Q-15 checks and 1:1 observations: Exacerbating a problem we are trying to solve?

Gazor, Afsoon; Mathew, Sanjay J.; Patriquin, Michelle A.

doi:10.1016/j.jad.2019.11.018

Cited by 7 publications

(4 citation statements)

References 16 publications

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“…Staff have also reported an improved understanding of precursors to self‐harm due to being able to review blurred footage of an incident directly after it has occurred. Another possible indirect mechanism is via decreased sleep disturbance: staff can use the VBPMS to carry out observation rounds remotely at night (Barrera et al., 2020) which could lead to fewer sleep problems for patients and, in turn, reduced suicidal ideation (Gazor et al., 2020). Research is needed to fully uncover and understand the myriad of ways in which adopting the system into clinical practice on acute mental health wards has the potential to prevent patients from harming themselves.…”

Section: Discussionmentioning

confidence: 99%

RETRACTED: Reduced self‐harm on acute mental health wards following the implementation of a vision‐based patient monitoring system: Evidence from five NHS trusts

Kekic,

Rose,

Baker

et al. 2024

Psychiatric Ment Health Nurs

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Accessible SummaryWhat is known on the subject? Inpatient mental health settings pose unique challenges for patient safety, in part because psychiatric disorders are well‐known risk factors for self‐harm and suicide. Ward staff follow protocols to try and keep patients safe including carrying out in‐person safety checks, usually every 15 min, but patients unfortunately still find opportunities to harm themselves. A vision‐based patient monitoring system (VBPMS) is a contact‐free technology that can help mental health nurses to monitor patients in hospital more effectively. For example, the tool alerts staff to situations where a patient might need assistance, like when they spend a long period of time in their ensuite bathroom. Research has shown that the VBPMS can support staff to prevent safety incidents from occurring and a recent study found a decrease in self‐harm after the tool was implemented at one NHS mental health trust. What does the paper add to existing knowledge?This paper presents data from five NHS mental health trusts and suggests that the VBPMS can consistently help staff to prevent self‐harm on acute mental health wards.What are the implications for practice? Managing self‐harm behaviours is a challenge for mental health nursing staff. Standard safety protocols are not effective enough – staff need new ways to monitor patients. In general hospitals, technology is used every day to support care. This research shows that the VBPMS can be used to improve patient safety in mental health hospitals. AbstractIntroductionSelf‐harm is sadly relatively common in mental health inpatient settings, and the effectiveness and appropriateness of strategies used to prevent it have long been disputed. The use of vision‐based patient monitoring systems (VBPMS) has been shown to improve various safety outcomes. Their potential to support staff in preventing inpatient self‐harm warrants further exploration.AimThis research investigated whether implementing a VBPMS—as an adjunct to existing clinical practice—within acute inpatient services at five NHS England mental health trusts led to reductions in self‐harm.MethodFive quasi‐experimental studies assessed the number of bedroom self‐harm incidents, across 12 adult wards, before and 5–12 months after a VBPMS was deployed. Percentage changes were calculated. Four studies used control groups and were included in a fixed‐effect meta‐analysis.ResultsIn the meta‐analysis, a significant inverse‐weighted average relative risk percentage change of −38.9% was recorded. For the study with no control groups, reductions in self‐harm were seen across all wards (range: −9.1% to −29.8%).DiscussionThis research demonstrates that VBPMS can support clinicians to create safer ward environments by preventing incidents of self‐harm from occurring.Implications for PracticeThe results provide preliminary support for wider rollout of the technology on acute mental health wards.

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Section: Discussionmentioning

confidence: 99%

RETRACTED: Reduced self‐harm on acute mental health wards following the implementation of a vision‐based patient monitoring system: Evidence from five NHS trusts

Kekic,

Rose,

Baker

et al. 2024

Psychiatric Ment Health Nurs

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“…As suicide rates continue to climb, inpatient psychiatrists are obligated to better understand all suicide outcomes: ideation, attempt, and death. Thus, we have advocated across multiple papers for reexamining our safety protocols and outcomes to determine the underlying predictors of this high-risk period (Gazor et al, 2020; Johnson et al, 2021). Inpatient psychiatric care has been revolutionized and greatly improved across the last 100 years.…”

Section: Discussionmentioning

confidence: 99%

“…Inpatient psychiatric care has been revolutionized and greatly improved across the last 100 years. However, there remain tremendous opportunities that we have described elsewhere (Gazor et al, 2020; Johnson et al, 2021) to continue to generate impactful clinical innovations that alleviate symptoms, reduce the risk of suicide, and save lives.…”

Section: Discussionmentioning

confidence: 99%

A false sense of security: Rapid improvement as a red flag for death by suicide.

Rufino

Beyene

Poa

et al. 2022

Journal of Consulting and Clinical Psychology

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Objective: Postdischarge from inpatient psychiatry is the highest risk period for suicide, thus better understanding the predictors of death by suicide during this time is critical for improving mortality rates after inpatient psychiatric treatment. As such, we sought to determine whether there were predictable patterns in suicide ideation in hospitalized psychiatric patients. Method: We examined a sample of 2,970 adult’s ages 18–87 admitted to an extended length of stay (LOS) inpatient psychiatric hospital. We used group-based trajectory modeling via the SAS macro PROC TRAJ to quantitatively determine four suicide ideation groups: nonresponders (i.e., high suicide ideation throughout treatment), responders (i.e., steady improvement in suicide ideation across treatment), resolvers (i.e., rapid improvement in suicide ideation across treatment), and no-suicide ideation (i.e., never significant suicide ideation in treatment). Next, we compared groups to clinical and suicide-specific outcomes, including death by suicide. Results: Resolvers were the most likely to die by suicide postdischarge relative to all other suicide ideation groups. Resolvers also demonstrated significant improvement in all clinical outcomes from admission to discharge. Conclusion: There are essential inpatient psychiatry clinical implications from this work, including that clinical providers should not be lulled into a false sense of security when hospitalized adults rapidly improve in terms of suicide ideation. Instead, inpatient psychiatric treatment teams should increase caution regarding the patient’s risk level and postdischarge treatment planning.

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“…On the regulatory side, the Joint Commission has extensive standards that are tied to accreditation, but practices related to meeting these standards are not necessarily indicative of quality care (Gazor et al, 2020). After a 10-year development period, the core quality measures for inpatient psychiatric care, the Hospital-Based Inpatient Psychiatric Services (HBIPS) are being implemented (Blair et al, 2015; CMS, 2019b).…”

mentioning

confidence: 99%

Delineating Quality Indicators of Inpatient Psychiatric Hospitalization

Delaney

Loucks²,

Ray

et al. 2020

J Am Psychiatr Nurses Assoc

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BACKGROUND: Assuring quality care is critical to the well-being and recovery of individuals receiving inpatient psychiatric treatment, yet a comprehensive map of quality inpatient care does not exist. AIMS: To isolate and describe quality elements of inpatient psychiatric treatment. METHOD: A survey queried psychiatric inpatient nursing leaders on what they considered to be critical elements of quality. The survey was emailed to 40 American Psychiatric Nurses Association members, and 39 individuals responded. In the survey, participants were asked to comment on the importance of six dimensions of quality as well as quality indicators used on their units. RESULTS: Data from this survey indicate how thought leaders conceptualized quality of inpatient care. A unifying philosophy of care was endorsed as a quality element as was structure that affords staff available time on the unit—engaging with patients. While staffing levels were viewed as important, the respondents commented on the nuances between staffing and quality. Participants endorsed the importance of involving individuals in their treatment planning as well as tapping into patients’ perspectives on the treatment experience. CONCLUSION: The participants’ responses compliment the quality literature and reinforce the need to develop a comprehensive map of quality elements. These elements interact in complex way, for instance, staffing, engagement, and teamwork is tied to the organizational structure and philosophy of care, which in turn facilitates consumer involvement in care. Thus, gauging the impact of quality on outcomes will demand consideration of the interaction of factors not just the linear relationship of one element to an outcome.

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Q-15 checks and 1:1 observations: Exacerbating a problem we are trying to solve?

Cited by 7 publications

References 16 publications

RETRACTED: Reduced self‐harm on acute mental health wards following the implementation of a vision‐based patient monitoring system: Evidence from five NHS trusts

RETRACTED: Reduced self‐harm on acute mental health wards following the implementation of a vision‐based patient monitoring system: Evidence from five NHS trusts

A false sense of security: Rapid improvement as a red flag for death by suicide.

Delineating Quality Indicators of Inpatient Psychiatric Hospitalization

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