant Women and Neonates CHHS Clinical Handover procedure CHHS Patient Identification: Correct Patient, Correct Site, Correct Procedure MHJHADS Transport of People Admitted to Mental Health, Justice Health and Drug and
Alcohol Services (MHJHADS) Bed Based Units across the Canberra Hospital Campus MHJHADS Assessment and Intervention for People Vulnerable to Suicide
Standards National Standards for Mental Health Services 2010 National Safety and Quality Healthcare Services Standards 2012 Mental Health Statement of Rights and Responsibilities 1991 Alcohol, Tobacco and Other Drug Strategy 2010-2014
Legislation Carers Recognition Act 2010 ACT Human Rights Act 2004 Guardianship and Management of Property Act 1991 Mental Health Act 2015 Children and Young People Act 2008 Public Advocate Act 2005 Work Health and Safety Act 2011 Human Rights Act 2004
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Search Terms
Alcohol and Drug, Withdrawal Unit, Adult Mental Health Unit (AMHU), Mental Health Short Stay unit (MHSSU), Consultation Liaison, Transfer of care, MHJHADS
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Attachments
Attachment 1 – Transfer from AHMU/MHSSU to WU FlowchartAttachment 2 – Transfer from WU to AMHU/MHSSU Flowchart
Disclaimer: This document has been developed by Health Directorate, Canberra Hospital and Health Services specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.
(to be completed by the HCID Policy Team)Date Amended Section Amended Approved ByEg: 17 August 2014 Section 1 ED/CHHSPC Chair
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Attachment 1 – Transfer from AHMU/MHSSU to WU Flowchart
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Attachment 2 – Transfer from WU to AMHU/MHSSU Flowchart
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