11 August 2017

Forensics: First steps, early signs of reduction and an exciting journey ahead!

By Nynn-Hui Chang, QI Lead for Forensics and Improvement Advisor to the Forensics Violence Reduction Collaborative & Day Njovana, Lead Nurse for Forensics & Lead for the Forensics Violence Reduction Collaborative

Forensics is a unique setting in that the majority of patients are admitted following a violent index offence in the context of their illness, which differs greatly from the general adult wards.  For this reason, we were unsure if the bundle of ideas, developed on the general wards would help us to reduce violence in Forensics. It’s been important therefore, for us to take it slowly; exploring and understanding how the issue manifests itself in our setting and the dynamics of how we are responding to it.

Something that we realised early on was that we had particular issues with sexual behaviours, particularly on our learning disabilities wards. We’ve created a different coloured dot to record this on our safety crosses, so we can keep track of the frequency of this, and we’re continuing to work to understand the drivers of these behaviours so we can address them.

Meeting together as a learning Collaborative gave us a chance to reflect on the change package from the general wards. Although we need to continue to understand things specifically in Forensics, we felt that it was worth testing a number of elements of the change package. Although there are differences between Forensics and non-Forensics settings, we too need to ensure we are communicating as effectively as possible and to try to predict risks before they occur – so we thought it was worth seeing if Safety Huddles could make a difference. As already noted, we also agreed that using Safety Crosses would help us to understand frequency of violence and share this across the service.

The fantastic news is that we’ve already seen a 51% reduction in violence across the group of wards involved in the work to date (Bow, Broadgate, Clerkenwell, Shoreditch and West Ferry) through using these ideas. Three more wards have now been inspired to join the Collaborative; Clissold, East India & Ludgate.

Shoreditch and Bow Wards have also seen individual reductions of 81% in physical violence and 54% in non-physical violence, respectively.

We asked project leads from Shoreditch & Bow what was the impact they noted from the violence reduction work. Here is what they said:

It’s been a great start. There is lots of energy and enthusiasm around this work in Forensics to stop violence and aggression being an accepted part of work.

Staff and patients are reporting that they feel safer on the wards. Safety crosses are starting to be discussed in community meetings on the wards, so that staff are working together with the patients to improve understanding and patients’ experience.

We’re really looking forwards to where the next year might take us!

For me the Violence Collaboration has meant that we have started to address the unspoken , unchallenged ideas .  The dirty word “violence”. Never has there been a focus in forensic services on this one main driver for staff and patient satisfaction.

The early results have been encouraging for staff and mainly our service users.  It has given staff the basis to pre-plan, support and engage with service users in times of distress.


Day Njovana, Lead Nurse for Forensics &

Lead for the Forensics Violence Reduction Collaborative


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