Patient Safety Strategies in Psychiatry and How They Construct the Notion of Preventable Harm: A Scoping Review

Abstract

Objectives:The literature on patient safety in psychiatry has not been explored systematically in terms of what interventions are used, how they are used, and what type of (preventable) harm is targeted. The aims of this scoping review are to explore patient safety strategies used in psychiatry and determine how they construct the notion of preventable harm. Method:A scoping review of literature on patient safety in psychiatry published in English between 2000 and 2019 was conducted using Scopus, MEDLINE, PsycInfo, and CINAHL. Keywords of patient safety strategies and possible outcomes were coded from the results, discussion, or conclusion. Patient safety strategies were inductively categorized into themes according to the focus of the strategy. Results:The review introduces 7 focus areas of patient safety strategies identified within the psychiatric literature: "risk management," "healthcare practitioners," "patient observation," "patient involvement," "computerized methods," "admission and discharge," and "security." The result shows that patient safety strategies mainly aim to reduce suicide, self-harm, violence, and falls and present a large diversity of measures, often aimed at reducing variability while increasing standardization. Conclusions:The strategies that are supported in the literature to achieve safer psychiatry mainly arise from linear cause-effect models and rely on staff performance, competence, and compliance. Contemporary safety science acknowledges the performance variability of everyday normal work and sees risk as the dynamic migration of these daily activities. The field of psychiatry has not yet included this view of safety in the strategic actions to reduce preventable harm.

Shared understanding of resilient practices in the context of inpatient suicide prevention: a narrative synthesis

“…The CAS perspective of clinical practice in suicide prevention also has implications for learning. To learn from variability, it is necessary to move from simple linear models (e.g., root cause analysis) to systemic models (e.g., resilience, CAS) focusing on why practices vary, succeed or fail at the clinical level, hospital management level and at the health system macro level [9,30,77].…”

“…Feedback systems are needed to acquire knowledge of how to adapt and its outcomes [82]. This implies that, systems in mental healthcare need to collect feedback on everyday clinical practice to learn what fosters success under various conditions (Safety-II), not merely from retrospective views of suicide incidents [6,9,14]. Suicidal patients provide valuable feedback on what makes them feel safe or unsafe, identify conditions for successful treatment, and those that may cause adverse events.…”

“…Methods such as root cause analysis, incident reporting and checklists to reduce healthcare professionals' (HCPs') errors are examples of the traditional approach to patient safety [7,8]. Likewise, in a scoping review of patient safety strategies in psychiatry, Svensson found that these measures are mainly intended to prevent adverse events by focusing on failure and ensuring compliance to procedures [9]. Across countries, clinical practice guidelines on suicide prevention include restricting lethal means, assessing evidence-based suicide risk factors and suicidal intent along with recommended treatment and post-intervention recommendation [10].…”

“…A safety-I approach narrows the gap between what HCPs do in practice and their procedures for that practice [6]. Patient safety in psychiatry has emphasised improving staff compliance to safety-I procedures [9]. At the same time, there is no single means of preventing inpatient suicides, and practice is characterised by uncertainty and complexity.…”

Influencing a Culture of Quality and Safety Through Huddles

“…While there have been efforts to address this safety concern, health care organizations struggle to sustain results due to complex structures and rigorous efforts and extensive costs needed to implement changes 2. Other patient populations, including those with psychiatric conditions, have unique patient safety issues, such as risks of self-harm, restraint injuries, or violence that may be preventable if organizational safety strategies are employed 3–5. In the United States, 115 out of every 1000 hospitalizations result in a preventable safety event, with a cost to payers averaging $8000 per admission 6.…”