44A QUALITY IMPROVEMENT PROJECT TO CREATE A CLIMATE OF CARE RESULTING IN A REDUCTION OF THE PRESCRIPTION OF ANTI-PSYCHOTICS ON THE WARD

Abstract

Background: A local audit identified that 46% of patients felt unsafe during their inpatient stay and that this was correlated with a high incidence of violence and aggression on the ward, resulting in the need to prescribe anti-psychotic medication to patients on the unit. Aim(s): To implement and evaluate the impact of an enhanced therapeutic environment within an older mental health ward to reduce the prescription of anti-psychotics. Project Design: A Quality Improvement project was used to address patients' safety concerns and ward violence, and to monitor prescription of anti-psychotics. Over a six month period a project team worked with staff and patients to enhance the therapeutic environment including: creating an indoor garden, a space which engaged the five senses, staff NEWS training and feedback of ward environment using observation and the Ward Atmosphere Scale. Outcomes measures included monthly rates of violence and aggression, anti-psychotics prescribing and staff sickness. Patients' and staff perception of safety was measured using the Ward Atmosphere Scale. Finding(s): Recorded incidence of physical aggression reduced by 40.4% and incidence of verbal aggression by 59.3 % (47 to 28 and 81 to 47 events). Patients now report feeling 100% safe. Rates of staff sickness reduced by 64% while prescribing of anti-psychotics was reduced by 26.9%. Conclusion(s): The enhancement of the therapeutic environment combining staff training and environmental changes improved outcomes for patients and staff. Involving the patients and staff in all stages of the redesign created a sense of calm, resulting in an overall reduction of prescribing anti- psychotics on admission.