BACKGROUND: Falls are a major health care concern for older adults in hospital settings. The incidence of falls on psychiatric units tends to be higher than that on general acute care hospital units, with estimated rates of 13.1 to 25 per 1,000 inpatient days compared to 3 to 5 per 1,000 inpatient days, respectively. OBJECTIVE: The purposes of this study were to quantify the number and types of falls and identify the associated risk factors relevant to a psychiatric inpatient setting. DESIGN: This was a descriptive study. Data were collected over a 6-month time period. Patients on a 28-bed acute care geriatric psychiatric unit provided the sampling frame. RESULTS: Twenty-eight patients fell during the study period for a total 45 falls. Six patients experienced multiple falls during their stay. Most of the falls that occurred did not result in serious injury. Individuals who experienced a fall were about 3 years older than nonfallers (73.6 years versus 76.36 years). There was no difference by gender as to rate of falls. Activity level was higher for the patients who had a fall, and medication had the strongest relationship to a falls episode. When census was low, the fall rate was slightly higher. CONCLUSIONS: There are many variables that contribute to the phenomenon of falls in an acute geriatric psychiatric inpatient unit. Use of research findings will allow the development of a fall risk prevention protocol to provide the safest environment and best quality of care possible for the geriatric patient.

The authors describe a quality and safety initiative designed to decrease seclusion/restraint (S/R) and present the results of a pilot study that evaluated the effectiveness of this program. The study sample consisted of consecutive admissions to a 120-bed psychiatric service after the intervention was implemented (October 2010-September 2012, n = 8029). Analyses compared S/R incidence and duration in the study sample to baseline (consecutive admissions during the year prior to introduction of the intervention, October 2008-September 2009, n = 3884). The study intervention, which used evidence-based therapeutic practices for reducing violence/aggression, included routine use of the Brøset Violence Checklist, mandated staff education in crisis intervention and trauma informed care, increased frequency of physician reassessment of need for S/R, formal administrative review of S/R events and environmental enhancements (e.g., comfort rooms to support sensory modulation). Statistically significant associations were found between the intervention and a decrease in both the number of seclusions (p < 0.01) and the duration of seclusion per admission (p < 0.001). These preliminary results support the conclusion that this intervention was effective in reducing use of seclusion. Further study is needed to determine if these prevention strategies are generalizable, the degree to which each component of the intervention contributes to improve outcome, and if continuation of the intervention will further reduce restraint use.

Introduction: In behavioral health care settings, a workforce well trained in suicide prevention is critically important for behavioral health care professionals across different disciplines and service sectors who are likely to have considerable exposure to patients at risk for suicidal behavior. This study examined the types of training behavioral health care professionals received, their self-reported skills, comfort level and confidence related to suicide prevention, the association of types and length of training with skills, comfort level and confidence, and areas in which participants would like more training. Methods: The Zero Suicide Workforce Survey was administered electronically to behavioral health care professionals at six behavioral health treatment centers with both inpatient and ambulatory programs in Connecticut, USA. Item numbers and percentages were calculated for 847 respondents with behavioral health care roles. The chi-square tests were performed to determine the statistical significance of group differences. Non-parametric sign tests were performed to determine the statistical significance of the collective differences in direction among items between groups. Results: Suicide prevention training is associated with increased levels of behavioral health care professionals’ skills and confidence, but one-third of behavioral health care professionals in the sample received no formal training in suicide prevention/intervention. Even brief training appears to have a positive impact on behavioral health care professionals’ assessment of their skills and confidence. Prominent topics for additional training include suicide-specific treatment approaches, suicide prevention and awareness, and identification of risk factors and warning signs. Conclusion: Although behavioral health care professionals may often encounter patients at risk for suicide, many have not obtained any relevant training. The findings highlight the need to strengthen suicide identification, assessment and treatment within behavioral health care treatment settings as part of an effort to prevent suicide.

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