Violence Reduction on Adult Inpatient Units; what has been achieved so far at ELFT?

Between 2012 and 2015, Tower Hamlets Adult Mental Health inpatient wards reduced violence by over 40% and by 60% on the acute admissions wards, using a Quality Improvement approach.  Since then we have scaled up the work to City & Hackney in early 2016 and Newham in mid-2016. Forensics also launched its own Collaborative in late 2016, testing the extent to which ideas developed in general adult units is effective in Forensics, as well as developing their own ideas.

Overall, violence reduction work across ELFT has meant that we have seen a 42% reduction in incidents of physical violence across our East London services since 2013 (see figure 1).

Figure 1

The change ideas that have helped in general adult settings work on 2 main drivers:

1. Increasing teams ability to identify and predict risks of violence and to take action proactively as a team. Two change ideas work on this; Safety Huddles and the Broset Violence Checklist
2. Creating a culture of much greater openness and transparency around the issue of violence with the whole ward community, including service users. Two ideas work on this: using Safety Crosses and having proactive discussions around violence and safety in ward community meetings. (See articles on City & Hackney and Newham Adult Mental Health Services)

For more information about these ideas see the other articles in this newsletter and this article, published in February 2017 in the Journal of Mental Health Nursing>>

Local reductions

Since the beginning of the work, local collaboratives have achieved the following reductions:

Tower Hamlets has reduced violence across all 6 wards by 40% and restraints by 60%, using Datix data. There has been a 57% reduction in violence and a 77% reduction in restraints across the acute wards.

In City & Hackney, violence has reduced by 40% across the unit and upwards of 60% on the acute wards, according to Datix data. Gardner Ward and Joshua Ward in City and Hackney have sustained 65-75% reductions in violence for 6-9 months. There has also been a 54% reduction in use of restraint on Conolly Ward and there are early signs of reduction on Bevan Psychiatric Intensive Care Unit (PICU).

In Newham , Topaz Ward has seen a reduction of 66%, Emerald Ward has seen a reduction of 74% and Sapphire has seen a reduction of 84%. Jade Ward are also seeing very positive signs of change, with no incidents at all between 30^th September 2016 and 12^th January 2017.

Forensics has just seen early signs of a 51% reduction in physical violence across Bow, Broadgate, Clerkenwell, Shoreditch and West Ferry wards. Shoreditch and Bow have seen individual reductions of 82% and 51% respectively.  For more information see our article – Perspectives from Forensics; Early signs of reduction and an exciting journey ahead for further specific detail on the directorate’s journey for far and the impact this work has had.

In 2017-18 we will be looking at extending the work to Luton and Bedfordshire and focusing dedicated work on restricted practices, as well as consolidating the work in existing Collaboratives and developing a Quality Control strategy (see this article).

For any queries get in touch with Jen Taylor-Watt, QI Lead for City & Hackney & IAPT  and Lead Improvement Advisor for Violence Reduction and/or Andy Cruickshank, Associate Director of Nursing for QI and Senior Improvement Advisor for Violence Reduction.