Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-26T05:05:21.174Z Has data issue: false hasContentIssue false
  • English
  • Français

An audit of the use of advance statements surrounding management of disturbed behaviour on a PICU

Published online by Cambridge University Press:  01 September 2010

Stephen Dye
Stephen Dye*
Affiliation:
Consultant Psychiatrist, Suffolk Mental Health Partnership NHS Trust
*
Correspondence to: Dr Stephen Dye, St Clements Hospital, Foxhall Rd, Ipswich, Suffolk, UK, IP3 8LS. E-mail: [email protected]
Get access

Abstract

Background: PICUs traditionally manage patients who can display disturbed behaviour. Recent guidance has advocated patient engagement in outlining preferences regarding management strategies should they display such behaviour.

Aim: To audit the use, within one PICU, of a mechanism that formally records individual patient preference in management of episodes of acute disturbed behaviour.

Method: Two sets of fifteen retrospective case note analyses in an audit cycle.

Results: Initial findings revealed that advance statements were completed by eight of the fifteen patients admitted (53%). Patients’ wishes were followed for two thirds of patients following incidents needing interventions. Following changes to practice, although only minimal improvement occurred in patients completing advance statements, they were completed sooner after admission and, despite more incidents needing interventions, patients’ wishes following episodes of disturbed behaviour were followed in two thirds of those who completed an advance statement.

Conclusion: Use of advance statements regarding management of disturbed behaviour can be introduced in PICUs and this should be advocated.

Keywords

Advance statementdisturbed behaviourPICUNICE guidelinesseclusionrestraint
Type
Original Article
Information
Journal of Psychiatric Intensive Care , Volume 7 , Issue 1 , June 2011 , pp. 27 - 33
Copyright
Copyright © NAPICU 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Antonelli, M. (2008) Restraint management: moving from outcome to process. Journal of Nursing Care Quality. 23: 227–232.CrossRefGoogle ScholarPubMed
Bowers, L., Brennan, G., Flood, C., Lipang, M. and Oladapo, P. (2006) Preliminary outcomes of a trial to reduce conflict and containment on acute psychiatric wards: city nurses. Journal of Psychiatric and Mental Health Nursing. 13: 165–172.CrossRefGoogle ScholarPubMed
Bowers, L., Hackney, D., Nijman, H., Grange, A., Allan, T., Simpson, A. et al. (2007) A Longitudinal Study of Conflict and Containment on Acute Psychiatric Wards. Report to the Department of Health Policy Research Programme. London: City University.Google Scholar
Brown, S., Chhina, N. and Dye, S. (2010) Use of psychotropic medication in seven English psychiatric intensive care units. The Psychiatrist. 34(4): 130–135.CrossRefGoogle Scholar
Champagne, T. and Stromberg, N. (2004) Sensory approaches in inpatient psychiatric settings: innovative alternatives to seclusion and restraint. Journal of Psychosocial Nursing and Mental Health Services. 42(9): 35–44.CrossRefGoogle ScholarPubMed
Department of Health (2002) Mental Health Policy Implementation Guide for National Minimum Standards for General Adult Services in Psychiatric Intensive Care Units (PICU) and Low Secure Environments. London: Department of Health.Google Scholar
Duxbury, J. (2002) An evaluation of staff and patient views of and strategies employed to manage inpatient aggression and violence on one mental health unit: a pluralistic design. Journal of Psychiatric and Mental Health Nursing. 9(3): 325–337.CrossRefGoogle ScholarPubMed
Dye, S., Johnston, A. and Pereira, S. (2005) The national psychiatric intensive care governance network 2004–5. Journal of Psychiatric Intensive Care. 1: 97–104.CrossRefGoogle Scholar
Dye, S., Brown, S. and Chhina, N. (2009) Seclusion and restraint in seven English psychiatric intensive care units (PICUs). Journal of Psychiatric Intensive Care. 5: 69–79.CrossRefGoogle Scholar
Farrell, G. and Cubit, K. (2005) Nurses under threat: a comparison of content of 28 aggression management programs. International Journal of Mental Health Nursing. 14: 44–53.CrossRefGoogle ScholarPubMed
Fisher, W. (2003) Elements of successful restraint and seclusion reduction programs and their application in a large, urban, state psychiatric hospital. Journal of Psychiatric Practice. 9: 7–15.CrossRefGoogle Scholar
Forster, P.L., Cavness, C. and Phelps, M.A. (1999) Staff training decreases the use of seclusion and restraint in an acute psychiatric hospital. Archives of Psychiatric Nursing. 13: 269–271.CrossRefGoogle Scholar
Gaskin, C.J., Caderyn, J., Elsom, S. and Happell, B. (2007) Interventions for reducing the use of seclusion in psychiatric facilities: review of the literature. British Journal of Psychiatry. 191: 298–303.CrossRefGoogle ScholarPubMed
Healthcare Commission (2008) National Audit of Violence 2006–7 Final Report – Working age adult services. London: Healthcare Commission.Google Scholar
Hellerstein, D.J., Staub, A.B. and Lequesne, E. (2007) Decreasing the use of restraint and seclusion among psychiatric inpatients. Journal of Psychiatric Practice. 13: 308–317.CrossRefGoogle ScholarPubMed
HSE (2006) Violence and Aggression Management Training for Trainers and Managers: A national evaluation of the training provision in healthcare settings. London: HMSO.Google Scholar
Hucksorn, K. (2006) Re-designing State mental health policy to prevent the use of seclusion and restraint. Administration and Policy in Mental Health. 33: 482–491.CrossRefGoogle Scholar
Janner, M. (2007) From the inside out: Star Wards – lessons from within acute in-patient wards. Journal of Psychiatric Intensive Care. 3(2): 75–78.CrossRefGoogle Scholar
Klinge, A. (1994) Staff opinions about seclusion and restraint at a state forensic hospital. Hospital and Community Psychiatry. 45: 138–141.Google Scholar
Meehan, T., Bergen, H. and Fjeldsoe, K. (2004) Staff perceptions of seclusion: has anything changed? Journal of Advanced Nursing. 47(1): 33–38.CrossRefGoogle ScholarPubMed
Morrison, P. and Lehane, M. (1995) Staffing levels and seclusion use. Journal of Advanced Nursing. 55: 1193–1202.CrossRefGoogle Scholar
Mortimer, A. (1995) Reducing violence on a secure ward. Psychiatric Bulletin. 19: 605–608.CrossRefGoogle Scholar
NICE (2005) Violence: The short-term management of disturbed/violent behaviour in psychiatric in-patient settings and emergency departments. London: NICE.Google Scholar
NHS Institute for Innovation and Improvement (2008) Releasing Time to Care: The productive mental health ward. Coventry: NHS Institute for Innovation and Improvement.Google Scholar
Nijman, H.L.I., à Campo, J.M.L.G., Ravelli, D.P. and Merckelbach, H.L.G.J. (1999) A tentative model of aggression on inpatient psychiatric wards. Psychiatric Services. 50: 832–834.CrossRefGoogle ScholarPubMed
NIMHE (2004) Mental Health Policy Implementation Guide: Developing positive practice to support the safe and therapeutic management of aggression and violence in mental health in-patient settings. London: NIMHE.Google Scholar
Ockwell, C., Gournay, K. and Turner, B. (2007) Restraint: a necessary evil? In: Hardcastle, M., Kennard, D., Grandison, S., Fagin, L. (eds). Experiences of Mental Health In-patient Care. London: Routledge pp 48–56.Google Scholar
Outlaw, F.H. and Lowery, B.J. (1992) Seclusion: the nursing challenge. Journal of Psychosocial Nursing and Mental Health Services. 30: 13–17.CrossRefGoogle ScholarPubMed
Palmstierna, T. and Wistedt, B. (1995) Changes in the pattern of aggressive behaviour among inpatients with changed ward organisation. Acta Psychiatrica Scandinavica. 91: 32–35.CrossRefGoogle Scholar
Parkes, J. (1996) Control and restraint training: a study of its effectiveness in a medium secure psychiatric unit. Journal of Forensic Psychiatry. 7: 525–534.CrossRefGoogle Scholar
Royal College of Psychiatrists (1998) Management of Imminent Violence. London: Royal College of Psychiatrists.Google Scholar
Van Citters, A.D., Naidoo, U. and Foti, M.E. (2007) Using a hypothetical scenario to inform psychiatric advance directives. Psychiatric Services. 58(11): 1467–1471.CrossRefGoogle ScholarPubMed
Veltkamp, E., Nijman, H., Stolker, J., Frigge, K., Dries, P. and Bowers, L. (2008) Patients’ preference for seclusion or forced medication in acute psychiatric emergency in the Netherlands. Psychiatric Services. 59(2): 209–211.CrossRefGoogle ScholarPubMed
Supplementary material: File

Dye Supplementary Material

Appendix.doc

Download Dye Supplementary Material(File)
File 27.1 KB