Quality improvement in forensic mental health: the East London forensic violence reduction collaborative

Quality improvement in forensic mental health: the East London forensic violence reduction collaborative

Blog Article

Ward-based violence is the most significant cause of reported safety incidents at East London NHS Foundation Trust (ELFT).It impacts on patient and staff safety, well-being, clinical care and the broader hospital community in various direct and indirect ways.The contributing factors are varied and complex.

Several factors differentiate the forensic setting, which has been identified as a particularly stressful work environment.Staff must constantly balance addressing therapeutic needs with robust risk management in a complex patient cohort.ELFT identified reducing inpatient physical violence on mental health wards as a major quality improvement (QI) priority.

The aim was to use a QI Pony methodology to reduce incidents of inpatient violence and aggression across two secure hospital sites by at least 30% between July 2016 and March 2018.Collaborative learning was central to this project.It sought to foster a culture of openness within the organisation around violence and to support service users and staff to work together to understand and address it.

A QI methodology was applied in medium and low secure inpatient settings.A change bundle was tested for effectiveness, which included: safety huddles, safety crosses and weekly community safety discussions.Operational definitions for non-physical violence, physical violence and sexual harassment were developed and used.

Reductions of Horse Water Repellents 8% and 16.6% in rates of physical and non-physical violent incidents, respectively, were achieved and sustained.Compared with baseline, this equated to one less incident of physical and 17 less of non-physical violence per week averaged across seven wards.

Three wards achieved at least a 30% reduction in incidents of physical violence per week.Five wards achieved at least a 30% reduction in incidents of non-physical violence per week.This collaborative brought significant improvements and a cultural shift towards openness around inpatient violence.