NURSING

transfer paperwork.
This led to his transfer to the
Patient F, with the intention of
Patient N is very happy with this,
Patient X is understandably
IPCU.
relieving any agitation that the
and does not wish to appeal. I
anxious about the upcoming
I complete a general risk
objective symptoms may be
complete all transfer paperwork.
day’s events and I provide verbal
assessment for this transfer
causing him. He refuses this.
At 1pm the late shift staff arrive
reassurance and reconfirm the
(which is based on the Health
At 11.30am there is a 15
and I take care of the handover.
process ahead.
and Safety Executive’s five steps
minute allocated patient cigarette
This includes a report of all
At 8am it is time for the
to risk assessment). Due to the
break in the IPCU garden,
inpatients’ presentations and
medication round. All other
risks present, i.e. Patient N’s
which I facilitate. In order to
recent activities, a safety briefing
patients are administered their
mental state; the potential for
adhere to IPCU policies and risk
of current IPCU risks (two patients
prescriptions. No issues arise.
unpredictability and aggression,
assessments, no inpatients have
on observations, potential for
Fifteen minutes later the IPCU
and the immediate increase in
access to this area unattended
unpredictability and the pending
consultant psychiatrist arrives at
stimulation, three members of
and do not have access to fire
transfer) and a review of the
the ward and verifies that all of
nursing staff will escort Patient
starting equipment.
staffing levels for the upcoming
the transfer paperwork is correct.
N during this transfer. This is
I ‘check’ all inpatients in and
three shifts (to ensure these are
I sit with Patient X as the
scheduled for 2.30pm. The senior
out of the garden on the relevant
adequate for the current level of
consultant finalises the discharge
charge nurse will organise escort
checklist and wear a garden
clinical activity).
process with him. No issues
staff.
personal attack alarm, should any
A third student nurse has just
arise. Patient X then leaves with
At 11am the second patient on
issues arise.
started duty and I invite them
his escort nurses.
constant observations, Patient F,
At 12pm I liaise with all
to assist me with preparing the
At 8.30am I complete all
is highlighting concerns regarding
other staff on the ward before
medication for Patient F’s planned
discharge paperwork for
his mental state by repeatedly
documenting all of the morning’s
intervention. Both oral and
Patient X. I discharge him from
responding to unseen stimuli.
activities via the computerised
intramuscular medications are
computerised systems, complete
Patient F has a diagnosis of
system used by the trust.
prepared.
various recording sheets and
schizophrenia, which has been
This ensures a thorough and
At 1.30pm we have the
inform the local Mental Health
ongoing for much of his life.
comprehensive reflection of all
scheduled intervention for
Act office and Patient X’s named
He has not been taking his
inpatient’s recovery.
Patient F. He initially refuses
person that he has left the
regular prescribed medications
I discuss Patient F with the
oral medication, despite a lot
hospital.
while in the community. Patient F
senior charge nurse and a fellow
of persuasion and reassurance
At 9am I provide a handover
recently had a hospital admission
staff nurse on duty. Patient F
about the justification for
of the night report (of the
at his local English NHS trust,
continues to exhibit overt signs of
treatment.
remaining patients) to the IPCU
but two weeks after discharge he
psychosis but continues to deny
Patient F is made aware that
senior charge nurse and IPCU
travelled to Scotland aware that
them.
intramuscular medications have
consultant psychiatrist. There are
his Community Treatment Order,
We have a duty of care to
been prepared as an alternative.
no changes, at this time, to any
under the English Mental Health
relieve mental distress, as far
Because of this he accepts the
care or management plans. Then I
Act, would not apply.
as possible, and it is decided
oral preparations instead.
grab a 15 minute breakfast break.
I approach Patient F, and
that Patient F should receive
At 2pm a ‘psychotropic PRN
At 10am the senior charge
attempt to generate a discussion
‘as required’ pharmacological
audit’ is under way, which I am
nurse informs me that another of
about his current experiences. He
prescribed treatment.
actively involved in.
the out of sector males, Patient
is very guarded, and denies any
This will be administered
I complete the required audit
N, will be transferred today.
psychotic phenomena or mental
intramuscularly should the patient
tool for patient F’s administration
They have just received
distress; consequently it is very
refuse oral treatment.
of the required medication;
confirmation from Patient N’s
difficult to engage him in any
An intervention is scheduled
which identifies the medications
local NHS trust (within Scotland)
meaningful conversation.
for 1.30pm, when there will be
given, time and route, who
that a bed is available today.
I offer ‘as required’
additional staff on duty to assist
initiated the administration, and
Patient N is presenting as
psychotropic medication to
with this administration.
a reassessment of the patient’s
hypomanic and is prescribed
Approved prevention and
mental state 30 minutes after
constant observations to manage
management of violence
medication is given.
this. He is currently being nursed
and aggression techniques
This is filed in Patient F’s notes,
in his room within the IPCU, in
may be adopted as a last
the data from which is collected
order to minimise stimulation.
resort, to facilitate medication
weekly and compiled by the IPCU
Patient N physically attacked
administration.
lead pharmacist.
a member of nursing staff while
At 12.30pm Patient N is
I document the above
he was an inpatient in the local
informed of their transfer by the
intervention in Patient F’s
general adult psychiatry ward.
IPCU consultant psychiatrist.
computerised notes. At this time,
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