Manager
Manager
The Manager domain tests safe stewardship: running a ward, allocating scarce beds, managing aggression and emergencies, keeping records, and improving quality.
Core rules
- Triage by risk and acuity, not by seniority or convenience; document the decision.
- Ward safety: ligature points, contraband search, observation levels, leave policy, seclusion and restraint only within legal and policy limits, with monitoring and documentation.
- ECT suite management: consent, anaesthesia review, monitoring, recovery, seizure duration, and adverse event reporting.
- Records: admission, consent, restraint, leave, discharge summaries, and medication charts must be contemporaneous and legible.
- Quality improvement: incident reporting, mortality review, audit cycles, PDSA, and learning from complaints.
- Personal management: prioritise emergencies, delegate appropriately, and escalate early; avoid carrying unsafe workload silently.
Worked example
At 2 a.m., a patient becomes agitated and a nurse asks for restraint. Reasoning: check for hypoxia, hypoglycaemia, intoxication, withdrawal, pain, and delirium. Attempt de-escalation and oral medication. If restraint is unavoidable, use the least restrictive option, monitor airway and vitals, document indication, duration, and review, and inform the consultant. Prescribe sedation only with a monitoring plan.
Traps
- Restraint or seclusion without a documented indication and review.
- Writing a discharge summary that omits risk and follow-up.
- Ignoring physical deterioration because the patient is on a psychiatric ward.
- Failing to escalate a bed crisis or staffing shortage.