Reference no: EM133792027 , Length: word count:2000

Part - Audio Recorded Reflection (500 words equiv)

Deterioration in mental state that was possibly precipitated by a reported sexual encounter in the previous November. The patient was transferred to a Base Hospital Mental Health Inpatient Unit from the MH Hospital. This was due to proximity to his home and bed pressure at the MH Hospital. The psychiatrist's recommendation was for close observation Level 2, 15-minute observations due to the high level suicide risk.

The medical records indicate a consistent picture of the patient's mental state. The Clinical Handover document for 22-27 February repeatedly indicates that the patient was flat in affect, low in mood / depressed, fixated about belief that he had a sexually transmitted disease. On 28 February, 20XX, the day of his death, the notes of the morning shift indicated "low mood" and that he requested weekend leave. The patient was later moved to a sub-acute ward from the intensive care unit. As later discussed, the shift from intensive care to the lower security unit may have created in some staff (noted in evidence by RN Smithfield) the impression that suicidality was no longer a prime risk. However, the evidence bore out that a move to the lesser security ward did not necessarily signify the alleviation of suicide risk, and that historically there had been patients in the that ward who remained suicidal, despite their transfer from intensive care.

On 28 February, 20XX RN Smithfield was the nurse in charge of the day shift in the sub- acute ward. This meant that her shift officially ran from 7:00am to 7.30pm. On the day of his death, the patient was seen pacing the corridors in the ward for some time after lunch. The evidence obtained from the hospital closed circuit television ("CCTV") footage indicated that the patient was last seen entering his room at 14:41 hours, and that he did not leave his room again.

At around 17:19hrs RN Smithfield opened the door of the patient's room and noted that he was sitting on the floor in the dark with his back resting against the end of the bed. Initially, the RN presumed him to be meditating or sleeping. This was when the dreadful discovery was made that the patient had hanged himself using the bed sheet rigged to the end of the bed, which he electronically elevated to affect the process. Resuscitation was attempted without success, the process ensuing for some thirty-five minutes until 17:58 hours.

RN Smithfield (nurse-in-charge) had signed the observation chart that the patient was observed at 15:00 hours. Such observation is not evidenced by the CCTV footage. RN Smithfield acknowledges that this entry was an approximation of time, and that the patient was more likely observed around 14:40 hours. RN Smithfield' recorded observations for the shift indicate half-hourly observations, rather than fifteen-minute observations which were required under the level 2 treatment plan. RN Smithfield had signed in the observation

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