Lois Bridges, an independent eating disorder treatment centre, is located at 3 Greenfield Road, Sutton, Dublin 13. 01 839 6147 or 086 60682403 and info@loisbridges.ie. Claiming to be Lois Bridges – Eating Disorders Clinic | Anorexia Bulimia Binge Eating Disorders had conditions attached to it registration due to failiure to comply with the Mental Health Commission inspections and regulations. Below you will find the Lois bridges conditions to registration
Lois Bridges Conditions to Registration
Condition 1:
Pursuant to Section 64(6)(b)(v) of the Mental Health Act 2001, the approved centre must continue to implement and review its protocols and procedures for the admission of residents, including detailed exclusion criteria reflective of the service provided.
Condition 2:
Pursuant to Section 64(6)(b)(v) of the Mental Health Act 2001, the approved centre must continue to implement and review its protocols and procedures to ensure access to necessary services and specialists, including but not limited to a gastroenterologist.
Condition 3:
Pursuant to Section 64(6)(a)(i) of the Mental Health Act 2001, the approved centre is not permitted to admit a high-risk resident with a Body Mass Index (BMI) of less than 13.
Safety in the Lois Bridges
The Mental Health Commission found that Lois Bridges was a safe facility but that there were some unsafe practices that occurred in contravention of Lois Bridges’s own admission policy.
However:
One resident had been admitted with a blood pressure lower than that permitted by Lois Bridges’s admission policy.
In three instances where a resident had a diagnosis of bulimia nervosa, there was no indication in the clinical file that the resident was seen by a gastroenterologist prior to admission, as required by Lois Bridges’s admission policy.
Governance of Lois Bridges
While there was a governance structure in place, we found that some areas of governance were unsatisfactory.
However:
Two incidents were not recorded on incident report forms.
The risk management policy did not specifically outline the process for risk rating incidents, and there was no incident risk rating assigned to any of the recorded incidents in Lois Bridges. The registered proprietor reported that, in practice, incidents arising were reviewed by management, and if deemed necessary, were upgraded to a risk by the senior management team and scored.
Daytime and nighttime staffing in Lois Bridges consisted of one staff nurse and one healthcare assistant (HCA). The Director of Service had clinical management of nursing staff. Staffing rotas indicated that there was not always a registered psychiatric nurse on duty and in charge at night. Instead, a registered general nurse (RGN) was frequently on duty at night.
The service had recently completed an audit examining the implementation of and adherence to their admission policy. Inspection of recent admission processes indicated that the service had not adhered to its own admission policy criteria.
Lois Bridges unrecorded incidents
Two incidents were not recorded on incident report forms. Since the previous inspection, the log of incident reports indicated that only three incidents occurred since the previous inspection. Upon review of one clinical file, it was found that a significant event involving a resident was not formally reported as an incident in the incident log. Despite a lack of formal reporting, the management team stated this incident was reviewed by them; however, no contemporaneous documentary evidence of this review was provided to the inspection team. There was documentary evidence of clinical management of the resident following the incident. Another incident arising in January, relating to a lack of nursing resources, was also not reported as a formal incident. The service maintained a risk register, and this was normally reviewed at the management team meetings.
Lois Bridges employed two full-time and two part-time registered psychiatric nurses and one registered general nurse. Agency nursing staff were occasionally utilised; however, the DOS reported that the service was continuing its recruitment drive for staff nurses to further build the staff bank, with a view to avoiding the use of agency staff going forward. Daytime and nighttime staffing in Lois Bridges consisted of one staff nurse and one healthcare assistant (HCA). Staffing rotas indicated that there was not always an appropriately qualified nursing staff member on duty and in charge at night. With the exception of one day shift, a registered psychiatric nurse was scheduled during the daytime. A registered general nurse (RGN), instead of a registered psychiatric nurse, was frequently on duty at night. There was no other nursing staff member with a psychiatric qualification on site during night duty to provide supervision. Nursing rotas from 01 December 2020 to 14 February 2021 indicated that there were 44 night shifts where only an RGN was on duty with the HCA.
The majority of therapeutic services were provided via contracted health professionals, and the therapeutic program was coordinated by the clinical psychologist. At the time of inspection, an assistant psychologist had recently been appointed on a full-time basis to Lois Bridges. The clinical psychologist agreed to undertake the supervisory role for this staff member.
Regulation 23: Ordering, Prescribing, Storing, and Administration of Medicines NON-COMPLIANT
Lois Bridges was noncompliant with this regulation for the following reasons:
a) A record of any known allergies or sensitivities to any medications, including if the resident had no allergies, was not documented on one Medication Prescription and Administration Record, 23(1).
b) A record of all medications administered to one resident had not been maintained, 23(1).
Regulation 26: Staffing NON-COMPLIANT
The skill mix of nursing staff was insufficient to meet resident needs in Lois Bridges. An appropriately qualified staff member was not on duty and in charge at all times. Staff rotas indicated that the nursing staff scheduled for duty in Losi Bridges consisted of one staff nurse and one health care assistant (HCA) per day shift and the same for each night shift. The nursing staff rota indicated that registered general nurses were undertaking night shifts regularly without the on-site supervision of a psychiatric qualified nurse. Nursing rotas from 01 December 2020 to 14 February 2021 indicated that there were 44 night shifts where only a registered general nurse was on duty with the HCA. Over the same time period, with the exception of one day shift, a registered psychiatric nurse was on duty and in charge for all daytime shifts. The Mental Health Act 2001, the associated regulations (S.I. No. 551 of 2006) and Mental Health Commission Rules and Codes, and all other relevant Mental Health Commission documentation and guidance were available to staff throughout Lois Bridges.
Lois Briges Conditions was noncompliant with this regulation for the following reasons:
a) The registered proprietor did not ensure that the skill mix of nursing staff was appropriate, 26(2).
b) The registered proprietor did not ensure that there was an appropriately qualified staff member on duty and in charge of Lois Bridges at all times, 26(3).
Regulation 32: Risk Management Procedures NON-COMPLIANT
Since the previous inspection, the log of incident reports indicated that only three incidents occurred since the previous inspection. These incidents were not individually risk rated by the service. Two incidents were not recorded on incident report forms. Upon review of one clinical file, it was found that a significant event involving attempted self-harm of a resident was not formally reported as an incident. Despite lack
of formal reporting, the management team stated this incident was reviewed by them; however, no contemporaneous documentary evidence of this review was provided to the inspection team. There was documentary evidence of clinical management of the resident following the incident. Another incident, arising in January, relating to staffing resources, was also not reported as a formal incident.
The service maintained a risk register, and this was normally reviewed at the management team meetings. The risk register documented clinical risks, including the risk of incidents of deliberate self-harm and the risk of harm in relation to the staffing complement at Lois Bridges.
The risk register also included the risk of breaching Lois Bridges’s conditions of registration as applied by the Mental Health Commission. This risk was not adequately treated and monitored by the service. The inspection team found that, in breach of Condition 1, the service did not follow its own policy with regard to admission exclusion criteria; on four separate occasions, residents were admitted in breach of the exclusion criteria outlined. In addition, the associated clinical risk of admitting residents that did not meet the specific admission criteria was not identified by the service.
Lois Bridges adequately identified, assessed, treated, reported, and monitored non-clinical risks, including health and safety and corporate risks. Structural risks, including ligature points, were removed or effectively mitigated. The Director of Services was responsible for reviewing incidents for any trends or patterns occurring in the service. Lois Bridges provided a six-monthly summary report of all incidents to the Mental Health Commission in line with the Code of Practice for Mental Health Services on Notification of Deaths and Incident Reporting. Information provided was anonymous at the resident level. There was an emergency plan that specified responses by Lois Bridges staff to possible emergencies. In this respect, the emergency plan incorporated evacuation procedures.
Lois Bridges conditions are inspected by the mental Health Commission of Ireland to ensure a compliance and patient safety. If Lois Bridges conditions are not followed the Mental Health Commission can request action to be take to address these.
Lois Bridges was noncompliant with this regulation for the following reasons:
a) The registered proprietor did not ensure that Lois Bridges had a comprehensive written risk management policy in place as the process for risk rating incidents was not included. 32(1).
b) The registered proprietor did not ensure that the risk management policy was implemented throughout Lois Bridges, as not all incidents were recorded, 32(1).
c) The registered proprietor did not ensure that the risk management policy was implemented throughout Lois Bridges. Not all identified risks were adequately treated and monitored, and associated clinical risks were not all identified by the service, 32(1).
Further reading on Lois Bridges conditions
Link to Mental Health Commission report Click Here
