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Patient and Staff Perspectives on a Non-Restrictive Leave Protocol at Springbank Ward, Specialist Personality Disorder Unit

Published online by Cambridge University Press:  20 June 2022

Adelaide Yue*
Affiliation:
University of Cambridge, Cambridge, United Kingdom
Owen Crawford
Affiliation:
University of Cambridge, Cambridge, United Kingdom Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
Jorge Zimbron
Affiliation:
Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
*
*Presenting author.
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Abstract

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Aims

Springbank Ward is a specialist unit for patients with a diagnosis of emotionally unstable personality disorder (EUPD). Psychiatric wards often use restrictive practices to try and minimise suicide risk. Using risk assessment checklists to decide whether to grant leave is one example. Research shows that it is not possible to predict suicide at an individual level, regardless of the assessment method used, so we questioned the utility of such an approach. A previous evaluation of our leave protocol showed that patients and staff would favour a less restrictive and more personalised approach. We introduced a new protocol that eliminated use of checklists, replacing them with an optional 1:1 conversation with staff before leaving the ward. Our aim was to gauge patient and staff satisfaction with the new protocol and investigate their views on the change.

Methods

Data were obtained through structured interviews with staff who assessed risk (nurses and psychiatrists) and patients. 9 patients and 8 members of staff were interviewed between 9–19 March 2021. Interviewees were presented with diagrams of both the new protocol and old risk assessment checklist and asked a series of questions, including: rating their satisfaction; any potential improvements; and whether they would prefer the previous or current protocol. Thematic analysis of interview answers was used to explore patient and staff perspectives. Two authors independently analysed the interview transcripts, before discussing any discrepancies to reach a unified set of themes, subthemes and codes.

Results

Both patients and staff gave the new protocol an average satisfaction rating of 4.1/5. Thematic analysis generated five themes: “taking ownership”, “autonomy Vs restriction”, “staff-patient interaction”, “staff expertise” and “protocol efficiency”. Most interviewees agreed that the new protocol supported patients in taking responsibility for their safety, helping to prepare for life in the community. The protocol was considered minimally restrictive and more efficient than the previous system. The importance of communication and trust between patients and staff, as well as the use of staff intuition in holistically assessing risk, was emphasised. Potential disadvantages included the perceived riskiness of reducing restrictions and difficulty seeking support early in the admission.

Conclusion

In general, the new protocol is rated highly by patients and staff and is considered to be minimally restrictive and more holistic, in line with the aims established by our previous evaluation. Our findings have implications regarding risk management for inpatients with EUPD.

Type
Rapid-Fire Presentation
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists
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