Patient safety in inpatient mental health settings: a systematic review

Thibaut, Bethan; Dewa, Lindsay H.; Ramtale, Sonny Christian; D’Lima, Danielle; Adam, Sheila; Ashrafian, Hutan; Darzi, Ara; Archer, Stephanie

doi:10.1136/bmjopen-2019-030230

Cited by 63 publications

(61 citation statements)

References 386 publications

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“…It should be aware that nurses' attitudes and beliefs on physical restraints are also key factors affecting the use of physical restraints. Previous surveys (36,37) show that most of ICU's physical restraint decisions are made by nurses. It is therefore particularly important for nurses to have a correct and complete understanding of physical constraints (38).…”

Section: Discussionmentioning

confidence: 99%

The characteristics of ICU physical restraint use and related influencing factors in China: a multi-center study

Zhang¹,

Liu²,

He³

2021

Ann Palliat Med

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Background: The use of physical restraint has been a common phenomenon in clinical practice. However, the current status of physical restraints in intensive care unit (ICU) patients and related potential factors in China remains unclear. We aimed to evaluate the status of physical restraint use of patients in ICU, and to identify the potential factors affecting the physical restraint use.Methods: Patients in 16 ICUs of five hospitals from September 15 to October 15, 2019 were included.The ICU Patients' Physical Restraint Evaluation Scale was used for survey investigation. The basic information, the behavioral, treatment and muscle strength level with 35 detailed items were collected and evaluated. Multivariate logistic regression analyses were performed to identify the potential risks of physical restraint use.Results: A total of 386 ICU patients were included, the incidence of physical restraint use was 59.07%.The incidence of physical restraint uses in patients with irritability, unconsciousness and disorientation, Richmond agitation-sedation scale (RASS) ≥2 or -3< RASS <2 were significantly higher that other conditions (all P<0.05); the incidence of physical restraint uses in patients with continuous renal replacement therapy (CRRT), temporary pacemaker, intracranial pressure (ICP) monitor, invasive blood pressure monitoring, tracheotomy, central venous catheter (CVC), extracorporeal membrane oxygenation (ECMO), peripheral intravenous infusion were significantly higher that other conditions (all P<0.05); the male gender, mechanical ventilation, retained catheters or tubes with level II or irritability were the independently influencing factors for the physical restraint use (all P<0.05). Conclusions:The incidence of physical restraint use is rather high in ICU, clinical attentions are needed especially for those patients with male gender, mechanical ventilation, retained catheters or tubes with level II or irritability.

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Section: Discussionmentioning

confidence: 99%

The characteristics of ICU physical restraint use and related influencing factors in China: a multi-center study

Zhang¹,

Liu²,

He³

2021

Ann Palliat Med

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“…Suicide is a particular concern for patient safety in mental health wards. However, knowledge to support an understanding of safety for patients hospitalised during a suicidal crisis is lacking [1,2]. Despite the growing body of literature on patient safety research, knowledge on patient safety in mental health settings is limited [3].…”

Section: Introductionmentioning

confidence: 99%

Adaptive capacities for safe clinical practice for patients hospitalised during a suicidal crisis: a qualitative study

et al. 2020

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Background: Safe clinical practice for patients hospitalised in mental health care during a suicidal crisis is situated within a dynamic, non-linear and uncertain context. Under such complex conditions, the adaptive capacity is considered vital to handling challenges and changes in clinical care. This study aimed to explore safe clinical practice for suicidal patients hospitalised in mental health wards through understanding healthcare professionals' (HCPs') capacities to adapt to challenges and changes in clinical care. Methods: This study applied a qualitative design with focus group and individual interviews. Twenty-five HCPs participated in the focus groups, and 18 participated in individual interviews. The study was conducted in open and locked wards in a university hospital in Norway providing specialised mental health services for patients with mental illness. Results: HCPs described their adaptive capacities for clinical practice relative to three themes. 1) HCPs used expertise to make sense of suicidal behaviour to support complex decision making. Their strategies included setting aside forms and checklists to prioritise trust and making judgements based on more than just patients' spoken words. They improved their understanding by seeking others' perspectives through collaborative sense-making processes involving the healthcare team and patient. 2) HCPs individualised the therapeutic milieu to address the diversity of patients with suicidal behaviour by creating individual clinical pathways, making trade-offs between under-and over-protection and adjusting observations. 3) HCPs described managing uncertainty as necessary for providing safe clinical practice. They managed uncertainty as a team by developing mutual collegial trust and support and creating a shared understanding. Conclusion: HCPs' adaptive capacities are vital to the complex set of practices involved in safe clinical practice for patients hospitalised during a suicidal crisis. By using expertise, individualising the therapeutic milieu, and managing uncertainty, HCPs individually and collectively develop their capacities to adapt to challenges and changes in clinical care. HCPs cannot easily ensure safe clinical practice by following standards; safe clinical practice depends on HCPs' adaptations. Ward systems that ensure collegial trust and support, as well as arenas that foster shared understanding and situational awareness, are needed.

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“…These findings also overlap with those from a systematic review by Thibaut et al . (2019) who identified ten research categories in inpatient mental health settings. Two of the categories directly overlapped with factors within the YCFF‐MH: safety culture and physical environment.…”

Section: Discussionmentioning

confidence: 99%

Health professionals’ perspectives of safety issues in mental health services: A qualitative study

Albutt

Berzins

Louch

et al. 2021

Int J Mental Health Nurs

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The study aimed to explore mental health professionals’ perceptions of patient safety issues across community and inpatient mental health services. Fourteen mental health professionals across community and inpatient settings participated in qualitative interviews. Framework analysis, guided by the Yorkshire Contributory Factors Framework – Mental Health, was used to analyse the data. Safety issues identified by mental health professionals mapped on to 19 of the 21 factors in the Yorkshire Contributory Factors Framework – Mental Health. The factors most frequently mentioned by participants were ‘safety culture’ which focused on raising concerns, learning from incidents and the influence of targets; ‘communication systems’ to support effective communication between staff; ‘service user factors’ including a perceived increase in illness acuity; ‘service process’ including how patients access and interact with services; and ‘staff workload’ perceived being as unmanageable. Mental health professionals consider there to be a broad range of safety issues associated with mental health services. Future research should aim to develop interventions to improve safety focused across the factors raised by professionals.

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Patient safety in inpatient mental health settings: a systematic review

Cited by 63 publications

References 386 publications

The characteristics of ICU physical restraint use and related influencing factors in China: a multi-center study

The characteristics of ICU physical restraint use and related influencing factors in China: a multi-center study

Adaptive capacities for safe clinical practice for patients hospitalised during a suicidal crisis: a qualitative study

Health professionals’ perspectives of safety issues in mental health services: A qualitative study

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