P03-14 - A Quasi-Experimental Controlled Intervention to Reduce Violence on an Acute Psychiatric Ward

Abstract

Introduction

Violence and aggression are a major concern in acute inpatient psychiatric wards. Hard outcome data on the impact of service change are scarce. This poster presents the outcomes of service changes designed to improve the acute ward environment and patient experience.

Aims and objectives

To implement changes to the delivery of acute inpatient psychiatric services and to measure the outcome of these changes in objective verifiable form.

Method

Significant changes were introduced to an acute psychiatric inpatient service. These included introducing a dedicated inpatient psychiatrist “hospitalist”, replacing weekly ward rounds with daily multidisciplinary care and discharge planning meetings and promoting increased roles for nursing staff in decision-making and patient contact. Outcomes measured included routinely recorded incidents of violence with and without injury, use of restraint for medication and use of constant nursing observation. The control group was a similar service in the same hospital subject to the same general policies and admitting patients demographically comparable, but that did not at the time undergo the interventions implemented in the trial service. All data was recorded by staff who were unaware of this study or even that any analysis of the data would occur.

Results and conclusions

Violent incidents in the intervention ward dropped by 34% per patient (p=< 0.02) whilst increasing by 3% in the control ward; restraints decreased by 28% (p=ns) whilst increasing by 12% in the control ward; with an overall reduction in constant observation. The intervention was highly effective in reducing violent incidents.