Low cost interventions can improve patient and staff safety in mental health wards

The study stems from a 20-year research program led by Professor of Psychiatric Nursing, Len Bowers, at the Institute of Psychiatry, Psychology & Neuroscience, King's College London.

The study reveals that, by using a set of ten small, low cost, Safewards interventions aimed at increase staff skills and improve relationships with patients, conflict and containment rates fall significantly; unpleasant forms of coercion are reduced, making psychiatric wards more peaceful places where both patients and nurses feel safer. "Overall, less time wasted on containment and conflict management means more time can be devoted to the nursing care and support of patients," said Professor Bowers.

The ten Safewards interventions include:

(1) mutually agreed and publicised standards of behaviour by and for patients and staff;

(2) short advisory statements (called 'soft words') on handling flashpoints, hung in the nursing office and changed every few days;

(3) a de-escalation model used by the best de-escalator on the staff (as elected by the ward concerned) to expand the skills of the remaining ward staff;

(4) a requirement to say something good about each patient at nursing shift handover;

(5) scanning for the potential bad news a patient might receive from friends, relatives or staff, and intervening promptly to talk it through;

(6) structured, shared, innocuous, personal information between staff and patients (e.g music preferences, favourite films and sports, etc.) via a 'know each other' folder kept in the patients day room;

(7) a regular patient meeting to bolster, formalise and intensify inter-patient support;

(8) a crate of distraction and sensory modulation tools to use with agitated patients (stress toys, mp3 players with soothing music, light displays, textured blankets, etc.);

(9) reassuring explanations to all patients following potentially frightening incidents; and

(10) a display of positive messages about the ward from discharged patients.