Patient Safety In Inpatient Psychiatry: A Remaining Frontier For Health Policy

Shields, Morgan C.; Stewart, Maureen T.; Delaney, Kathleen R.

doi:10.1377/hlthaff.2018.0718

Cited by 36 publications

(37 citation statements)

References 31 publications

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“…A study in the VHA system found that over the course of two years, falls were the most common type of reported adverse events in safety reports in mental health units, followed by adverse medication events, verbal and physical assaults, un‐addressed medical problems, and the presence of inappropriate or dangerous items (Mills et al, ). Despite a growing body of evidence for strategies to reduce adverse events and increase patient safety, however, uptake has been slow in the psychiatric healthcare setting (Daumit & McGinty ; Shields et al ., ).…”

Section: Introductionmentioning

confidence: 97%

Speaking up about patient safety in psychiatric hospitals – a cross‐sectional survey study among healthcare staff

Schwappach

Niederhauser

2019

Int J Mental Health Nurs

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Speaking up is an important communication strategy to prevent patient harm. The aim of this study was to examine speak up‐related behaviour and climate for the first time in psychiatric hospitals. A cross‐sectional survey was conducted among healthcare workers (HCWs) in six psychiatric hospitals with nine sites in Switzerland. Measures assessed speak up‐related behaviour with 11 items organized in three scales (the frequency of perceived safety concerns, the frequency of withholding voice, and the frequency of speaking up). Speak up‐related climate was assessed by 11 items organized in 3 subscales (psychological safety for speaking up, encouraging environment for speaking up, and resignation). Statistical analyses included descriptive statistics, reliability, correlations and multiple regression analysis, confirmatory factor analysis, and analysis of variance for comparing mean scores between professional groups. A total of 817 questionnaires were completed (response rate: 23%). In different items, 45%–65% of HCWs reported perceived safety concerns at least once during the past four weeks. Withholding voice was reported by 13–25% of HCWs, and speaking up was reported by 53%–72% of HCWs. Systematic differences in scores were found between professional groups (nurses, doctors, psychologists) and hierarchical groups (lower vs higher status). The vignette showed that hierarchical level and perceived risk of harm for the patient were significant predictors for the self‐reported likelihood to speak up. Situations triggering safety concerns occur frequently in psychiatric hospitals. Speaking up and voicing concerns should be further promoted as an important safety measure.

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Section: Introductionmentioning

confidence: 97%

Speaking up about patient safety in psychiatric hospitals – a cross‐sectional survey study among healthcare staff

Schwappach

Niederhauser

2019

Int J Mental Health Nurs

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“…Safety in mental health services is a priority internationally (Mascherek & Schwappach, 2016; National Health Service, 2016; National Mental Health Commission, 2019; Shields, Stewart, & Delaney, 2018). Despite its priority status, safety in mental health care is an under‐explored area (Dewa et al., 2018).…”

Section: Introductionmentioning

confidence: 99%

Nurses' influence on consumers' experience of safety in acute mental health units: A qualitative study

Cutler

Sim

Halcomb

et al. 2020

Journal of Clinical Nursing

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Aims and objectives: To explore how nurses influence the perceptions and experience of safety among consumers who have been admitted to an acute mental health unit. Background: Safety is a priority in acute mental health inpatient units, yet consumers do not always experience acute units as safe. Despite being primary stakeholders, little is known about what safety means for consumers in acute mental health units. Design: A qualitative descriptive study informed by naturalistic enquiry was conducted and is reported using the COREQ checklist. Methods: Fifteen consumers with experience of mental illness participated in semistructured individual interviews. These interviews explored what safety meant for them during their acute mental health unit admissions. Thematic analysis was used to analyse the data. Findings: The theme Influence of Nurses reflected that the way nurses engaged in acute mental health units had a profound impact on participants' sense of safety. Three sub-themes emerged as follows: (a) Availability: "It's about nurses spending time with you"; (b) Being responsive: "They would listen if you had a concern"; and (c) Caring: "Little acts of kindness." Conclusions: These findings challenge the dominant discourse around safety in mental health organisations, in which nursing practice is often oriented towards the management of risk, rather than the promotion of safety. The findings demonstrate that, through their clinical practice, nurses can enhance consumers' feelings of safety in the acute mental health unit. Relevance to clinical practice: Nurses play a key role in providing care within acute mental health units. It is vital that the behaviours and actions nurses can enact in order to promote feelings of safety among consumers in this setting are enabled at individual, unit and organisational levels.

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“…Examples of these AEs are those regarding seclusion and use of restraint, self-harm and suicidal behaviour. Some of these events have been investigated, such as suicide and self-harm [1][2][3][4][5], medication errors [6,7] and seclusion and restraint [8,9], but the overall level and nature of AEs within psychiatry have been sparsely explored [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Adverse events in psychiatry: a national cohort study in Sweden with a unique psychiatric trigger tool

et al. 2020

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Background: The vast majority of patient safety research has focused on somatic health care. Although specific adverse events (AEs) within psychiatric healthcare have been explored, the overall level and nature of AEs is sparsely investigated. Methods: Cohort study using a retrospective record review based on a two-step trigger tool methodology in the charts of randomly selected patients 18 years or older admitted to the psychiatric acute care departments in all Swedish regions from January 1 to June 30, 2017. Hospital care together with corresponding outpatient care were reviewed as a continuum, over a maximum of 3 months. The AEs were categorised according to type, severity and preventability. Results: In total, the medical records of 2552 patients were reviewed. Among the patients, 50.4% were women and 49.6% were men. The median (range) age was 44 (18-97) years for women and 44.5 (18-93) years for men. In 438 of the reviewed records, 720 AEs were identified, corresponding to the AEs identified in 17.2% [95% confidence interval, 15.7-18.6] of the records. The majority of AEs resulted in less or moderate harm, and 46.2% were considered preventable. Prolonged disease progression and deliberate self-harm were the most common types of AEs. AEs were significantly more common in women (21.5%) than in men (12.7%) but showed no difference between age groups. Severe or catastrophic harm was found in 2.3% of the records, and the majority affected were women (61%). Triggers pointing at deficient quality of care were found in 78% of the records, with the absence of a treatment plan being the most common. Conclusions: AEs are common in psychiatric care. Aside from further patient safety work, systematic interventions are also warranted to improve the quality of psychiatric care.

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Patient Safety In Inpatient Psychiatry: A Remaining Frontier For Health Policy

Cited by 36 publications

References 31 publications

Speaking up about patient safety in psychiatric hospitals – a cross‐sectional survey study among healthcare staff

Speaking up about patient safety in psychiatric hospitals – a cross‐sectional survey study among healthcare staff

Nurses' influence on consumers' experience of safety in acute mental health units: A qualitative study

Adverse events in psychiatry: a national cohort study in Sweden with a unique psychiatric trigger tool

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