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TMA Teaching Session

TMA Teaching Session

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Gsa teaching pp Gsa teaching pp Presentation Transcript

  • A guide to the Royal Collage of Psychiatrists National Audit of Violence By Louis R Sideras
  • Aims • To have a better understanding of the wider context of violence in health and social care. • To generate discussion over the accuracy of the findings when compared with our own experiences.
  • About the audit The RCP’ Research and Training Unit established the National Audit of Violence in 1999. 265 inpatient units participated. Its success led the Healthcare Commission to fund a new wave of work, which ended in October 2007. The funding enabled all NHS trusts and independent sector providers of in-patient mental health services in England and Wales to select three wards to take part.
  • Who took part Each participating trust/organisation enrolled • One acute psychiatric ward • One ward of older people with MH problems • One ‘other’ ward of their own choice • A total of 67 Trusts/Organisations took part in the audit, enrolling a total of 211 wards.
  • Key findings cover • Being treated with respect and dignity, and giving privacy and choice • Being offered meaningful occupation • Being given adequate information • Ward communication systems and culture • Staff supervision • Support from other colleagues • Environmental safety • Being supported in relation to actual incidents
  • Being treated with respect and dignity, and giving privacy and choice A large portion of questions in this section were answered positively by the majority of patients. In general, the comments raised specific concerns: • Local practices relating to administration of medication • The involvement of patients in decision making about their own care, particularly in relation to choice of medication and proffered way of being managed in the even of becoming violent • The involvement of patients in decision-making about aspects of how the ward is run, e.g. mealtimes, choice of menu, availability of refreshments outside of meal time, waking times.
  • Being offered meaningful occupation Boredom was still a problem on many wards; Large numbers of patients complained about the lack of exercise and general absence of things to do, particularly in evenings and weekends. The report states that wards should look at this as a mater of priority Measures should also be put in place to ensure that activities and therapies are reviewed regularly so that the provision is appropriate t the current patient and staff mix.
  • Being given adequate information Patient responses show that in the large majority of wards, staff are communicating effectively with them, even during stressful times- such as admission If not currently available, wards should consider providing written information, in a leaflet or on a notice board, to reduce any potential confusion.
  • Ward communication and culture • The overall picture nationally was of coherent, supportive staff teams, with well-structured communication systems and strong multi- disciplinary working. • Most common source of problem was staffing on the ward. Whilst some wards have well-established teams and flexible systems that allow them to manage staffing with ward needs; – Problems recruiting staff – Financial constraints leading to restrictions on Bank/Agency staff and overtime – Poor skills mix – Retaining experienced staff – Financially driven reductions to the number of qualified/unqualified staff – High reliance on Band/Agency staff – Concerns about the gender of ethnic mix of staff teams were generally linked to local recruitment problems
  • Staff training Access to training related to the prevention and management of violence was variable, both between services, and between different respondent groups; • Training of nursing staff in undertaking searches • Training for all staff in recording incidents • On-going competency training in observation for nurses • Access for nurses to all recommended training related to the use of rapid tranquilisation Appeals were expressed for more regular, in-depth, accessible training; In some services, even when training courses were available, staff shortages and difficulties funding backfill often prevented staff from attending. Leavings some staff ill-equipped and ‘at risk’ in volatile environments
  • Staff supervisions Whilst large majority of nursing and other clinical staff were receiving one-to-one clinical support, large numbers were not. Those that were receiving supervisions reported high levels of satisfaction with quality, though nursing staff were less happy with the frequency. As many staff were required to work in increasingly challenging environments, particular value was placed on supervision as a forum for dealing with the aftermath of violent and aggressive incidents. As well as need for flexible access to advice and support.
  • Support from other colleagues Majority of staff reported they were satisfied with the support they received from their team on the ward, though less so with support from senior managers. Many ward staff had become highly reliant on each other, especially in the context of managing actual incidents. On wards were staff teams was unstable and/or high reliance on Bank/Agency, individual team members were often left feeling vulnerable, unsupported and unappreciated.
  • Environmental safety Nationally the results were mixed. Some wards demonstrate well designed, safe environments . However there were many wards where the physical environment exposed staff, patients an visitors to unnecessary risk. • A sizeable number still lack basic safety features e.g.. Alarms • Inappropriate designs e.g. long corridors , blind spots • Audit revealed that new wards were still being built without taking into account available intelligence about safety design
  • Being supported in relation to actual incidents Generally the range of support being offered to patients and visitors in relation to actual incidents were poor. More proactive measures need to be taken to ensure that those at risk have access to advice about what to do in a violent situation Data reporting from serious incidents is high, however services need to examine the potential barriers to reporting for less severe incidents e.g. threatening behaviour