Studying nursing activities in inpatient units: a road to sustainability for hospitals.

BACKGROUND: Since the United Nations has adopted the Sustainable Development Goals in 2015, sustainability has been increasingly considered. Working time is an important resource (time is money), as well as the nurses inside hospitals. So, nursing activities must be studied and analyzed well. Consequently, the resulting information gives hospital managers a clear picture of the current status-the basics of developing plans for sustainability and keeping pace with developed countries. AIM: This study was designed to study nursing activities performed in inpatient units and to determine which types of nursing activities are the most frequent and time-consuming, how much time each category of nursing personnel spends in different activities, and how units divide their time between patient care and other activities. METHOD: A work sampling method was used on 36 nurses in six units for three successive years, using two tools: a demographic data sheet and guidelines for the level of activities and area of activities. RESULTS: There were 5,184 observations per year. According to area of activities, personal, and patient activities were the most time-consuming and frequent. According to the level of activities, unclassified and nursing activities were the most time-consuming among the intensive care, medical, and surgical units under study (44.1%, 41.6%, and 55.2%, respectively, and 28.2%, 34.8%, and 28.3%, respectively). The work of technical and diploma nurses was similar. CONCLUSION: Personal, unclassified, and patient activities consumed a large portion of nursing hours during the morning shift. Meanwhile, unit and personnel activities have consumed a minimal portion of hours. No significant differences in work were observed between technical and diploma nurses. RECOMMENDATIONS: Nursing managers and leaders should take a step to improve sustainability in their hospitals through study the nursing activities to gather data to develop plans for the future and rearrange the entire nursing staff in hospital units according to the needs of each shift.

Comparison of reports of missed nursing care: Registered Nurses vs. practical nurses in hospitals.

BACKGROUND: Missed nursing care is an error of omission defined as standard, required nursing care that is not completed or is seriously delayed. Study findings from around the world show that missed nursing care is a global concern. PURPOSE: The purpose of this study was to compare reports of missed nursing care by two types of nurses - registered nurses and practical nurses - in acute care hospitals in Iceland. Former studies in the USA indicate a variance in reports of missed nursing care by staff with different roles. METHODS: This was a cross-sectional descriptive study using the MISSCARE Survey-Icelandic questionnaire for data collection. The questionnaire asks about the amount of missed nursing care on the unit for 24 nursing elements (Part A) and 17 reasons of care being missed (Part B). Participants were nursing staff from medical, surgical and intensive care units in all hospitals in Iceland. FINDINGS: A t-test for independent groups showed a significant difference for the overall missed nursing care score (Part A) between registered nurses (M = 2.09, SD = 0.51) and practical nurses (M = 1.82, SD = 0.59) [t(541) = 5.703, p < 0.001]. A comparison of the overall mean score for reasons of missed nursing care (Part B) between registered nurses (M = 2.32, SD = 0.38) and practical nurses (M = 2.21, SD = 0.62) indicated a significant difference in their reporting [t(299) = 2.210, p = 0.028]. In spite of the overall significant difference in ratings of the elements and reasons for missed nursing care by registered nurses and practical nurses, a pattern is evident in the ranking of the elements of nursing care being missed and reasons. CONCLUSIONS: The findings of this study point to the need to acknowledge certain aspects of missed nursing care and the different roles within nursing. They indicate a need to improve open, sincere and structured communication and mutual respect and trust within healthcare teams in Icelandic hospitals.

Inpatient flow management: a systematic review.

PURPOSE: In hospitals, several patient flows compete for access to shared resources. Failure to manage these flows result in one or more disruptions within a hospital system. To ensure continuous care delivery, solving flow problems must not be limited to one unit, but should be extended to other departments - a prerequisite for solving flow problems in the entire hospital. Since most current studies focus solely on overcrowding in emergency units, additional insights are needed on system-wide patient flow management. The purpose of this paper is to look at the information available in system-wide patient flow management studies, which were also systematically evaluated to demonstrate which interventions improve inpatient flow. DESIGN/METHODOLOGY/APPROACH: The authors searched PubMed and Web of Science (Core Collection) literature databases and collected full-text articles using two selection and classification stages. Stage 1 was used to screen articles relating to patient flow management for inpatient settings with typical characteristics. Stage 2 was used to classify the articles selected in Stage 1 according to the interventions and their impact on patient flow within a hospital system. FINDINGS: In Stage 1, 107 studies were selected. Although a growing trend was observed, there were fewer studies on patient flow management in inpatient than studies in emergency settings. In Stage 2, 61 intervention studies were classified. The authors found that most interventions were about creating and adding supply resources. Since many hospital managers these days cannot easily add capacity owing to cost and resource constraints, using existing capacity efficiently is important - unfortunately not addressed in many studies. Furthermore, arrival variability was the factor most frequently mentioned as affecting flow. Of all interventions addressed in this review, the most prominent for advancing patient access to inpatient units was employing a specialized individual or team to maintain patient flow and bed placement across hospital units. ORIGINALITY/VALUE: This study provides the first patient flow management systematic overview within an inpatient setting context.

Use of restrictive interventions in a child and adolescent inpatient unit - predictors of use and effect on patient outcomes.

OBJECTIVES: Restrictive interventions (seclusion, physical restraint, and use of acute/p.r.n. sedation) may have negative effects on patients. Identifying factors associated with use of restrictive interventions and examining their effect on admission outcomes is important for optimising inpatient psychiatric care. METHODS: This study documented use of restrictive interventions within a child and adolescent psychiatric inpatient unit for 15 months. Two models examined predictors of use of restrictive interventions: (i) incident characteristics; and (ii) patient characteristics. The relationship between use of restrictive interventions and global clinical outcomes was also examined. RESULTS: Of 134 patients admitted during the study period (61.9% female, mean age=13.8±2.9 years), 26.9% received at least one restrictive intervention. Incident factors associated with restrictive interventions were: physical aggression, early admission stage, and occurrence in private space. Patient factors that predicted use of restrictive interventions were developmental disorder and younger age. Use of restrictive interventions was not associated with increased length of stay or diminished improvement in global symptom ratings. CONCLUSIONS: Further research is needed to identify best practice in children at high risk for receiving restrictive interventions.

The therapeutic relationship from the perspective of patients and nurses in the first days of admission: A cross-sectional study in acute mental health units.

The therapeutic relationship (TR) is essential in mental health nursing care and plays a fundamental role in the understanding and treatment of the patient's health status. Despite being a bidirectional construct, limited evidence is available to shed light on this issue in mental health units and even less so in the first days of admission. This study aimed to examine the association and differences between nurses' and patients' perspectives on the establishment of the therapeutic relationship in acute mental health units during the first days of hospitalization. A cross-sectional study was carried out in 12 Spanish mental health units. Data were collected from patients and nurses using the Working Alliance Inventory-Short (WAI-S) questionnaire. A total of 234 cases were analysed, including 234 patients and 58 nurses. The results showed a positive association between nurses' and patients' perspectives on the therapeutic relationship, but also revealed significant differences on each WAI-S dimension. Nurses assigned higher scores compared to patients on the perception of the quality of the therapeutic relationship. The dimensions with the greatest weight from the patients' perspective regarding the quality of the therapeutic relationship were the perception of greater agreement on goals and tasks among nurses. This study demonstrates the importance of establishing shared goals and tasks with nurses from the first days of hospitalization to improve the quality of the therapeutic relationship as perceived by patients. These findings underline the need to consider the different perspectives of both parties to promote a high-quality therapeutic relationship.

Using Delphi method to address factors contributing to aggressive behaviour in mental health settings.

WHAT IS KNOWN ABOUT THE SUBJECT?: Nurses' perspectives and consensus on the possible key factors contributing to aggression at inpatient units can be summarized into patients' related factors, staff related factors and environment related factors. Results of the possible factors contributing to aggression at inpatient units reflect the complicated nature of this problem. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: Perspectives of nurses as frontline mental health professionals on factors contributing to aggression as one of the psychiatric emergencies were considered through an iterative process. This approach gave nurses an opportunity to revisit their own views in each round to provide an in-depth reflection in the light of the contribution of others. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING PRACTICE?: Nursing curricula should focus on nurses' communication skills and emotion regulation training. An open dialogue between nurses and people with mental health issues should be initiated to discuss the possible key factors contributing to aggressive behaviour at inpatient units from both standpoints. Mental health nurses' turnover at inpatient settings could be targeted through the design and implementation of aggression prevention protocols ABSTRACT: Introduction Aggression at inpatient units is a universal problem leading to hazardous outcomes. Aim To generate group consensus about factors contributing to aggressive behaviour among patients with mental health issues at inpatient units. Methods Nurses working at inpatient psychiatric departments were approached, and purposive sampling was employed to implement Delphi technique. A total of three Delphi rounds were conducted online. The average percent of majority opinions method was followed to measure consensus in which questions with a cut-off rate below 69.7% were included in the next round. Results Twenty-one nurse experts with different skills participated in this study. Consensus increased among nurse experts across rounds for the following items: Patients' misinterpretation of the attitude of the healthcare providers, severity of mental health issues, attitude and communication style of the healthcare providers, nurses limited emotional regulation capacity and the inadequate staff-patient ratio in psychiatric wards. Discussion The complicated nature of aggressive behaviour displayed by people with mental health issues is reflected on the results of the current study; patients' related factors, staff related factors and environment related factors constitute interacting facets for this issue. Implications for Mental Health Nurses Nurse scientists could use insights derived from this study to design studies aiming at assessment and management of aggression at inpatient units guided by implementation science frameworks. Additionally, open dialogues between nurses and people with mental health issues could be initiated about factors contributing to aggression at inpatient units. Mental health nursing training should focus on nurses' communication and emotion regulation skills.

Development of an intervention to support parents receiving treatment in psychiatric inpatient hospital using participatory design methods.

Introduction: When parents of dependent children are treated in psychiatric inpatient hospital, it typically involves separation of parent and child for the duration of treatment, which can be highly distressing to the dyad and can result in disruption to the parent-child relationship. Parents who have experienced hospitalisation have expressed a desire for their parenting identity to be recognized and appropriately engaged with during their treatment. This recognition includes provision of interventions which support them as parents to limit the impact of their mental health on their children. The current study, the first of its kind known to have taken place, details a collaborative intervention development project for parents receiving inpatient care. Methods: The current study, the first of its kind known to have taken place, details a collaborative intervention development project for parents receiving inpatient care. This project involved the adaptation and extension of a prior parenting-focused course for parents high in anxiety to meet the needs of parents being treated in inpatient settings. In the first two stages of the three-phase project, patients, carers and mental health practitioners contributed to the revision and delivery plan for the course including developing new content for the intervention. In the final stage, which took the form of a participatory evaluation, the intervention was delivered to 11 parents receiving inpatient treatment who then provided extensive feedback. A series of iterative adaptations to the intervention were made in response to this feedback alongside stakeholder input. Results: The final intervention comprises five modules focused on exploring the experience of parents alongside specific learning and skills orientated toward boosting their connection with their children during hospitalisation and in readiness for discharge. Preliminary feedback from patients and ward staff has been positive and the process of delivering the project on inpatient wards was associated with no increase in negative clinical outcomes. Discussion: The successful development of a targeted intervention within inpatient psychiatric units offers a signal that parents treated in this setting welcome the opportunity to be supported in their parenting role. As the first known UK intervention of its kind to be developed in partnership with patients, ward staff and management, it is specifically tailored to the context and needs of this group with the potential to be delivered by a range of health professionals in this setting.

Key features of adolescent inpatient units and development of a checklist to improve consistency in reporting of settings.

WHAT IS KNOWN ON THE SUBJECT?: Little is known about adolescent inpatient units, key features which define them, and how these essential services operate and deliver care. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Adolescent inpatient unit studies are limited in their descriptions of settings in terms of how they operate and key features. The proposed preliminary checklist is a practical tool to assist clinicians, policy makers, and researchers when reporting to ensure comprehensive descriptions of adolescent inpatient settings. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This could be used to inform service design processes for inpatient and other mental health service models which is of critical importance in the context of reforms and implementation of these in Australia currently. Greater attention to operational models, services, and philosophies of practice will improve reporting and allow for the advancement of knowledge, comparison of study results, and a clearer direction for mental health nursing clinicians and researchers. ABSTRACT: Introduction Adolescent inpatient units care for vulnerable population groups; however, little is known about how these essential services operate and deliver care. Aims To examine the descriptions of adolescent mental health inpatient units in Australian and international research publications and to identify key features which were used to define them. A secondary aim was to develop a checklist to improve consistency when reporting on the operations and services delivered within adolescent mental health inpatient units (both public and private). Methods Five electronic databases (CINAHL, MEDLINE, ERIC, EMBASE, and PsycINFO) were systematically searched. We included studies that provided descriptions of operations and services within adolescent inpatient units where participants had a mean age between 12 and 25. Narrative synthesis was used to explore the similarities and differences between descriptions of settings. Results Twenty-eight studies were identified, which varied in their descriptions of adolescent inpatient units, providing inconsistent information to inform best practice. Discussion Studies lack consistency and comprehensive detail when describing the operational models within inpatient units, making interpretation challenging. Consequently, a preliminary checklist is proposed to improve reporting of adolescent inpatient units.

Training direct-care staff to implement sensory integration strategies on a psychiatric inpatient unit.

PROBLEM: Despite the importance of sensory integration therapy on psychiatric inpatient units, there continues to be a paucity of trained providers that can delivery this service to patients. METHOD: This study evaluated components of a training program to teach nurses and direct-care staff appropriate use of sensory integration strategies. Using the research team as confederates, we collected data on how three direct-care staff used sensory integration strategies across two conditions and with a patient admitted to the unit. Next, we implemented the didactic-only training, which provided education for when to use different aspects of the sensory room. Finally, we transitioned to a condition in which feedback supplemented the didactic training. FINDINGS: Before training and following the Didactic Only Training condition, accuracy was low for all participants. All three participants' accuracy with using sensory integration strategies improved and maintained when they implemented the strategies with a patient after completing the combined intervention. We were able to use the combined intervention to improve two additional direct-care staff's accuracy. CONCLUSIONS: Staff training incorporating didactic training plus feedback was most effective for training appropriate use of sensory integration strategies. We also discuss the importance of having performance-based measures to track occurrence of important skills.

Applications of artificial intelligence to improve patient flow on mental health inpatient units - Narrative literature review.

BACKGROUND: Despite a growing body of research into both Artificial intelligence and mental health inpatient flow issues, few studies adequately combine the two. This review summarises findings in the fields of AI in psychiatry and patient flow from the past 5 years, finds links and identifies gaps for future research. METHODS: The OVID database was used to access Embase and Medline. Top journals such as JAMA, Nature and The Lancet were screened for other relevant studies. Selection bias was limited by strict inclusion and exclusion criteria. RESEARCH: 3,675 papers were identified in March 2020, of which a limited number focused on AI for mental health unit patient flow. After initial screening, 323 were selected and 83 were subsequently analysed. The literature review revealed a wide range of applications with three main themes: diagnosis (33%), prognosis (39%) and treatment (28%). The main themes that emerged from AI in patient flow studies were: readmissions (41%), resource allocation (44%) and limitations (91%). The review extrapolates those solutions and suggests how they could potentially improve patient flow on mental health units, along with challenges and limitations they could face. CONCLUSION: Research widely addresses potential uses of AI in mental health, with some focused on its applicability in psychiatric inpatients units, however research rarely discusses improvements in patient flow. Studies investigated various uses of AI to improve patient flow across specialities. This review highlights a gap in research and the unique research opportunity it presents.

Measures to Maintain a SARS-CoV-2 Negative Inpatient Hematological Unit in the Midst of the COVID-19 Pandemic.

The University Hospital of Salamanca, in Spain, had its first COVID-19 case on March 1st and as of May 11th, we had 1,100 positive cases. Based on the vulnerability of patients with blood cancers, on March 9th, the Hematology Department developed a protocol, amended as the new information was available, to maintain the Hematology Unit as a "free COVID-19 island." The protocol included symptom-based surveys and screening tests to patients, caregivers, and healthcare personnel to identify early potential positive cases and prevent its spread. Between March 9 and April 28, 32 asymptomatic patients and caregivers were tested and 68 rT-PCR diagnostic assays have been performed with two positive results. A 106 healthcare workers have been tested (208 rT-PCR) and seven of them were positive. In summary, the implementation of preemptive measures after the first case appeared allowed us to be able to provide treatment to our patients.

Drug-Related Problems and Pharmacist Intervention at a General Hospital in the Jazan Region, Saudi Arabia.

OBJECTIVE: This study examined the incidence of drug-related problems (DRPs) in different inpatient departments along with the medical team response to pharmacist's action in addressing DRPs at Jazan Hospital, Saudi Arabia. PATIENTS AND METHODS: This retrospective study was conducted among inpatients at Ministry of Health hospital in Jazan, a region in southwestern Saudi Arabia. We collected data for a 2-year period (from 2016 to 2017). For any detected DRP of the ordered medications for dispensing, the inpatient pharmacist is sending report for that particular DRP with recommendation to the medical team which in turn might accept or reject such recommendation. Serious drug-drug interactions, as part of DRP, were assessed by utilizing three different online DDI checkers, including Lexi-Comp, Medscape, and Drugs.com. RESULTS: The most common type of DRP was serious drug-drug interactions (49%). Over the study period, most incidences of DRPs were decreased. Of the DRPs in 2016 and 2017, antibiotics were the most commonly involved (51% and 69.5%) of cases, respectively, followed by proton pump inhibitors (25.3% and 14.1%) and statins (12.9% and 9.4%). Interestingly, of the 241 interventions for DRPs in 2016, 199 (82.5%) were accepted, resulting in a change in drug therapy (p=0.006). In 2017, 90 (70.3%) interventions out of 128 were accepted by the physician and the drug therapy changed (p=0.029). CONCLUSION: Pharmacist interventions appear to decrease the incidence of DRPs, which emphasize the importance of an optimal pharmaceutical care plan for clinical care settings.

Perceptions of nurses working with psychiatric consumers regarding the elimination of seclusion and restraint in psychiatric inpatient settings and emergency departments: An Australian survey.

Seclusion and restraint continue to be used across psychiatric inpatient and emergency settings, despite calls for elimination and demonstrated efficacy of reduction initiatives. This study investigated nurses' perceptions regarding reducing and eliminating the use of these containment methods with psychiatric consumers. Nurses (n = 512) across Australia completed an online survey examining their views on the possibility of elimination of seclusion, physical restraint, and mechanical restraint as well as perceptions of these practices and factors influencing their use. Nurses reported working in units where physical restraint, seclusion, and, to a lesser extent, mechanical restraint were used. These were viewed as necessary last resort methods to maintain staff and consumer safety, and nurses tended to disagree that containment methods could be eliminated from practice. Seclusion was considered significantly more favourably than mechanical restraint with the elimination of mechanical restraint seen as more of a possibility than seclusion or physical restraint. Respondents accepted that use of these methods was deleterious to relationships with consumers. They also felt that containment use was a function of a lack of resources. Factors perceived to reduce the likelihood of seclusion/restraint included empathy and rapport between staff and consumers and utilizing trauma-informed care principles. Nurses were faced with threatening situations and felt only moderately safe at work, but believed they were able to use their clinical skills to maintain safety. The study suggests that initiatives at multiple levels are needed to help nurses to maintain safety and move towards realizing directives to reduce and, where possible, eliminate restraint use.

Assessment of nursing workload in adult psychiatric inpatient units: A scoping review.

WHAT IS KNOWN ON THE SUBJECT?: There is a shortage of empirical research in the field of psychiatric and mental health nursing regarding how to calculate a safe staffing level in psychiatry inpatient units. Furthermore, the tools to assess nursing workload in this specialty are limited. No systematic reviews on measurement tools in adult psychiatric inpatient settings were found. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This study confirms the scarcity and heterogeneity of instruments with which to evaluate nursing workload in this specific context. Likewise, the instruments identified do not capture the complexity of the psychiatric nursing setting, namely, the relational and psychotherapeutic strategies that must be implemented in the patient care approach. The findings of the study suggest that evidence-based tools for adult psychiatric inpatient settings require further development. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This review shows the need to continue to develop tools that assess workload in psychiatric inpatient units that embrace activities related to patient (direct and indirect) and nonpatient activities. The great challenge is providing a sensitive understanding of the workload resulting from psychotherapeutic interventions, the primary treatment that many patients need. This review reinforces the need to add patient outcomes to workload assessment processes. ABSTRACT: Introduction No systematic reviews on measurement tools in adult psychiatric inpatient settings exist in the literature, and thus, further research is required on ways to identify approaches to calculate safe nurse staffing levels based on patients' care needs in adult psychiatric inpatient units. Aim To identify instruments that enable an assessment of nursing workload in psychiatric settings. Method A scoping review was conducted. Results Four studies were identified, with five instruments used to support the calculation of staff needs and workload. All four studies present methodological limitations. Two instruments have already been adapted to this specific context, but validation studies are lacking. Discussion The findings indicate that the tools used to evaluate nursing workload in these settings require further development, with the concomitant need for more research to clarify the definition of nursing workload as well as to identify factors with the greatest impact on nursing workload. Implications for practice This review highlights the need to develop tools to assess workload in psychiatric inpatient units that embrace patient-related and non-patient-related activities. The great challenge is to enable a sensitive perception of workload resulting from nurses' psychotherapeutic interventions, an important component of treatment for many patients.

A nationwide study of why and how acute adolescent psychiatric units use restraint.

The purpose of this study was to examine the type, reason, and duration of restraint episodes in acute adolescent psychiatric units. In a retrospective design we included data from paper-based protocols on all episodes of restraint and data from electronic patient records during 2008-2010 in all acute adolescent psychiatric in-patient units in Norway (N=16). The episodes of restraint included mechanical and pharmacological restraint, seclusion and physical holding that was not part of the implementation of forced feeding. Six-and-a-half per cent of all 4099 adolescents admitted to the acute units experienced restraint. Of the 2277 episodes, 13.4% were mechanical restraint, 1.6% were pharmacological restraint, 5.9% were seclusion and 78.7% were physical holding. The median number of restraint episodes per patient was two, the range was 1-171 and 47 patients (18%) experienced ≥10 episodes. The most common reason for using restraint was harming others. The median duration of the mechanical restraint episodes was 3.5h. The median duration of seclusion was 30min and the median duration of physical holding was 10min.

Patterns of antipsychotics' prescription in Portuguese acute psychiatric wards: A cross-sectional study.

This study aimed to establish the prescribing patterns of antipsychotics in acute psychiatric wards across Portugal, to determine the prevalence of polypharmacy and "high-doses" treatment, and to identify possible predictors. Twelve acute psychiatric inpatient units and 272 patients were included. The majority (87.5%) was treated with antipsychotics regardless of diagnosis, and 41.6% had at least two antipsychotics prescribed in combination. Age, use of depot antipsychotics, and antipsychotic "high-doses" were significant predictors of antipsychotic polypharmacy. Excluding 'as required' prescriptions, 13.8% of the patients were prescribed "high-doses" of antipsychotics. When antipsychotics 'as required' prescriptions were considered, 49.2% of the patients were on antipsychotic "high-doses". Age, use of depot antipsychotics, previous psychiatric hospitalization and involuntary admission were significant predictors of antipsychotic "high-doses". These results show that in Portugal the antipsychotics prescribing practices in psychiatric inpatient units diverge from those that are universally recommended, entailing important clinical and economic implications. It seems advisable to optimize the prescription of these drugs, in order to prevent adverse effects and improve the quality of the services provided.

Development and effectiveness of an integrated inpatient and community service for challenging behaviour in late life: From Confused and Disturbed Elderly to Transitional Behavioural Assessment and Intervention Service.

A common method of managing challenging behaviour associated with dementia is long-stay special care units, though models are very diverse. In New South Wales, Australia, the five remaining state-run long-stay special care units for this population were funded to adopt a shorter-term model which had been trialled by one of the units. Transitional Behavioural Assessment and Intervention Service Units, incorporating an integrated outreach team, were to provide multi-disciplinary assessments, develop individualised bio-psychosocial management plans for, and appropriately discharge people with significant levels of Behavioural and Psychological Symptoms in Dementia. The current study assessed both the effects of the change and the clinical effectiveness of the model. METHOD: A repeated measures design, supplemented by multiple one-time measures. A range of standard instruments were administered, patient data from other types of inpatient units were obtained, interviews conducted, and medical records examined. RESULTS: Transitional Behaviour Assessment and Intervention Service units were admitting patients with dementia and a variety of significant challenging behaviours. Length of stay was shortened in all units, patients turnover greatly increased, and there was a low re-admission rate. The model was substantially cheaper than psychiatric care in two units where it was fully implemented; one unit cost the same as psychiatric care, and two units were not cost-effective because of low occupancy - related to not fully implementing the model. Referring facilities reported that in the absence of the units, their main strategy would have been to increase sedation. In the Transitional Behavioural Assessment and Intervention Service units, behavioural incidents were primarily managed through psychosocial means. It is not known whether behaviour is reduced over time, staff become better at managing the behaviour when it occurs, or both. CONCLUSION: The evaluation showed that the model can be transferred to other units and is a cost-effective way of assessing, managing, and successfully discharging people with complex challenging behaviours, though only when fully implemented.

Emergency mental health admissions for children: a naturalistic study.

OBJECTIVE: Emergency mental health admissions (EA) for children under 13 years are not routinely offered in the UK, which may be related to preconceptions about their safety, appropriateness and acceptability. Our aim was to evaluate routinely offered EA of children in a national unit over a three-year period. METHOD: A retrospective, naturalistic study was conducted, comparing EA with planned admissions (PA) in terms of children's functioning on admission and discharge, clinical characteristics, significant risk-related incidents and parental and children satisfaction. RESULTS: EA children (N=47) did not differ from PA children (N=35) in age, length of admission, medication treatment, significant risk-related incidents, functioning at discharge, access to education at discharge and satisfaction. EA children had lower functioning and were less likely to have been out of education on admission. Parental satisfaction in EA was higher compared to PA. CONCLUSIONS: EA for children are an appropriate, clinically indicated and safe alternative to PA, associated with higher parental satisfaction.

Perfil de adolescentes usuários de crack e suas consequências metabólicas / Profile of teenage crack users and metabolic consequences

Introdução: O crack, droga derivada da cocaína, está se disseminando entre os jovens de diferentes classes sociais do Brasil. O objetivo do estudo foi caracterizar o perfil dos usuários de crack e verificar suas consequências metabólicas. Métodos: Estudo descritivo exploratório, do tipo quantitativo. Aplicaram-se questionários e analisaram-se os exames bioquímicos dos participantes através de prontuários. Foram entrevistados 22 adolescentes internados para tratamento de desintoxicação. Resultados: O perfil do usuário de crack foi jovem, nível de escolaridade baixo e sem emprego formal. O crack foi eleito a droga de preferência pela maioria dos pacientes (86,3%), seguida do pitico e da maconha. A maioria (95,4%) relatou mudanças quanto aos hábitos alimentares. A forma em que o crack era mais utilizado foi em cachimbos (50%). Em relação às alterações metabólicas, foi observado apenas o aumento na fosfatase alcalina, que pode indicar dano hepático. Os outros exames não apresentaram alterações significativas. Conclusão: O presente estudo demonstra que o crack causa prejuízos sociais, econômicos, além de danos à saúde do dependente, como alterações no estado nutricional pela inapetência e possíveis danos hepatotóxicos. Portanto, observa-se que esses sujeitos estão expostos a diversas situações de risco e vulnerabilidade, o que indica grave problema de saúde pública.

Introduction: Crack, a drug derived from cocaine, is spreading among young people from different social classes in Brazil. The aim of this study was to characterize the profile of crack users and assess its metabolic consequences. Methods: A descriptive exploratory study of the quantitative type. Questionnaires were administered and the participants’ biochemical tests in medical records were analyzed. We interviewed 22 adolescents admitted for detoxification treatment. Results: The profile of the crack user was young, low education level and without formal occupation. Crack was the most used drug by most patients (86.3%), followed by pitico and marijuana. The majority (95.4%) reported changes regarding eating habits. The most common way of consuming crack was through pipes (50%). Concerning metabolic changes, only an increase in alkaline phosphatase was detected, which may indicate liver damage. The other tests did not show significant changes. Conclusion: This study demonstrates that crack has adverse social and economic consequences and causes damage to the health of the user, such as changes in nutritional status and appetite for possible hepatotoxic damage. Therefore, it is observed that these subjects are exposed to various situations of risk and vulnerability.