Staffing woes after a controversial merging of surgical wards at Dunedin Hospital resulted in healthcare assistants (HCAs) being asked to watch up to four patients at risk of self-harm at a time, a newly released report says.
Such patients are meant to be watched on a one-to-one basis, but staff shortages meant assistants were often asked to watch more than one patient at a time - and also resulted in more people being restrained for their own safety.
Details of the problems which befell Dunedin Hospital's ward 3 surgical after its 2017 opening are contained in two reviews now released to the Otago Daily Times under the Official Information Act.
The SDHB said proper resourcing, staffing and support were not in place before the ward opened, but that the reviews had led to steady improvements.
A 54-bed ward, ward 3 surgical was created to solve the problem of how to allow Dunedin Hospital's intensive care unit and high dependency units to be rebuilt.
Ward space on the hospital's fifth floor was allocated to the rebuild, and those beds were merged into existing rooms on the third floor to create ward 3 surgical.
The ward opened in January last year, but things did not go smoothly.
Hospital staff, who wished to remain anonymous, have told the Otago Daily Times of regular problems with getting enough staff to work on the ward, especially nurses.
Concerns have also been raised about inexperienced staff being asked to tackle tasks more senior staff would normally handle, and that nurses were not able to devote adequate time to care for patients.
The first review backed up many of the staff concerns, and noted one area of particular concern was patient watches, where people at risk of self-harm were given one-to-one supervision.
HCAs, who were meant to be working with clinical teams and providing housekeeping duties, were frequently asked to provide cover for patient watches.
''HCAs who are providing the cohorted watches report concerns for patients when trying to supervise four patients at once, and were unable to feel confident that they could prevent harm to all,'' the review said.
''In addition, restraint use has increased because of the inability to prevent harm in that situation.''
The first review highlighted eight areas for improvement, and the second assessed what progress had been made.
''The merging of wards to create ward 3 surgical involved introducing a new nursing model of care,'' chief nursing and midwifery officer Jane Wilson said.
''However, we underestimated the resourcing and support required for this approach to be successful and enable us to provide the level of care our patients should expect.''
The first review identified staffing and skill mix, team nursing, education, leadership, access to equipment and the ward environment as areas which all needed improvement.
The ward needed more nurses and HCAs, better education of staff and training of managers, better allocation of time for patient care, a full complement of support staff, and it needed to become part of a hospital-wide focus on bed and staffing management, it said.
The second review said all the required clinical staff had been recruited and hiring other staff was in progress.
Extra training had been done, new management systems put in place, and work was under way to ensure the clinical team worked better together.
Since the review, steady improvement had been seen, Ms Wilson said.
''We have increased our base nursing staff complement which now more closely matches the care needs of patients admitted to 3 surgical.
''Significant support and education has been provided and is ongoing, to enable staff to be more confident in caring for patients admitted with a broad range of conditions.
''Investment in equipment was also made as well as improvements in how the ward is organised as part of the 'releasing time to care' programme of work so that staff have more immediate access to the right equipment, in the right place when they need it.''
Auditing of the ward was ongoing, and feedback from staff, patients and families was still being sought, Ms Wilson said.
