National Preventive Mechanism
frequent rounds are not an equivalent replacement. More human attention
and presence is required. The decisive question of why conditions in which
the personal integrity of human beings is intruded upon despite possible
milder alternatives continue to be tolerated must not only be posed to those
acting directly in stationary psychiatric care but also to the operators of such
facilities and to those who have the political responsibility.
Based on the observations made by the commissions, it can be assumed that
the staff situation – especially with regard to adequate night shift personnel –
must be evaluated on an ongoing basis. It is necessary to take the individual
requirements in the respective wards into consideration and to react flexibly
to the requirements that have to some extent become greater.
PRN medication
insufficiently
determined
In the course of examining care records, the commissions have dealt
intensively with questions regarding medication. Administering medicines/
drugs is fundamentally the job of doctors that can be delegated to qualified
nursing staff within the scope of a field of activity for which they are jointly
responsible. For this to occur, however, it is necessary that amount, dose and
type and time of administration be noted in written form in the patients’
charts by the doctors authorised to issue prescriptions.
PRN (“pro re nata”) medication is permitted in exceptional, individual cases
if the criteria for the assessment of timing and dose of the medication to be
administered is unambiguous, beyond any doubt and verifiable according
to the doctor’s instructions without the nursing staff making inadmissible
diagnostic or therapeutic decisions that exceed their competence at their
own discretion.
However, in the course of reviewing care records in the psychiatric ward of the
Wels-Grieskirchen Clinic, Commission 2 found that these requirements are
not fulfilled seamlessly. In the case of one patient, the additional prescription
said only “as needed”. After the commission’s visit, the hospital’s doctors were
strongly advised as to proper procedure to ensure that nursing staff can act
with confidence. Additionally, it was ordered that regular reviews of the PRN
medication prescribed by a doctor be undertaken by the competent senior
physicians in the wards during rounds. Specifically a regular evaluation
of this kind is absolutely necessary in order to be able to quickly modify
medication that is no longer therapeutically indicated.
Prevention of falls
90
If one reviews the mere number of measures that restrict freedom using bed
rails, it becomes apparent that they are used particularly for the following
patients: persons who are very aged or have been diagnosed with dementia
and persons who are being treated in geriatric psychiatric wards. Falls
represent significant hazard potential, including in hospitals. Neurological
ailments have a particularly high risk of falls, as frequently there are several
age- or illness-related physiological risk factors. Using measures that restrict
freedom instead of providing proper care and implementing evidence-based
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