Department of Health

Assessment of inpatient services

Key messages

  • There are 15 key recommendations to improve the standard of care provided by inpatient units in Victoria.
  • These recommendations are based on a self-assessment tool developed by the Office of the Chief Psychiatrist.

There are 15 key recommendations to improve the standard of care provided by inpatient units in Victoria. These recommendations are based on a self-assessment tool developed by the Office of the Chief Psychiatrist to assist mental health staff to safeguard and monitor the quality of care in inpatient units where people face acute and wide-ranging needs.

Recommendations to improve the standard of care provided by inpatient units

  1. Health services should develop clear policies, procedures and training to guide staff after the death of a patient, including support for families, other patients and staff.
  2. Senior clinicians and external quality and safety managers should be involved in incident reviews to improve root-cause analyses and risk reduction plans.
  3. Clear guidelines should be developed for clinicians and staff on searches of patients or inpatient units (for example, for illicit substances) and what visitors may bring into these units.
  4. New inpatient units should be carefully designed to balance patients’ safety and security with their individual rights to privacy, accessibility, gender segregation and amenity.
  5. Acute inpatient units should have 24/7 access to multidisciplinary staff, including consultant psychiatrists and allied health clinicians, and additional staff in times of need.
  6. Health services should ensure all high dependency areas (HDAs) have appropriate staffing levels and skill mixes to safely manage patients’ vulnerabilities and behaviours.
  7. Nursing observations of patients should be governed by clear policies and procedures, including their frequency, documentation and processes for clinical handovers.
  8. Clinicians and relevant staff should receive ‘dual diagnosis’ training to recognise and manage alcohol or drug withdrawals and refer patients to addiction medicine specialists.
  9. Policies and training should be provided to assist staff to recognise and respond to acute physical health deterioration, including access to specialist medical services.
  10. All inpatient staff should be provided with training on clinical risk assessments, and the recognition, treatment and management of acute arousal within patients.
  11. Health services should develop clear policies with emergency departments, delineating responsibilities for providing care to mental health patients and notifying and supporting families in case of an adverse event.
  12. A process should be developed to review the circumstances in which an inpatient unit may have to be locked, including communication of any changes to staff, other patients and visitors.
  13. Health services should fully engage with carers and family members from the time of a patient’s admission, including discussions regarding leave, carers’ supervision, etc.
  14. Health services should ensure that generic policies and procedures are adapted to the mental health context wherever appropriate, including in relation to the death of a patient.
  15. The Chief Psychiatrist should convene a panel every three years to enquire into inpatient deaths and consider potential practice improvements and other issues relevant to the mental health system.

Reviewed 29 May 2015

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