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.
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 medication is
insufficiently
determined
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.
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
40
Prevention of falls
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