THE SAFEWARDS
RANDOMISED
CONTROLLED TRIAL
Reducing Conflict and Containment on psychiatric wards
Lead by Professor Len Bowers
CONFLICT AND CONTAINMENT
Conflict
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Aggression
Rule breaking
Substance/alcohol use
Absconding/missing
Medication refusal
Self-harm/suicide
Containment
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PRN medication
Coerced IM medication
Special observation
Seclusion
Manual restraint
Time out
THE SAFEWARDS MODEL
Staff
modifiers
Patient
modifiers
Originating
domains
Flashpoints
Conflict
Containment
PATIENT COMMUNITY
Patient-patient interaction
Contagion & discord
Patient modifiers
Anxiety management; Mutual support; Moral commitments;
Psychological understanding; Technical mastery;
Staff modifiers
Explanation/information; Role modelling;
Patient education; Removal of means;
Presence & presence+
Flashpoints
Assembly/crowding/activity
Queuing/waiting/noise
Staff/pt turnover/change
Bullying/stealing/
prop. damage
CONFLICT
&
CONTAINMENT
Denial of request; Staff
demand; Limit setting
Bad news;
ignoring
Flashpoints
Staff anxiety & frustration; Moral commitments;
Psychological understanding; Teamwork &
consistency; Technical mastery; Positive
appreciation
Staff modifiers
Rules; Routine; Efficiency; Clean/tidy;
Ideology; Custom & practice
Internal Structure
STAFF TEAM
THE SAFEWARDS TRIAL
Aim:
– Devise a set of the most feasible interventions for
inpatient nurses with potentially maximal impact on
conflict and containment
– Subject those to a rigorous RCT.
DEVELOPMENT OF
INTERVENTIONS
• Generated ideas, started to narrow down
to..
•Consulted expert nurses and service users, got it
down to..
•Pilot Study ( 4 Wards (2/2)) took out a further 6
• To full Trial (31 Wards (16/15))
FINAL INTERVENTION LIST
Experimental intervention (Organisational)
Mutual Help Meeting, Clear Mutual Expectations, Soft Words,
Talk Down, Know Each Other, Reassurance, Positive Words, Bad
News Mitigation, Discharge Messages, Calm Down Methods.
(n = 10) + handbook
Active Control intervention (Wellbeing)
desk exercises, pedometer competitions, healthy snacks, diet
assessment and feedback, health and exercise magazines, health
promotion literature, linkages to local sports and exercise
facilities
Mean No. of conflict and containment events/shift
MAIN OUTCOMES
CONFLICT
14.6% decrease
CI 5.4 – 23.5%
p = 0.004
CONTAINMENT
23.6% decrease
CI 5.8 – 35.2%
p = 0.001
ADDITIONAL INFO
• Fidelity check indicated a low take up (38%) of interventions in
the time frame.
• Multiple checking of statistics including removing outliers and
modelling for missing data. Does not change results.
• Disappointing return of staff questionnaires.
• Turn it around and look as if Wellbeing Intervention makes staff
fitter. Still checking.
• Bottom line – we recommend all 10 interventions are adopted.
DISSEMINATION
• Trial results first announced NPNR in September 2013
• Since then a programme of dissemination both
nationally and internationally
• Initially this was combined with dissemination through
social media.
• In December of 2103, www.safewards.net went
online
SINCE SEPTEMBER..
• 9 “International “ presentations ( Europe and Australia)
• 25 presentations to UK conferences, Universities, Trusts or Wards.
• 500+ Facebook Members ( International)
• 100+ Twitter members ( primarily UK)
• Definite contact in 31/59 NHS trusts (England)
• 9 Identified Wards/units in Trusts additional to Trial (9) and Pilot wards (1)
• 2 non UK (Canada and Holland)
• 1 Trust has Safewards as a CQUIN or Quality standard for 2014
ITS ALL HERE!!!
WWW.SAFEWARDS.NET
TO HAVE MORE DETAILED
PRESENTATION FOR YOUR TRUST
•Geoff.brennan@kcl.ac.uk