Patient was restrained for an hour at mental health unit, inspectors find

A patient in a mental health unit was placed under restraint for an hour by staff, an inspection has found.

The incident at University Hospital Wishaw was one of five cases noted by Healthcare Improvement Scotland where prone restraint - when someone is held face down - was used on patients.

Guidance by health bodies suggests that restraint should not be used for longer than 10 minutes, while it has been described as "inhuman and degrading".

The report also found that mixed-sex wards at the facility were challenging for staff and patients with regards to privacy and dignity.

The Scottish government said the issue should be addressed as a priority, following recent guidance published by the Equalities and Human Rights Commission about single-sex spaces.

HIS chief inspector Donna Maclean said concerns had been raised about both the use of prone restraint and the lack of physical health monitoring during and after the restraint taking place.

The National Institute for Healthcare and Clinical Excellence (NICE) states manual restraint should not routinely be used for longer than 10 minutes, and prone restraint should be for as short a time as possible.

However the report noted: "We observed five incident reports submitted as evidence detailing the use of prone restraint.

"The majority of these were to enable the administration of intramuscular medication due to stress and distress including violence and aggression.

"This included one incident where, although no patient harm was noted, it is documented that the restraint lasted for approximately one hour.

"However, it is not clear if the patient was restrained in the prone position for all of the duration."

Some of the cases did not have documentation detailing how long the patients were restrained for.

The full inspection resulted in four areas of good practice being highlighted, three recommendations and 12 requirements.

It covered three mental health wards and an intensive psychiatric care unit.

Maclean noted there were inconsistencies with how the use of seclusion - where a patient is isolated and stopped from leaving a room - was documented by staff.

This meant that on some occasions patients were restricted to just their side rooms but this was not marked down as being seclusion.

Another issue raised was that the three wards at the North Lanarkshire hospital are for mixed-sex accommodation, something the inspection said "can impact patient dignity and personal choice", although the hospital's multibed bays are single sex.

It noted: "Curtains provide limited privacy, and the bays have windows to the outside corridor."

The report praised staff for treating patients with care and compassion, with "leadership visible on the wards" and younger staff feeling well supported.

It added: "The hospital environment, including communal areas, were clean and inspectors found that the majority of areas were well maintained."

The Scottish government's mental wellbeing minister Maree Todd said NHS Lanarkshire would be expected to "urgently progress" the recommendations.

She said: "While the report identifies good practice, we take very seriously the concerns around the issue of mixed-sex and mixed-function wards, the use of prone restraint, and the lack of physical health monitoring during and post restraint.

"The government is clear that the NHS must uphold the Supreme Court's judgment and adhere to the EHRC's new guidance on single-sex spaces. I expect (NHS) Lanarkshire to address this as a priority.

"Restraint must always be properly recorded, monitored and audited – used safely and only as a last resort."

Claire Rae, the chief officer at University Health and Social Care North Lanarkshire, said: "We're pleased to see the good work of staff recognised in the report.

"Our staff work hard to provide safe, compassionate and person-centred care, and it's encouraging that their commitment and professionalism is acknowledged."