Safety and security procedures in psychiatric acute admission wards

Abstract

Violence and assaultive behaviour is a serious and growing problem in psychiatric services across the world. Despite many concerns about violence and assault in healthcare, there is an alarming lack of clarity on matters of procedure and policy pertaining to safety and security in psychiatric hospitals. This paper describes the safety and security measures in psychiatric acute admission wards in the Republic of Ireland and may be considered to be representative of acute psychiatric settings in other jurisdictions. A population study was undertaken, which included all psychiatric acute admission wards in the Republic. A descriptive survey research design was adopted, with the use of a questionnaire for data collection. The questionnaire was analysed using SPSS (version 11) and descriptive statistics were used to present the results. There was wide variation in safety and security practices across the wards. Measures aimed at ensuring staff security were also lacking, with no overall acceptable minimal standards discernible. It may be concluded that there is a lack of coherent policy and procedure in safety and security measures across psychiatric acute admission wards. One has to ask to what extent the disparate practices in safety and security revealed in the results of the study account for the escalation in violent episodes and assaultive behaviour in psychiatric services in recent years.

Nurses' accounts of locked ward doors: ghosts of the asylum or acute care in the 21st century?

“…Similar to the findings of a number of recent reports (MWCS 1999, HSCAS 2003, Healthcare Commission 2005, MHAC 2006), all participants in this study had experience of working on acute wards whose doors had been locked; however, unlike previous studies (Bowers et al . 2002, Cowman & Walsh 2004), none of the wards were permanently locked. This finding may suggest that different acute wards in different geographical regions may have little in common and that any differences in the practice of locking doors are locally determined.…”

“…Despite the recommendation that ‘service providers should ensure that there are clear service‐wide policies on the locking of wards’ (MHAC 2001), the nurses in this study were unable to identify any such policies in their clinical areas. It could be argued that they were simply unaware of existing policies or it could be, as Cowman & Walsh (2004) have suggested, that there appears ‘to be a lack of protocol and rational in the practice of locking ward doors’. Some support for this latter position comes from the Healthcare Commission (2005), which audited 111 acute wards and found that 22% ( n = 24) had no policy on locking the ward.…”

“…(2002) identified 25% of acute wards in Inner London as permanently locked and a further 45% were sometimes locked. Similarly, in a study conducted in the Republic of Ireland, Cowman & Walsh (2004) reported that 27% of acute wards were permanently locked. In both studies 16% of wards were never locked.…”

“…The available evidence suggests that MHNs' reasons for locking ward doors include the following: to prevent patients absconding from the ward (Adams 2000, Bowers et al . 2002, Cowman & Walsh 2004, Haglund et al . 2007); to avoid the use of the nurses' holding power (Carver & Ashmore 2000); to prevent patients harming themselves or others; to avoid unwanted access to the ward; to reduce substance misuse; as a holding procedure while awaiting a specialist assessment; and because there were insufficient nursing staff on the ward (Adams 2000, HSCAS 2003, Haglund et al .…”

On conflict, containment and the relationship between them

“…Our own data shows that within shifts there are modest correlations between differing containment methods (Cronbach alpha 0.26), and stronger correlations within patients (Cronbach alpha 0.53). Two surveys of ward safety and security policies have now been conducted (Bowers et al 2002; Cowman and Walsh 2004). Using the combined data from these two projects (124 wards in total), the Cronbach alpha of security measures is 0.60.…”