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Where do we draw the line on providing a ‘home from home’ environment on a PICU?

Published online by Cambridge University Press:  28 March 2012

Catherine Adams ,
Maja Lazarevic ,
Emily Simon Thomas  and
John Lowe
Catherine Adams*
Affiliation:
Central and North West London NHS Foundation Trust (CNWL), UK
Maja Lazarevic
Affiliation:
Central and North West London NHS Foundation Trust (CNWL), UK
Emily Simon Thomas
Affiliation:
Central and North West London NHS Foundation Trust (CNWL), UK
John Lowe
Affiliation:
Central and North West London NHS Foundation Trust (CNWL), UK
*
Correspondence to: Catherine Adams, E-mail: [email protected]
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Abstract

Background: A proposal to introduce metal cutlery onto a PICU in order to create a more homely environment prompted staff concerns about safety.

Aims: Based on the premise that past behaviour is a strong predictor of future behaviour, we undertook a pilot audit of history of weapon use as a measure to guide decision making on weapons security on our PICU.

Methods: Retrospective case note audit of 30 PICU patients to determine historical rates of weapon use. Secondary measures included level and type of weapon use, and mental disorder. 30 ‘non PICU pathway’ general ward patients were sampled as a ‘control’.

Results: 19/30 patients on the PICU had a history of weapon use, compared to 7/30 on the general ward. There were 23 recorded incidents in the PICU sample and 7 on the general ward.

Conclusions: The majority of the PICU sample had a history of weapon use, often recent, including improvised and bladed weapons, at times of acute disturbance and non-compliance with medications. Comparison with the non-PICU group indicates that the measure had good construct validity as rates in this group were significantly lower. Therefore history of weapon use could be a useful measure in guiding decision making about security protocols on PICU, however, further research is required.

Keywords

Inpatient psychiatryweapon useward environmentsafety
Type
Review Article
Information
Journal of Psychiatric Intensive Care , Volume 8 , Issue 2 , August 2012 , pp. 126 - 133
Copyright
Copyright © NAPICU 2012

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References

Burns, T. (1998) Not just bricks and mortar. Report of the Royal College of Psychiatrists working party on the size, staffing, structure, siting, and security of new acute adult psychiatric in-patient units. Psychiatric Bulletin. 22: 465–466.CrossRefGoogle Scholar
Department of Health (2002) Mental Health Policy Implementation Guide: National minimum standards for general adult services in psychiatric intensive care units (PICU and low secure environments. London: Department of Health, 64pp.Google Scholar
Dix, R. (2005) Psychiatric intensive care and low secure units, past, present and future - introducing the Journal of Psychiatric Intensive Care. Journal of Psychiatric Intensive Care. 1(1): 1–2.CrossRefGoogle Scholar
Dix, R. and Page, M. (2008) Physical environment: general philosophy of psychiatric intensive care low secure unit design. In: Beer, M., Pereira, S., Paton, C. (eds) Psychiatric Intensive Care. 2nd edition. Cambridge University Press. pp. 294–305.Google Scholar
Dix, R. and Williams, K. (1996) Psychiatric intensive care units, a design for living. Psychiatric Bulletin. 20: 527–529.CrossRefGoogle Scholar
DuHart, D. (2001) Violence in the Workplace, 1993–99. NCJ 190076. Washington, DC: US Dept. Justice, Bureau of Justice Statistics. 13pp.Google Scholar
Gillespie, G., Donna, M., Gates., Miller, M., and Howard, P. (2010) Workplace violence in healthcare settings: risk factors and protective strategies. Journal of Rehabilitation Nursing. 35(5): 177–184.CrossRefGoogle ScholarPubMed
House of Commons (2009) Knife Crime. Seventh report of session 08–09. HC 112. House of Commons, Home Affairs Committee.Google Scholar
Kennedy, H. (2002) Therapeutic uses of security: mapping forensic mental health services by stratifying risk. Advances in Psychiatric Treatment. 8: 433–443.CrossRefGoogle Scholar
Lanza, M., Kayne, H., Hicks, C. and Milner, J. (1994) Environmental characteristics related to patient assault. Issues in Mental Health Nursing. 15(3): 319–335.Google ScholarPubMed
Mills, P., Watts, B., Miller, S., Kemp, J., Knox, K., DeRosier, J. and Bagian, J. (2010) A checklist to identify inpatient suicide hazards in Veterans Affairs hospitals. Joint Commission Journal on Quality and Patient Safety. 36(2): 87–93.Google ScholarPubMed
National Institute of Clinical Excellence (2005) Violence: The short term management of disturbed and violent behaviour in inpatient psychiatric settings and emergency departments. Clinical Guideline 25. London: NICE, 83pp.Google Scholar
Pereira, S., Chaudhry, K., Pietromartire, S., Dale, C. and Halliwell, J. (2006) Designing psychiatric intensive care units: problems and issues. Journal of Psychiatric Intensive Care. 1(2): 70–76.CrossRefGoogle Scholar
Royal College of Psychiatrists (1995) Strategies for the Management of Disturbed and Violent Patients in Psychiatric Units. Council Report CR41. London: Royal College of Psychiatrists.Google Scholar
Royal College of Psychiatrists (1998)? Management of Imminent Violence: Clinical practice guidelines to support mental health services. Occasional paper 41. London: Royal College of Psychiatrists.Google Scholar
Waller, S. and Finn, H. (2004) Enhancing the Healing Environment: A guide for NHS trusts. King’s Fund, 74pp.Google Scholar
World Health Organization (1992) ICD-10 Classifications of Mental and Behavioural Disorder: Clinical descriptions and diagnostic guidelines. Geneva: World Health Organization.Google Scholar
Zigmund, A. (1995) Special care wards: are they special? Psychiatric Bulletin. 19: 310–312.CrossRefGoogle Scholar