Voluntary patient safety incidents reporting in forensic psychiatry-What do the reports tell us?

WHAT IS KNOWN ON THE SUBJECT?: Patient safety incident reporting has been recognized as a key process for organizational learning and safety culture; however, there is limited knowledge about patient safety in forensic psychiatric care. There are distinct patient safety issues in psychiatric nursing, associated (inter alia) with the self-harm, violence, seclusion/restrain and restrictions. Many adverse events are preventable. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: No harm was caused to patients in less than half (51%) of all reported incidents (in a Finnish forensic psychiatric hospital during a six-year period) considered in this study. The most common location of violent incidents was corridors (31%), followed by day rooms (20%), and patient rooms (15%). The most common patient safety incidence type was violence against another patient (38%), which typically occurred in corridors (36%), dayrooms (25%) and patient rooms (15%), and was usually related to daily activities in the afternoon (1,400-1,600 hr) and evening (1,800-2,000 hr). Typically, recommendations for improving patient safety focus on human behaviours. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There is a need to notify and report all patient safety incidents (following staff training), learn from previous incidents (also learn for success), prevent typical incidents, learn for success, promote patient participation in incident prevention, share development measures outside the ward to enable exploitation by others and strengthen safety culture. In forensic psychiatry, conversation with patients regarding safety measures is strongly recommended to prevent patient safety incidents related to violence. The perspective should be extended from patient-specific factors to general factors such as patient treatment and general comfort and privacy. ABSTRACT: INTRODUCTION: Patient safety incident reporting has been recognized as a key process for organizational learning and safety culture, but there is limited knowledge about patient safety in forensic psychiatric care. AIMS: To characterize the types and frequencies of incidents in forensic psychiatric care and assess the implications for practice. METHODS: Data were collected from a patient safety incident reporting system (PSiRS) database of one forensic psychiatry hospital in Finland and analysed using descriptive statistics. RESULTS: No harm was caused in more than half of the 2,521 reported incidents examined (51%, n = 1,260). The most frequently recorded incident type was violence (38%), which typically occurred in corridors (31%) or dayrooms (20%). The most frequently recommended action to prevent violent events was that potential risks should be discussed (77%). DISCUSSION: Patient safety incidents related to violence are common in forensic psychiatric hospitals. Although very few adverse events were classified as causing serious harm to patients, many cases of violence could be prevented by identifying potential circumstances that lead to violence. IMPLICATIONS FOR PRACTICE: Staff need encouragement and training to detect and report all patient safety incidents. Safety culture is strengthened by learning and sharing development measures to improve patient safety.

Nurses' Views Highlight a Need for the Systematic Development of Patient Safety Culture in Forensic Psychiatry Nursing.

BACKGROUND: Although forensic nurses work with the most challenging psychiatric patients and manifest a safety culture in their interactions with patients, there have been few studies on patient safety culture in forensic psychiatric nursing. OBJECTIVES: The aim of this qualitative study was to describe nurses' views of patient safety culture in their working unit and daily hospital work in 2 forensic hospitals in Finland. METHODS: Data were collected over a period of 1 month by inviting nurses to answer an open-ended question in an anonymous Web-based questionnaire. A qualitative inductive analysis was performed on nurses' (n = 72) written descriptions of patient safety culture in state-owned forensic hospitals where most Finnish forensic patients are treated. RESULTS: Six main themes were identified: "systematization of an open and trusting communication culture," "visible and close interaction between managers and staff," "nonpunitive responses to errors, learning and developing," "balancing staff and patient perspectives on safety culture," "operational safety guidelines," and "adequate human resources to ensure safety." CONCLUSIONS: The findings highlight the influence of the prevailing culture on safety behaviors and outcomes for both healthcare workers and patients. Additionally, they underline the importance of an open culture with open communication and protocols.

Changes in patient safety culture: A patient safety intervention for Finnish forensic psychiatric hospital staff.

AIM: To evaluate how a 3-year patient safety intervention, more specifically, the implementation of a patient safety incident reporting system, influences patient safety culture. BACKGROUND: Positive patient safety culture improves both the quality of health care and patient safety. Nevertheless, nursing managers need tools that can help them develop and evaluate patient safety culture. METHODS: The Hospital Survey on Patient Safety Culture was used to evaluate patient safety culture at two Finnish forensic psychiatric hospitals (study and control) over two periods, baseline and follow-up. Data were analysed using Z-score and T test statistics. RESULTS: The follow-up results from the study hospital showed that five patient safety culture dimensions exhibited a significantly (p < 0.05) positive change in positive response rates over the 3-year period. Furthermore, nine out of twelve patient safety culture dimensions at the study hospital showed a significant improvement in mean score. At the control hospital, only the dimension of frequency of reporting events showed a significantly positive change (p < 0.05) in mean score. CONCLUSION: This research shows that the studied patient safety intervention (implementation of the patient safety incident reporting system) significantly influences patient safety culture. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers should utilize a variety of patient safety interventions to improve patient safety and focus on leveraging information from patient safety incidents to advance patient safety culture.

Patient safety culture in two Finnish state-run forensic psychiatric hospitals.

Safety culture refers to the way patient safety is regarded and implemented within an organization and the structures and procedures in place to support this. The aim of this study was to evaluate patient safety culture, identify areas for improvement, and establish a baseline for improving state hospitals in Finland. Cross-sectional design data were collected from two state-run forensic hospitals in Finland using an anonymous, Web-based survey targeted to hospital staff based on the Hospital Survey on Patient Safety Culture questionnaire. The response rate was 43% (n = 283). The overall patient safety level was rated as excellent or very good by 58% of respondents. The highest positive grade was for "teamwork within units" (72%). The lowest rating was for "nonpunitive response to errors" (26% positive). Good opportunities for supplementary education had a statistically significant (p ≤ 0.05) effect on 9 of 12 Hospital Survey on Patient Safety Culture dimensions. Statistically significant (p ≤ 0.05) differences in patient safety culture were also found in the staff's educational background, manager status, and between the two hospitals. These findings suggest there are a number of patient safety problems related to cultural dimensions. Supplementary education was shown to be a highly significant factor in transforming patient safety culture and should therefore be taken into account alongside sufficient resources.