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Safer wards

Reducing violence on older people's mental health wards

Published quality improvement report by BMJ

Staff members involved in the project were empowered to make meaningful changes and to recognise the impact they have made.

The aim of the quality improvement project was to address the problem of physical violence on the wards.

Risk factors for violence in adults with mental illness include active psychotic symptoms, use of substances, a history of violence, and comorbid personality disorders. In addition to these, there is also a group of older people with organic mental illness at high risk of violence.

The National Audit of Violence 2006–2007 found a greater likelihood of assault on staff working on wards for older people with organic mental illness than in any other psychiatric in-patient site.

Existing processes for reporting data on incidents of violences, namely the Datix system, were used to establish a baseline of measures. The core project team analysed the baseline data to consider where best to focus the work.

On the wards with most violent incidents it was found that on average there was an incident of physical violence every three days and a staff injury due to violence every eight days. There were 177 days of staff absence across the three wards per month at the beginning of the process.

Following a series of interventions aimed at addressing unmet needs, making more sensitive risk assessments, providing a more therapeutic environment, and creating a suite of meaningful structured activities for our patients that were all adjusted according to PDSA testing, there was a reduction in physical violence on the wards of 50%. Days between staff injury due to physical violence rose from an average of an injury every 11 days to an injury on average every 30 days.

The project not only resulted in a reduction in harm caused by violence, but changes in the physical environment on the ward improved staff morale. Staff members involved in the project were empowered to make meaningful changes and to recognise the impact they have made.

quoteBMJ Quality Improvement Reports publishes quality improvement work, original research and reviews. The online-only, open access journal covers all aspects of quality and patient safety in healthcare.