Week 6 - Ethical practice - Systems (technology) put in place to capture at risk patients (SWAS)

 

Middle Hospital implemented the SWAS (social work alert system) response system is a way to adequately respond to at-risk patients with faster and more efficient quality care that contributes to a positive outcome for the whānau in need. (Todman & Mulitalo-Lauta, 2010). Despite these protocols being in place to protect and identify risks, errors can occur when staff are not adequately trained to recognize alerts on patient’s medical files, leading to potential safety risks. I observed a situation with a vulnerable child who was admitted to the hospital, and an alert on the file indicated a previous non-accidental injury. The social worker could pick up on the missed alert, inform staff and organize a watch (person) to be present with the child. At the same time, further investigation into the current circumstances was completed. It highlighted that further training was required for emergency department staff and rotating junior doctors to ensure that safety protocols were taken seriously to prevent future mistakes.

A scenario example where the SWAS was missed but the advanced social worker was able to pick up on the error that was involving a child patient who was admitted with what appeared to be a non-accidental injury (NAI) burn. The steps taken included conducting thorough research on historical medical events and checking for alerts on the child's file. Due to the concerns raised about how the incident occurred, a WATCH was implemented, referring to a person assigned to remain in the room with the child and family until a thorough investigation was completed. The social worker then contacted the police to inform them, and they would complete a home visit with the family to gather information about what happened. The social worker disclosed that she had previously worked with the family due to another child's NAI. Although ethically she could conduct the assessment, the decision was made to seek support from another social worker to prevent any information from being withheld by the family due to the relationship between the mother and the burns social worker.

All professionals were invited to a hui to discuss the matter at hand, including Oranga Tamariki consultants (surgeons), nurses, social workers, and police. The discussions included the extent of the burn and what the police had found at the property. Any child under the age of two years is required to have a skeletal scan to determine any past or present fractures.

All evidence discussed indicated risks to the safety of the children, which was acknowledged by the hospital staff and police. However, the social workers from Oranga Tamariki did not identify any harm, and the children were discharged from the hospital back into the care of their mother and father. The concerns of other professionals in this situation were not acknowledged, leading the burns social worker to escalate the matter to the Oranga Tamariki regional manager. A complaint was raised due to the ongoing investigation, which was dismissed by their staff. The issue was handled internally, and the young children were uplifted and placed into the care of their paternal grandmother.