The Interface of COVID-19 and Inpatient Psychiatry: Our Experience and Lessons Learned.

The coronavirus disease 2019 (COVID-19) pandemic presented unprecedented challenges to the provision of inpatient psychiatric care. The nature of the physical plant, programmatic constraints, and the patient population required a rapid and agile approach to problem-solving under conditions of uncertainty and stress. Flexibility in decision-making, excellent communication, an effective working relationship with infection prevention and control experts, and attention to staff morale and support were important elements of successful provision of care to our inpatients. We present our experience, lessons learned, and recommendations should a resurgence of the pandemic or a similar crisis occur.

Epidemiology, Infection Prevention, Testing Data, and Clinical Outcomes of COVID-19 on Five Inpatient Psychiatric Units in a large Academic Medical Center.

Inpatient psychiatric facilities can face significant challenges in containing infectious outbreaks during the COVID-19 pandemic. The main objective of this study was to characterize the epidemiology, testing data, and containment protocols of COVID-19 in a large academic medical center during the height of the COVID-19 outbreak. A retrospective cohort analysis was conducted on hospitalized individuals on five inpatient psychiatric units from March 1st to July 8th, 2020. Demographic data collected include age, race, gender, ethnicity, diagnosis, and admission status (one or multiple admissions). In addition, a Gantt chart was used to assess outbreak data and timelines for one unit. Testing data was collected for patients admitted to inpatient psychiatric units, emergency room visits, and employees. 964 individuals were hospitalized psychiatrically. The study population included ethnically diverse patients with various mental illnesses. We also describe infection prevention strategies, screening, and triage protocols utilized to safely continue patient flow during and beyond the study period with a low patient and employee infection rate. In summary, our study suggests that early implementation of triage, screening, extensive testing, and unit-specific interventions can help prevent and contain the spread of COVID-19 in inpatient psychiatric units and help facilitate safe delivery of care during a pandemic.

[Health care delivery and psychiatric hospitalizations in the prisons of the North of France: An observational study]. / Offre de soins et recours aux hospitalisations psychiatriques en milieu pénitentiaire : une étude observationnelle dans le Nord de la France.

BACKGROUND: In French prisons, psychiatric care for inmates is organized into three levels: ambulatory care within each jail in "unités sanitaires en milieu pénitentiaire" (USMP: sanitary units in correctional settings), day hospitalizations in the 28  services médico-psychologiques régionaux (SMPR, "regional medical-psychological services") and full-time hospitalizations in one of the nine "unités d'hospitalisation spécialement aménagées" (UHSA: specially equipped hospital units). Despite high prevalence of mental disorders among French prisoners, the efficiency of these specialized psychiatric care units has been insufficiently studied. The main goal of this study is to describe full-time psychiatric hospitalizations for inmates in the twenty prisons located in the North of France. METHODS: We conducted a descriptive study based on medical and administrative data and survey results. The following data were collected for each prison regarding 2016: 1) number and occupancy rates for mental health professionals and 2) psychiatric hospitalization rates (in the UHSA of Lille-Seclin and the general psychiatric hospitals). RESULTS: Provision of care is incomplete: the vacancy rate in the health units studied reaches 40 %. Moreover, access to UHSA is unequal: it varies pronouncedly according to the location of the prison; only inmates in prisons close to the UHSA benefit from satisfactory access. CONCLUSION: Access to psychiatric care for inmates remains problematic in France, particularly due to a lack of mental health professionals in USMPs, the overload of patients in UHSAs and the distance of theses facilities from certain prisons and jails.

Challenges and Priorities in Responding to COVID-19 in Inpatient Psychiatry.

This Open Forum focuses on specific challenges, contingency planning considerations, and downstream impacts of COVID-19 on inpatient psychiatric care. COVID-19 is a novel coronavirus that has been declared a pandemic. Challenges for inpatient psychiatry include risky close contact among staff and patients, space constraints, and structural barriers in care delivery. Nuanced considerations of five contingency planning strategies in response to COVID-19 are described, including COVID-19-specific precautions, visitor restrictions, physician workforce considerations, operational adjustments, and group therapy changes. Organized leadership and clear communication are identified as early priorities in pandemic response to minimize misinformation and address immediate challenges.

Training healthcare assistants working in adult acute inpatient wards in Psychological First Aid: An implementation and evaluation study.

WHAT IS KNOWN ON THE SUBJECT: Healthcare assistants are untrained and unregistered frontline staff but are expected to be proactive in preventing and responding to 'untoward' incidents quickly and efficiently when working within adult acute inpatient psychiatric settings. Healthcare assistants should be trained to provide enhanced care to service users residing in acute psychiatric settings. To date, a training programme in Psychological First Aid has not been expended in such a setting with nonregistered staff. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: The study demonstrates that training healthcare assistants in Psychological First Aid is useful in improving their confidence in caring for service users, therapeutic engagement with service users and ward culture in general. WHAT ARE THE IMPLICATIONS FOR PRACTICE: A training programme in Psychological First Aid for healthcare assistants to enhance ward culture can be implemented in different practice environments. Psychological First Aid is harmonious with nursing values and provides healthcare assistants with a relevant, useful and easily understood toolkit to apply in acute psychiatric settings. ABSTRACT: Introduction Healthcare assistants working within adult acute inpatient psychiatric settings are untrained and unregistered, however, they can contribute to quality service if they receive some training. Psychological First Aid training has never been expended in these settings, so this study intends to fill this gap in the existing evidence with this category of healthcare personnel. Aim The aim of this study was to introduce and evaluate first aid training for healthcare assistants. Method A pre/post design was adopted to gather data using questionnaires and interviews. The groups of participants included 16 healthcare assistants trained in Psychological First Aid, a sample of service users and four ward managers. Results Post-training, (a) healthcare assistants and service users ranked the therapeutic milieu of the ward more favourably, (b) the self-efficacy of the healthcare assistants increased, and the number of 'untoward' incidents decreased, and (c) health care assistants' confidence in their skills was high. The ward manager interviews post-training revealed four themes: (a) staff utilization of new skills and renewed enthusiasm, (b) calmer atmosphere on the ward and staff togetherness, (c) confidence and reflection on practice and (d) therapeutic engagement. Discussion Training healthcare assistants is useful in improving staff confidence, therapeutic engagement with service users and ward culture in general. Implications for practice Techniques and skills learnt are relevant and useful to healthcare assistants and provide an easily understood toolkit that is harmonious with nursing values. If executed correctly, the training can enhance practice and care outcomes and the overall service user experience.

Implementation of a wound care education project to improve the wound care competency among psychiatric nurses: A quality improvement project and feasibility study.

WHAT IS KNOWN ON THE SUBJECT?: Compared to the general population, people with mental illness die several years prematurely. The prevalence of chronic physical illnesses such as diabetes and cardiovascular disease is higher in people with mental health illnesses, putting them at increased risk of developing skin wounds. The majority of the studies on wound care education and management were carried out in acute care and long-term care settings. A very few addressed the wound care needs for psychiatric patients and the educational needs of nurses in the mental health setting. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study adds to the existing evidence by offering an evidence-based solution to equip Psychiatric and Mental Health Nurses (PMHNs) with the necessary knowledge and skills to provide high-quality wound care to patients. When a lack of wound care competency has been identified, it may be worth the effort to provide education and training to psychiatric nurses on wound care management. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This project has the potential benefit of healthcare cost savings, which can be further investigated in a future study, for instance, a pilot randomized controlled trial to estimate the parameters for a full-trial and cost-effectiveness study. Future mental health nursing practice and research need to focus on finding solutions to help support PMHNs improve their competence in caring for physical illnesses. ABSTRACT: Introduction People with mental illnesses are at increased risk of developing skin wounds. A very few studies addressed the wound care needs for psychiatric patients and the educational needs for psychiatric and mental health nurses (PMHNs). Aim A wound care education-feasibility and quality improvement project-was implemented to improve wound care competence among nurses on the Seniors' Mental Health Units at a psychiatric hospital. Methods A total of 36 nurses participated in wound care knowledge education and completed both the pretest and post-test. Four nurses participated in wound care skills training. Results The post-intervention mean score increase for wound care knowledge was 5.14 (178%) and for skills was 7(75.7%). The results were statistically significant (p < .001). Discussion This study adds to the existing evidence by offering an evidence-based solution to equip PMHNs with the necessary knowledge and skills to provide high-quality wound care to patients. Implications for Practice and Research Future mental health nursing practice and research need to focus on finding evidence-based practical solutions to help support PMHNs improve their ability to care for physical illnesses. A future pilot randomized controlled trial will be needed to estimate the parameters for a full-trial and cost-effectiveness study.

Activities on acute mental health inpatient wards: A narrative synthesis of the service users' perspective.

WHAT IS KNOWN ON THE SUBJECT?: Boredom is a big issue on inpatient mental health wards that is linked to poor patient satisfaction, feelings of frustration and increased incidents of self-harm and aggression. This is even more so for people detained under the Mental Health Act. Where wards have a good range of activities, for example art, music, computer games, gardening and exercise, service users felt less bored and had improved well-being. Over many years, studies have reported a lack of activities, especially during evenings and weekends. It has also been found that little is known about what activities service users want, or how activities might be meaningful for them. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This review found that very few studies have asked service users about what activities would be useful and why. By seeing what makes activities desirable and accessible, we can understand how to improve the experiences of service users on wards. Overall, these data help to understand what impact activities (or lack of activities) have on service users and staff experiences on these wards. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Through identifying the activities most appreciated and engaged with by service users and by asking service users what activities they would like available, we can inform best practice guidance for the commissioning and provision of inpatient mental health care. This will enable service provider organizations to target their effort and resources on supporting good practice and to redirect resources from less useful activities. ABSTRACT: Background Concern about the lack of activities on mental health inpatient wards is long-standing with reports consistently finding that service users receive insufficient access to a range of activities and report high levels of boredom. There is recognition that little is known about what service users want when admitted to inpatient wards. Aim This review seeks to understand service users' experiences and views in relation to the provision and availability of activities, and to explore the perceived benefits and barriers to service users. Methods We searched multiple databases (Scopus, MEDLINE, CINAHL, PsycINFO and Embase) for studies that evaluated activities on acute adult inpatient mental health wards. We identified 12 papers across a range of methodological designs from which the narrative synthesis has been analysed. Results Findings show that the provision of activities is unsatisfactory for many service users, which in turn is related to increased boredom that has a negative impact on service users' well-being. We explore the benefits and barriers to engagement, providing an insight into the aspects that make an activity important. Conclusion There are few studies exploring the needs of service users regarding activity provision; therefore, there is limited knowledge about what is meaningful for individuals.

Factors influencing adequate and effective clinical supervision for inpatient mental health nurses' personal and professional development: An integrative review.

WHAT IS KNOWN ON THE SUBJECT: CS was developed to give healthcare professionals a space to reflect, problem solve and recognise their own practice. It is different from managerial supervision as it is for the benefit of the individual staff member's personal and professional development firstly, but can potentially benefit the quality of care delivered by the organisation. There have been a range of problems associated with inpatient mental health nurses' engagement in CS and in experiencing the benefits of CS. This is concerning for the delivery of high quality care and the recruitment and retention of inpatient mental health nurses. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE: This paper explores and identifies factors influencing adequate and effective CS for inpatient mental health nurses' personal and professional development. It identifies 6 themes incorporating enablers and barriers for inpatient mental health nurses' CS which lead to practice recommendations for improvement. WHAT ARE THE IMPLICATIONS FOR PRACTICE: This paper advocates a needs analysis to improve access to CS for inpatient mental health nurses. This review specifically adds further knowledge relating to inpatient mental health nurses' engagement with CS which the application of the needs analysis could influence. ABSTRACT: Introduction Clinical supervision (CS) has been recognized as a reflective mechanism in inpatient mental health nursing practice; however, it remains unclear what adequate and effective supervision entails for inpatient mental health nurses. Aim To explore factors which influence adequate and effective clinical supervision for inpatient mental health nurses' personal and professional development. Method Whittemore and Knafl's model for ensuring rigour was utilized. This included stages to address problem identification, literature searching, data evaluation, data analysis and presentation. Seven electronic databases were searched with hand searching/Internet searching. Fourteen retrieved articles were selected and appraised using the Mixed Method Appraisal Tool (MMAT). The data extracted from the papers were analysed thematically. Results The review synthesis resulted in identifying six themes: (a) what makes CS effective; (b) reflection; (c) the facilitation of professional identity and knowledge through CS; (d) participation; (e) knowledge and understanding of CS; and (f) the facilitation of personal awareness and coping. Discussion This review adds further knowledge on the identification of effective CS for inpatient mental health nurses as a defined occupational healthcare group. Implications for practice A suggested needs analysis is presented to improve access to CS options with the aim of promoting effective CS and increased engagement.

Evaluation of the transitional discharge model on use of psychiatric health services: An interrupted time series analysis.

WHAT IS KNOWN ON THE SUBJECT?: The period between hospital discharge and community reintegration is a vulnerable time for people with mental illness due to a lack of continuity of care. They are at a high risk of undesired outcomes, including return to hospital. Many transitional models have been developed. It is important to continue evaluating models for improvement and adaptability to different contexts. The transitional discharge model (TDM) is an intervention that incorporates both continued support from hospital staff after discharge and peer support to facilitate a smooth transition. Previous studies have reported positive outcomes such as increased discharges, decreased readmissions, reduced inpatient length of stay and improved quality of life. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Health service use outcomes were examined separately for acute and tertiary care psychiatric units. Previous TDM studies in Canada only examined tertiary care units, but many patients also receive care in acute care units. Although recent studies of different interventions generally reported decreased readmissions, the current study found readmissions increased after TDM and then decreased over time for acute care units, whereas no change was observed for tertiary care units. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Transitional discharge model evidence supports nursing practice based on interpersonal relations and strategies. Nurses need to be aware of peer support resources to facilitate this part of the model. The effectiveness of TDM may be increased by considering the differences in needs of distinct patient groups, such as those discharged from acute versus tertiary care units. ABSTRACT: Introduction The transitional discharge model (TDM) bridges hospital discharge and community living for people receiving psychiatric services. TDM, based on Peplau's theory of interpersonal relations, ensures continued support from hospital staff until a therapeutic relationship is established with community providers and formal peer support. Aim To compare temporal trends in psychiatric health services use before and after TDM implementation within acute and tertiary care psychiatric units in Ontario, Canada. Method Using health administrative databases, monthly discharges from psychiatric units 3 years prior to 2 years after TDM implementation were identified. Median inpatient length of stay (LOS), psychiatric readmission rates and mental health-related emergency department visit rates were compared using segmented regression analyses. Results Among acute care units, median LOS decreased significantly below the projected historical trend following TDM implementation, while readmissions increased significantly and declined thereafter. No significant changes were found for tertiary care units. Discussion Studies on various interventions have shown decreased readmission rates, whereas the trend differed between acute and tertiary care units in this study. Possible reasons include different patient needs and staff practices. Implications for Practice Needs of people from different unit types should be considered when implementing TDM. Nurses should recognize the development of therapeutic relationships and availability of peer support resources.

Reducing adverse medication events in mental health: Australian National Survey.

AIM: To determine the extent to which evidence-based medication safety practices have been implemented in public and private mental health inpatient units across Australia. METHODS: The Reducing Adverse Medication Events in Mental Health survey was piloted in Victoria, Australia, in 2015, and rolled out nationally in 2016. In total, 235 mental health inpatient units from all States and Territories in Australia were invited to participate. The survey included questions about the demographics of the mental health unit, evidence-based strategies to improve prescription writing, the administration and dispensing of medicines and pharmacy-led interventions, and also questions relating to consumer engagement in medication management and shared decision-making. RESULTS: The response rate was 45% (N = 106 units). Overall, the survey found that 57% of the mental health units had fully or partially implemented evidence-based medication safety practices. High levels of implementation (80%) were reported for the use of standardized medication charts such as the National Inpatient Medication Chart as a way to improve medication prescription writing. Most (71%) of the units were using standardized forms for recording medication histories, and 56% were using designated forms for Medication Management Plans. However, less than one-fifth of the units had implemented electronic medication management systems, and the majority of units still relied on paper-based documentation systems.Interventions to improve medicine administration and dispensing were not highly utilized. Individual patient-based medication distribution systems were fully implemented in only 9% of the units, with a high reliance (81%) on ward stock or imprest systems. Tall Man lettering for labelling was implemented in only one-third of the units.Pharmacy services were well represented in mental health units, with 80% having access to onsite pharmacist services providing assessments of current medications and clinical review services, adverse drug reaction reporting and management services, patient and carer education and counselling, and medicines information services. However, pharmacists were involved in only half of medical reconciliations. Their involvement in post-discharge follow-up was limited to 4% of units. CONCLUSIONS: Gaps in medication safety practices included limited use of individual patient supply systems for medication distribution, a high reliance on ward stock systems and high reliance on paper-based systems for medication prescribing and administration. With regards to service provision, clinical pharmacist involvement in medical reconciliation services, therapeutic drug monitoring and interdisciplinary ward rounds should be increased. Discharge and post-discharge services were major gaps in service provision.

Barriers and facilitators to incident reporting in mental healthcare settings: A qualitative study.

WHAT IS KNOWN ON THE SUBJECT?: The barriers and facilitators to incident reporting are becoming well known in general healthcare settings due to a large body of research in this area. At present, it is unknown if these factors also affect incident reporting in mental healthcare settings as the same amount of research has not been conducted in these settings. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: Some of the barriers and facilitators to incident reporting in mental healthcare settings are the same as general healthcare settings (i.e., learning and improvement, time and fear). Other factors appear to be specific to mental healthcare settings (i.e., the role of patient diagnosis and how incidents involving assault are dealt with). WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Interventions to improve incident reporting in mental healthcare settings may be adapted from general healthcare settings in some cases. Bespoke interventions for mental healthcare settings that focus specifically on violence and aggression should be co-designed with patients and staff. Thresholds for incident reporting (i.e., what types of incidents will not be tolerated) need to be set, communicated and adopted Trust wide to ensure parity across staff groups and services. ABSTRACT: Introduction Barriers and facilitators to incident reporting have been widely researched in general health care. However, it is unclear if the findings are applicable to mental health care where care is increasingly complex. Aim To investigate if barriers and facilitators affecting incident reporting in mental health care are consistent with factors identified in other healthcare settings. Method Data were collected from focus groups (n = 8) with 52 members of staff from across West London NHS Trust and analysed with thematic analysis. Results Five themes were identified during the analysis. Three themes (a) learning and improvement, (b) time and (c) fear were consistent with the existing wider literature on barriers and facilitators to incident reporting. Two further themes (d) interaction between patient diagnosis and incidents and (e) aftermath of an incident-prosecution specifically linked to the provision of mental health care. Conclusions Whilst some barriers and facilitators to incident reporting identified in other settings are also prevalent in the mental healthcare setting, the increased incidence of violent and aggressive behaviour within mental health care presents a unique challenge for incident reporting. Clinical implications Although interventions to improve incident reporting may be adapted/adopted from other settings, there is a need to develop specific interventions to improve reporting of violent and aggressive incidents.

The psychiatric ward environment and nursing observations at night: A qualitative study.

WHAT IS KNOWN ON THE SUBJECT?: Nursing observations at night are conducted on psychiatric wards to ensure the safety and well-being of patients as well as to reduce the risk of suicide or severe harm. To our knowledge, no studies have examined the lived experience of the psychiatric ward environment and of nursing observations at night. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: The main complaint from patients was the constant interruption of their sleep, as most of the patients in this study were observed 2-4 times an hour. Their sleep was interrupted by (a) the light from torches shone into their faces by staff checking on their safety, (b) the noises produced by the opening and closing of bedroom/ward doors, and/or (c) staff talking to each other during the observation. Patients also reported that they found having somebody enter the room in the middle of the night intimidating and unsettling. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Poor sleep has been associated with an increase in suicide risk and mental health problems. Identifying practices that promote sleep hygiene is vital. The study could be used to develop a Quality Improvement Project to improve patients' sleep and perhaps reduce duration of stay. ABSTRACT: Introduction A fundamental component of nursing care is observations at night to ensure the well-being of patients. However, there is no literature on the lived experience by inpatients of such observations or of the general environment of a psychiatric ward at night. Aim/Question This study aims (a) to understand the lived experience of being an inpatient on a psychiatric ward at night with a focus on intermittent observations and (b) contribute to developing a tool to monitor the psychiatric ward environment for use in quality improvement projects. Method Semi-structured interviews were conducted with twelve inpatients from five psychiatric wards who had experienced intermittent observations at night. These interviews were subsequently transcribed and analysed using content analysis. Results Environmental disturbances including light and noise, invasion of privacy and safety considerations on the ward all contributed to sleep disturbance. The unintended consequences of disturbances caused by intermittent night observations, and by staff in general and other patients formed the core of the inpatients' experience. We developed a clinical tool that could be used to identify the factors that are relevant on an individual ward. Discussion Participants interviewed unanimously agreed that poor sleep quality had a significant negative impact on their psychological and social well-being. These were discussed in relation to the environment and the experience of observations at night. Implications for nursing practice Deprivation of inpatients' sleep is currently under-reported, and the usefulness of intermittent observations at night in psychiatric wards is questioned. Much could be done to adjust the environment at night to support quality sleep and improve psychiatric symptoms. This paper aims to highlight the lived experience of patients to help bring improvements.

Enfermagem em unidade de internação psiquiátrica / Enfermería en unidad de internación psiquiátrica / Nursing in the psychiatric hospitalization unit

OBJETIVO: Conhecer a opinião de trabalhadores da enfermagem e portadores de transtornos mentais sobre a assistência de enfermagem em unidade de internação psiquiátrica. MÉTODO: Estudo exploratório com 27/84 pacientes, 10/14 auxiliares de enfermagem e 6/6 enfermeiros de uma unidade psiquiátrica de hospital geral. Entrevistas individuais baseadas em questões norteadoras. Análise temática de conteúdo. RESULTADOS: pacientes: mulheres (66,7%); média etária 41,9 anos; primeira internação (44%). Profissionais: 68,8% mulheres, em média, formados há 9,8 anos. A enfermagem enfrenta dificuldades relacionadas aos pacientes (alucinações/delírios, crianças, isolamento, risco de suicídio, sintomas maníacos) e à rotina de trabalho (burocracia, omissão perante condutas inadequadas dos colegas, número insuficiente de profissionais, organização vertical do trabalho em equipe). CONCLUSÃO: Apesar da evolução da reforma psiquiátrica e dos avanços profissionais, a enfermagem ainda enfrenta dificuldades no cuidado aos pacientes internados. Identificálas, ajuda a refletir e aprimorar a prática profissional

OBJETIVOS: Identificar la opinión de los trabajadores de enfermería y los portadores de trastornos mentales sobre la asistencia de la enfermería en el servicio de internación psiquiátrica. MÉTODO: Estudio exploratorio con 27 pacientes, 10 asistentes de enfermería y seis enfermeros de una unidad de internación psiquiátrica de hospital general. Encuestas individuales basadas en cuestiones norteadoras. Análisis de contenido temático. RESULTADOS: pacientes: mujeres (66,7%); promedio de 41,9 años; primera internación (44%). Profesionales: mujeres (68,8%); graduados hace 9,8 años. La enfermería enfrenta dificultades relacionadas a los pacientes (alucinaciones/delirios, niños, aislamiento, riesgo de suicidio, síntomas maníacos) y la rutina de trabajo (actividades burocráticas, omisión delante de conductas inadecuadas de los colegas, número insuficiente de profesionales, organización vertical del trabajo en equipo. CONCLUSIÓN: Además de la evolución de la reforma psiquiátrica y de los avances profesionales, la enfermaría todavía afronta dificultades en el cuidado a pacientes internados. Identificarlas, ayuda a reflexionar sobre esta práctica profesional y su perfeccionamiento

AIM: Identify the opinion of nursing professionals and mental health patients about the nursing care in the service of psychiatric hospitalization. METHODS: Exploratory study with 27 patients, 10 nursing assistants and 6 nurses from a psychiatric hospitalization unit of a general hospital. Individual interviews based on guiding questions. Thematic content analysis. RESULTS: patients: women (66,7%); mean age 41,9 years old; first hospitalization (44%). Professionals: women (68,8%); graduated for 9,8 years. The nursing faces difficulties related to patients (hallucinations/deliria, children, isolation, suicide risk, mania symptoms) and work routine (bureaucratic activities, omission before misconduct of colleagues, insufficient number of professionals, vertical organization of teamwork). CONCLUSION: Despite the evolution in the psychiatric reform and the professional advancement, the nursing still faces difficulties in the care of hospitalized patients. Identifying them helps to reflect about this professional practice and its improvement

Patient safety in inpatient mental health settings: a systematic review.

OBJECTIVES: Patients in inpatient mental health settings face similar risks (eg, medication errors) to those in other areas of healthcare. In addition, some unsafe behaviours associated with serious mental health problems (eg, self-harm), and the measures taken to address these (eg, restraint), may result in further risks to patient safety. The objective of this review is to identify and synthesise the literature on patient safety within inpatient mental health settings using robust systematic methodology. DESIGN: Systematic review and meta-synthesis. Embase, Cumulative Index to Nursing and Allied Health Literature, Health Management Information Consortium, MEDLINE, PsycINFO and Web of Science were systematically searched from 1999 to 2019. Search terms were related to 'mental health', 'patient safety', 'inpatient setting' and 'research'. Study quality was assessed using the Hawker checklist. Data were extracted and grouped based on study focus and outcome. Safety incidents were meta-analysed where possible using a random-effects model. RESULTS: Of the 57 637 article titles and abstracts, 364 met inclusion criteria. Included publications came from 31 countries and included data from over 150 000 participants. Study quality varied and statistical heterogeneity was high. Ten research categories were identified: interpersonal violence, coercive interventions, safety culture, harm to self, safety of the physical environment, medication safety, unauthorised leave, clinical decision making, falls and infection prevention and control. CONCLUSIONS: Patient safety in inpatient mental health settings is under-researched in comparison to other non-mental health inpatient settings. Findings demonstrate that inpatient mental health settings pose unique challenges for patient safety, which require investment in research, policy development, and translation into clinical practice. PROSPERO REGISTRATION NUMBER: CRD42016034057.

Implementation of the CLiP database.

PURPOSE: The purpose of this paper is to review the findings from an audit of the implementation of a consultation-liaison psychiatry (CLiP) database in all inpatients referred to a CLiP service at the largest hospital in Malaysia with the aim of improving the quality CLiP services. DESIGN/METHODOLOGY/APPROACH: All inpatient referrals to the CLiP team were recorded over a three-month period and compared to previous audit data from 2017. Four audit standards were assessed: the reporting of referrals, timeliness of response indication of reason for referral and presence of a management plan. FINDINGS: The compliance of reporting using the CLiP form was 70.1 per cent compared to 28 per cent in the audit data from 2017 after interventions were conducted. Analysis of the completed CLiP form reveals that 89 per cent of referrals were seen within the same working day. All referrals included the reason for referral. The most common reason for referral was for depressive disorders, but post-assessment, delirium was the most common diagnosis. In total, 87.8 per cent satisfied the audit criteria for a completed written care plan. ORIGINALITY/VALUE: Specialised CLiP services are relatively new in Malaysia and this is the first paper to examine the quality of such services in the country. Interventions were effective in improving the compliance of reporting using the CLiP database. The findings suggest that the CLiP services are on par with international audit standards. Furthermore, data from this clinical audit can serve as a benchmark for the development of national operating policies in similar settings.

The quality and quantity of staff-patient interactions as recorded by staff. A registry study of nursing documentation in two inpatient mental health wards.

BACKGROUND: Therapeutic staff-patient interaction is fundamental in psychiatric care. It is recognized as a key to healing in and of itself, or a premise to enhance psychiatric treatment adherence. Still, little is known about how these interactions are recorded in nursing documentation. The purpose of the study was to assess the quality and quantity of staff-patient interactions as recorded in progress notes in nursing documentation. METHODS: The study has an observational registry study design. A random sample of 3858 excerpts was selected from progress notes in 90 patient journals on an acute psychiatric unit and an open inpatient district psychiatric centre (DPC) in Norway. The Scale for the Evaluation of Staff-Patient Interactions in progress notes (SESPI) was used to assess the progress note excerpts. It is developed to assess the quality and quantity in excerpt descriptions of staff-patient interactions in terms of empathic attunement. Descriptive statistics were calculated for the total sample and for each ward separately. Ordinal and multinomial logistic regression were used to estimate control for shift type, staff education level, and type of hospital ward. RESULTS: Only 7.6% of the total number of excerpts (N = 3858) described staff-patient interactions sufficiently to analyze them in terms of attunement. Compared to the DPC, the acute ward reported more staff-patient interactions. The evening excerpts reported more successful types of attunement than those from the night shifts. Education level did not contribute significantly to our models. CONCLUSION: These findings present a unique insight into the quality and quantity of mental health nursing documentation regarding staff-patient interactions. Therapeutic interactions where staff tried to attune to the patients were rarely described. However, this is the first study measuring nursing documentation with the SESPI, and more studies are required to validate the scale and our findings. One potential clinical implication of this research is the development of a scale that personnel in psychiatric wards can have for evaluation of the quality of their reporting practice with emphasis on staff-patient interactions. By regular use this may help keeping up emphasis on emphatic attunement in milieu treatment contexts.

Reducing seclusion and restraints on the inpatient child and adolescent behavioral health unit: A quality improvement study.

BACKGROUND: The utilization of seclusion and restraint during psychiatric inpatient treatment increases the risk of trauma, humiliation, physical injuries, psychological distress, and even death. Compared to adult patients, pediatric patients are more likely to be placed in seclusion and restraints. In a short-term child and adolescent behavioral health unit, the average seclusion and restraint rate was 0.031. The hospital's goal was to achieve a zero seclusion and restraint rate. PURPOSE: The purpose of this project was to decrease the rate of seclusion and restraints at the study site. METHOD: A quality improvement study was implemented based on a bundled intervention strategy. The intervention included a decision-making algorithm for initiation of seclusion and restraints, behavioral modification plans for patients at risk of seclusion and restraints, and a patient-debriefing tool to be used post a seclusion and restraint event. Post implementation, data were collected over a 3-month period. RESULTS: The implementation of a seclusion and restraint decision-making algorithm, behavioral modification, and patient debriefing successfully decreased the seclusion and restraint rate by 55% on an inpatient pediatric behavioral health unit. CONCLUSION: Although, the project resulted in a successful reduction in the rates for seclusion and restraint, continued quality improvement efforts are indicated to achieve zero restraint/seclusions on the unit.

A brief intervention to improve rates and quality of physical examinations for admissions to acute adult psychiatry units.

OBJECTIVE: To determine the frequency and quality of physical examinations within 24 h of admission to an acute adult psychiatry unit, and whether a brief intervention involving feedback to clinicians could lead to improvement. METHOD: Retrospective review of the electronic medical records followed by four brief feedback sessions and email correspondence, followed by a further review of the medical records 1 month later. RESULTS: The proportion of patients receiving a physical examination increased from 36/71 (50.7%) in the initial audit to 41/64 (64.1%) in the re-audit. The mean score of the quality of physical examinations improved from 7.5 to 9.3 (out of 15). The greatest improvement on re-audit occurred in the documentation of additional cardiac sounds (33.9% increase), additional breath sounds (17.7% increase), breath sounds (17.1% increase), cardiac sounds (14.2% increase) and bowel sounds (12.5% increase). CONCLUSION: This audit supports the use of brief peer-led feedback to improve the rates and quality of physical examinations.