548 / Prevention of self harm, suicide and violence in psychiatric wards

ROMANIA
Classification of the PSP
Type of Patient Safety Practice Safe
 
Clinical Practice (CP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Suicide / Self-mutilation
Violence against health care professionals There is no specified text here
Topic of the reported practice
Patient safety system
Aim and the benefit of the Patient Safety Practice
 
The patient safety practice is meant to improve the surveillance and comfort of psychiatric patients in acute phase of illness ( psychotic agitation; delirium; hallucinations, depression, aggression) and reduce the circumstances that may lead to suicide attempt or self mutation to zero and at the same time reduce the risk of violent acts against the health care professionals working in psychiatric and drug addiction wards to zero
Description of the Patient Safety Practice
 
The practice covers the main areas found critical in terms of ensuring an adequate balance between surveillance, personal comfort and quality treatment for our patients from the moment of entering to ER psychiatric ward, on the duration of the first assessment and consultation, along all the period of time spend on hospital and the follow up time done on ambulatory system.
Same time our method covers also the issue of personal security for the health care professionals working on our hospital and to reduce to 0 the violent incidents against them in the interaction with patients on acute phases of illness.
The main conditions for implementing the practice are .
1. Insure an adequate hospital infrastructure for patient safety.
- Arrange very specific separate inner circuits and separate access doors to different levels of the clinic for patients and health care professionals,
- Arrange separate wards on each floor with different level of security measures for patients according to the severity of mental disorder. Access to each ward is possible only with special magnetic cards for the health care professional staff.
- Implement a viable surveillance system. Patients and visitors are accompanied by a staff member for entrance and exit. Surveillance cameras are on each corridor and each entrance door. On the ground floor is a special space with a central monitoring station where the staff from the external surveillance guard is watching 24 hours to prevent unwanted exits or entrances.
- Prepare patient`s rooms to be safe rooms. Patients rooms - only for 2 persons, with restricted window opening to outside building, TV ; AC, and camera surveillance on each patient room connected to main nurse station located on each floor.
- Ensure security measures for all shared spaces by patients - safe bathroom areas, safe eating area for patients, safe waiting areas, safe recreational areas.
- Ensure access to modern and safe consulting cabinets for medical evaluation, individual or group therapy on each floor (ward in this case).
- Offering complex facilities for patients comfort during hospitalization - emergency dental care unit, physical activity, art therapy, a small inner chapel for spiritual guidance when patients request this service.
2. Training the hospital staff for patient safety :
- Developing a health care professionals balanced team form by a diverse number of health care professionals able to cover all patients’ needs
- Ensure professional training for hospital staff – annually
- Create and implement inner procedures and practice guidelines for doctors, nurses and all other staff working in hospital team based on the models of care approved by National Psychiatric Commission and Ministry of Health.
3. ensure a security system for patients and staff protection
- Ensure a professional company for surveillance and protection of the medical unit and medical staff - through an inner mobile guarding unit and an external guarding unit for major intervention on special events
4. Involve patients and their relatives to participate in their own care
- Involving patients on health care process – by signing an agreement when they are admitted on the psychiatric ward, regarding behavior rules on the wards, assuming responsibility to take prescribed medication and participate to different therapeutic activities.
Getting feedback from patients at the end of treatment regarding the quality of care they got or complaints or suggestions they may have on a questionnaire.
- Involving families or relatives of the patients - by sharing responsibilities, in what concerns visits during hospitalization, behavior around hospitalized patients, counseling for coping abilities at home after patients are discharged, assuming responsibility for home treatment administration in correct and continuous way, as prescribed.
This procedure is meant for psychiatric wards from Romania admitting patients presenting violent behavior, psychotic agitation, delirium, withdrawal symptoms, depression. The model of practice presented is actually full implemented and functional on Saint Stelian hospital , Bucharest. The model and the results were presented at “ The Second National Conference on Addictions” organized in Bucharest, on October 2012 for decision makers and psychiatric specialists. The model was implemented in 2 years on Saint Stelian hospital Bucharest starting from 2010 to 2012 and is functional till present day.
Attachment of relevant written information and/or photos, as appropriate
There is no specified text here
There is no specified text here
There is no specified text here
There is no specified text here
Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, fully
Level of implementation of reported practice
Institution level
Specific and measurable outcome for the reported practice were defined
Yes
A baseline measurement before implementation of the reported practice was obtained
Yes
A measurement after full implementation of the reported practice was obtained
Yes
Evaluation of a "positive" effect of the reported practice on Patient Safety
The evaluation showed improvements in Patient Safety outcomes
Type of before-and after evaluation
Qualitative
Enclosure of a reference or attachment in case of published evaluation's results
The model of care was presented at our First National Conference on Drug Addiction Treatment network, in Romanian language, on October 2012, in Bucharest
There is no specified text here
Health care context where the Patient Safety Practices was implemented
 
Hospital
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
Not known
Specification of implementation in another health care setting(s)
There is no specified text here
Successful implementation's level  of this Patient Safety Practice across settings
There is no specified text here
Involved health care staff
 
Physicians
Nurses
Health care assistants
Therapists
Social workers
Clinical support
Administrative support (secretary, clerk, receptionist etc.)
Dentist
Other or not relevant
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
Yes
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
Patient(s)
Relative(s)
Point of time in which service user or their reprasentatives' involvement takes place
During implementation of the Patient Safety Practices
During evaluation of the Patient Safety Practices
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
Yes
Short description of the service users' level of involvement
Consultation, such as asking for information
Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
No
List of sources where public information is accessible
There is no specified text here
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
Yes
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
No
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
There is no specified text here
List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
Management support
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
No
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
Yes
Total number of person days required to implement this Patient Safety Practice
Clinical staff: 11
External consultants: 0
Support staff: 6
Managerial staff: 1
Others: 0
Not relevant: 0
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: 20
External consultants: 0
Support staff: 8
Managerial staff: 1
Others: 0
Not relevant: 0
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
10000
Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
300
Contact information
 
Name: Cristina Hudita
Country: ROMANIA
Organisation: St Stelian Hospital for Psyhiatric and Drug Addiction
E-mail: cristina.hudita@yahoo.com
Phone: +40722585751
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