I

Best practice for patients with Borderline Personality Disorder is for a short stay admission of
up to 48hrs duration. A current inpatient was admitted to provide extra support while having
therapy from an outside source. This therapy only began over a week ago, despite the patient
being admitted on 25/11/2019 (54 days ago). Since admission, the patient has had a number
of significant non-suicidal self-injuries, requiring suturing and antibiotic cover. It is known that
evidence suggests self-harm behaviour increases in these individuals in an inpatient
environment. How is this admission beneficial? (This patient was discharged on 30/1 to
boarding house accommodation with significant supports and follow-up).
5. Loss of experienced staff

Issues involving discharge planning are profoundly exacerbated with the recent resignation
of [redacted]. Currently on ward there are a number of patients with no current address or
previous addresses which are no longer suitable once discharged. Three clients are awaiting
transfer to a rehab facility, one of these referrals is from mid-2019. A referral for an 18yo
male for rehab has been discussed but not yet completed, despite a protracted admission
since mid-2019. This latter patient is not acutely unwell and does not currently require an
inpatient bed and they have twice been cleared for respite by different consultants, but
remain on the ward as they have declined to go to respite. As a result, other more acute/
higher risk patients have been sent to respite when a bed is required. Could some more
thought be put into a better way to manage this patient other than in an acute inpatient
environment? (Update: this patient's care manager is currently on leave, and decisions
regarding referral etc are "on hold")
6. Overcrowding in de-esc and other areas

There have been up to five patients in de-escalation. On the 18 th January 2020, at the end of
the night shift, a Tauira patient was taken to de-esc approx. six am after becoming aggressive
and throwing chairs in the Tauira main area. The total of patients at that time in de-esc came
to six. This patient remained agitated and began to repeatedly hit the window to the de-esc
office. With no available room (seclusion or otherwise) to enable time out and a safer
environment, the patient was directed to the courtyard area. Five of the patients were male,
the other a first episode female with psychosis. Due to their current levels of risks and recent
behaviours, they are unable to be moved to Tauira. Five patients in this area means that the
interview room and TV room is being utilised as bedrooms with mattresses on the floors. This
results in increased frustration from the patients who are unable to leave the area or access
the television, or have private areas for review with their medical team. Currently a female
must be present in WW to support the female patient in the area. When female RN's are the
only RN available to work in WW, they must also work with the antisocial and sexually
inappropriate male patients also there. It makes it difficult to establish rapport and assess
mental state and risk on these occasions. How can management better support the ward to
manage this area more safely, and more closely in line with the DHB policies that relate to
Whakatau Wairua?