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      A cross‐sectional survey of mental health service users’, carers’ and professionals’ priorities for patient safety in the United Kingdom

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          Abstract

          Background

          Establishing patient safety priorities in psychiatry has received less international attention than in other areas of health care. This study aimed to identify safety issues as described by people in the United Kingdom identifying as mental health service users, carers and professionals.

          Methods

          A cross‐sectional online survey was distributed via social media. Identified safety issues were mapped onto the Yorkshire Contributory Factors Framework ( YCFF) which categorizes factors that contribute to patient safety incidents in general hospital settings. Service user and carer responses were described separately from professional responses using descriptive statistics.

          Results

          One hundred and eighty‐five responses from 95 service users and carers and 90 professionals were analysed. Seventy different safety issues were identified. These were mapped onto the 17 existing categories of the YCFF and two additional categories created to form the YCFFMH. Most frequently identified issues were as follows: “Individual characteristics” (of staff) which included competence and listening skills; “Service process” that contained concerns about waiting times; “Management of staff and staffing levels” dominated by staffing levels; and “External policy context” which included the overall resourcing of services. Professionals identified staffing levels and inadequate community provision more frequently than service users and carers, who in turn identified crisis care more frequently.

          Conclusions

          This study updates knowledge on stakeholder perceived safety issues across mental health care. It shows a far broader range of issues relating to safety than has previously been described. The YCFF was successfully modified to describe these issues and areas for further coproduced research are suggested.

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          Safewards: a new model of conflict and containment on psychiatric wards

          Accessible summary Rates of violence, self-harm, absconding and other incidents threatening patients and staff safety vary a great deal by hospital ward. Some wards have high rates, other low. The same goes for the actions of staff to prevent and contain such incidents, such as manual restraint, coerced medication, etc. The Safewards Model provides a simple and yet powerful explanation as to why these differences in rates occur. Six features of the inpatient psychiatric system have the capacity to give rise to flashpoints from which adverse incidents may follow. The Safewards Model makes it easy to generate ideas for changes that will make psychiatric wards safer for patients and staff. Abstract Conflict (aggression, self-harm, suicide, absconding, substance/alcohol use and medication refusal) and containment (as required medication, coerced intramuscular medication, seclusion, manual restraint, special observation, etc.) place patients and staff at risk of serious harm. The frequency of these events varies between wards, but there are few explanations as to why this is so, and a coherent model is lacking. This paper proposes a comprehensive explanatory model of these differences, and sketches the implications on methods for reducing risk and coercion in inpatient wards. This Safewards Model depicts six domains of originating factors: the staff team, the physical environment, outside hospital, the patient community, patient characteristics and the regulatory framework. These domains give risk to flashpoints, which have the capacity to trigger conflict and/or containment. Staff interventions can modify these processes by reducing the conflict-originating factors, preventing flashpoints from arising, cutting the link between flashpoint and conflict, choosing not to use containment, and ensuring that containment use does not lead to further conflict. We describe this model systematically and in detail, and show how this can be used to devise strategies for promoting the safety of patients and staff.
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            The top patient safety strategies that can be encouraged for adoption now.

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              Patient and carer identified factors which contribute to safety incidents in primary care: a qualitative study

              Patients can have an important role in reducing harm in primary-care settings. Learning from patient experience and feedback could improve patient safety. Evidence that captures patients' views of the various contributory factors to creating safe primary care is largely absent. The aim of this study was to address this evidence gap.
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                Author and article information

                Contributors
                K.M.Berzins@leeds.ac.uk
                Journal
                Health Expect
                Health Expect
                10.1111/(ISSN)1369-7625
                HEX
                Health Expectations : An International Journal of Public Participation in Health Care and Health Policy
                John Wiley and Sons Inc. (Hoboken )
                1369-6513
                1369-7625
                17 August 2018
                December 2018
                : 21
                : 6 ( doiID: 10.1111/hex.2018.21.issue-6 )
                : 1085-1094
                Affiliations
                [ 1 ] School of Healthcare University of Leeds Leeds UK
                [ 2 ] Social Spider CIC London UK
                [ 3 ] School of Psychology University of Leeds Leeds UK
                Author notes
                [*] [* ] Correspondence

                Kathryn Berzins, School of Healthcare, University of Leeds, Leeds, UK.

                Email: K.M.Berzins@ 123456leeds.ac.uk

                Author information
                http://orcid.org/0000-0001-5002-5212
                Article
                HEX12805
                10.1111/hex.12805
                6250880
                30120809
                ea6368e6-51c0-4871-adac-1783d8b09396
                © 2018 The Authors. Health Expectations published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 25 May 2018
                Page count
                Figures: 1, Tables: 3, Pages: 10, Words: 7842
                Funding
                Funded by: School of Healthcare Research Pump Priming Fund
                Funded by: University of Leeds
                Funded by: National Institute for Health Research (NIHR)
                Categories
                Original Research Paper
                Original Research Papers
                Custom metadata
                2.0
                hex12805
                December 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.5.3 mode:remove_FC converted:23.11.2018

                Health & Social care
                attitude of health personnel,caregivers,health services research,inpatients,mental health services,patient safety,surveys and questionnaires

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