1.3 Obiski psihiatričnih bolnišnic 92 1.3 Visits to psychiatric hospitals Predlagamo, da bolnišnice zdravstveno osebje na oddelkih pod posebnim nadzorom opozorijo na skrbnost pri presoji, ali je pacient sposoben izraziti svojo pravo voljo, in na nedopustnost aktivnega nagovarjanja pacienta ali celo siljenja k podpisu soglasja z raznimi oblikami groženj. Ob tem naj bolnišnice (kolikor tega še nimajo), poskrbijo, da se primerno dopolnijo obrazci o podaji soglasja za zdravljenje na oddelku pod posebnim nadzorom z rubriko o možnosti preklica soglasja (vključno s pojasnilom o pomenu preklica). We propose that hospitals inform their staff on secure wards about diligence when assessing whether patients are able to express their true wishes and the inadmissibility of actively exhorting patients or even forcing them to sign a consent with different forms of threat. Hospitals should further suitably amend their forms on the provision of consent for treatment on secure wards (if they have not amended this already) with a section on the possibility of revoking the consent (including a clarification of the meaning of revocation). PB Begunje je v odzivu na predhodno poročilo pojasnila, da pacientu zdravnik pojasni, za kakšen čas velja podano soglasje in da ga lahko kadar koli prekliče, možnost preklica pa bodo izrecno zavedli na obrazec, kar vsekakor pozdravljamo. In its response to the preliminary report, Begunje Psychiatric Hospital specified that a physician explains to patients for what period of time the consent is given and that it may be revoked at any time. However, they will explicitly equip the form with a section for revocation, which we commend. Predlagamo, da bolnišnice, kjer (še) ni vzpostavljen sistem klicnih zvoncev, proučijo možnost, da se namesti oziroma obnovi sistem klicnih zvoncev, s katerimi bodo pacienti lahko v stiski na varen način poklicali osebje, in da bolnišnica posveča posebno pozornost nadziranju, da klicni zvonci ne bi bili odstranjeni pacientom, ki jih pogosto (po oceni osebja morebiti celo neupravičeno) uporabljajo. We propose that hospitals where a system of call bells has not been installed study the possibility of installing or renovating a call bell system to enable patients in distress to safely call staff, and that the hospitals ensure that call bells are not removed from patients who use them frequently (perhaps even without good reason, according to the staff). PB Begunje je v odgovoru pojasnila, da bi bili klicni zvonci potrebni predvsem v primeru, ko bi šlo za nepokretne paciente in za velike interne oddelke z več kot 30 posteljami, kar pa niso oddelki pod posebnim nadzorom te bolnišnice. Osebje je na oddelku stalno prisotno in tako na voljo pacientom, ki bi potrebovali pomoč. Zato sicer ne vidijo potrebe po namestitvi klicnih zvoncev, bodo pa predlog DPM proučili, kar vsekakor pozdravljamo. Begunje Psychiatric Hospital explained in its reply that call bells are particularly necessary in the case of bedridden patients and for large internal medicine units with more than 30 beds, which do not include the secure wards of this hospital. Staff are continuously present on the ward and thus available to patients who need help. They do not recognise a need for installing call bells, but they will nevertheless consider the NPM proposal, which we commend. Predlagamo, da bolnišnice pacientu ob telefonskem klicu zagotovijo zasebnost. We propose that hospitals ensure patients’ privacy when they are making calls. Zavedamo se, da je tudi v primeru telefonskih klicev treba upoštevati vidik varnosti, a bi se ta tudi pri pacientih, kjer bi res obstajal varnostni zadržek, lahko opravljala tako, da bi osebje pacienta sicer videlo, ne pa tudi slišalo (npr. na način, da se pacient nahaja v sobi za izvedbo PVU, osebje pa v sestrski sobi). Tudi potrebo po tovrstnem nadzoru pa je treba jemati restriktivno, torej zgolj v primeru, ko je to res nujno zaradi pacientove varnosti in ko varnosti tudi sicer ni možno zagotoviti na drug način. We are aware that, also in the case of phone calls, the safety aspect must be observed; however, this could be provided also for patients with safety concerns in a way that the staff could see the patient but not hear them (e.g. the patient is in room where special protection measures are implemented and the staff are in an adjoining room). The need for such supervision must also be understood as restrictive, i.e. only when this is necessary for patient safety and when safety cannot be provided in any other way. PB Begunje je pojasnila, da je težava lahko v primeru, ko bi pacient (med telefonskim klicem) lahko ogrožal sebe ali drugega. Razgovor v ambulanti torej ne poteka zaradi nadzora nad vsebino pogovora, temveč zato, da se zagotovi oziroma ve, kdo je klic opravil – torej pacient, ki je zaprosil za klic. Begunje Psychiatric Hospital clarified that the problem arises only when patients (during the phone call) could pose a threat to themselves or others. The call does not take place in the consulting room in order to supervise the content of the conversation, but to establish who made the call, i.e. the patient who asked to make a call. Predlagamo, da bolnišnice posebno skrb zagotovijo stalnemu nadzoru nad korektnim odnosom osebja in skrbjo za pacientovo dostojanstvo in da preprečijo zlasti kakršno koli maščevalno ravnanje osebja proti posameznemu pacientu in poskrbijo za ustrezno prejemanje terapije, ki jo pacient sicer odklanja. Predvsem pa predlagamo, da bolnišnice pritožbe pacientov glede fizičnega nasilja s strani osebja obravnavajo resno, dokaze, da je do njih prišlo, pa s pomočjo ustreznega zdravnika specialista zabeležijo in v primeru dokazanega nestrokovnega ravnanja ustrezno ukrepajo. We suggest that hospitals provide permanent supervision of the correct attitude of the staff; care for patients’ dignity; prevent any vengeful behaviour against individual patients, and ensure suitable taking of medication which patients decline. We particularly propose that hospitals discuss patients’ complaints about physical abuse from staff seriously and record evidence that such events actually happen with the help of a suitable physician, and take suitable action in the case of proven unprofessional conduct. Predlagamo, da v primeru predpisovanja odmerkov zdravil, ki so višji od maksimalnih dovoljenih odmerkov, bolnišnice ravnajo skladno z določili ZDZdr. We propose that hospitals comply with the provisions of the ZDZdr in the case of prescribing dosages higher than the maximum permitted. PB Begunje je pojasnila, da je v Pravilniku o upravljanju z zdravili določeno, kako se predpisujejo zdravila na terapevtski listi, vključno z zdravili po potrebi. Upoštevali bodo tudi predlog DPM. Begunje Psychiatric Hospital explained that the Rules on the management of medicinal products determine the prescription of medications on the therapeutic list, including other necessary medicinal products. They will also observe the NPM proposal. poročilo o izvajanju nalog DPM v letu 2014 DržavnI preventivnI mehanizEm po Opcijskem protokolu h Konvenciji OZN proti mučenju in drugim krutim, nečloveškim ali poniževalnim kaznim ali ravnanju IMPLEMENTATION OF THE DUTIES AND POWERS OF THE NPM IN 2014 National Preventive Mechanism under the Optional Protocol to the UN Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment 93