Which patients are in highest risk of coercive measures after admission to a general psychiatric ward?

Mikkel Højlund, Lene Høgh, Anne-Mette Nørregaard

Research output: Chapter in Book/Report/Conference proceedingConference abstract in proceedingsResearchpeer-review

Abstract

Background
Coercive measures, especially mechanical restraint, are more frequently applied to some patients in general psychiatry. In order to tailor an intervention to reduce mechanical restraint we sought to create an evidence base speci c to our population in general psychiatry.
Aims
To identify possible predictive markers for coercion among general psychiatric inpatients.
Methods
Systematic analysis of all coercive episodes at ward P2, Department of Psychiatry Haderslev, Denmark during 2015. Data regarding admission, psychiatric diagnosis, substance abuse, type and time of coercive measures were sampled from case records.
Results
We identi ed 18 coercive episodes in 16 different patients (admissions) from approximately 300 admissions to ward P2 during 2015. Of these 13 episodes (72%) happened within the rst 24 hours following admission. In all episodes the patients were involuntarily admitted, and in 11 episodes (61%) the patient suffered from a psychotic condition. In 9 episodes (50%) the patients were under the in uence of psychoactive substances. Eight patients (44%) had not been taking psychotropic medication in prescribed or suf cient doses, and the same 8 patients had not had regular contact with psychiatric outpatient services prior to admission.
Conclusions
The majority of coercive episodes happened within the rst 24 hours after admission, and in patients with concurrent psychotic disorder and substance abuse. We propose an intervention based upon these data which includes: Systematic evaluation of violence risk, individual plans for patients in increased risk of violence, systematic analysis of all episodes and near-episodes of coercion, group therapy during admission dedicated towards substance abuse, better staf ng levels and continuous training of staff. This intervention is currently being tested at the Department of Psychiatry in Aabenraa, Denmark and has until now lead to a decrease in episodes with mechanical restraint from 18 in 2015 to 9 in 2016, and only 1 episode in the rst half of 2017.
Original languageEnglish
Title of host publicationViolence in Clinical Psychiatry : Proceedings of the 10th European Congress on Violence in Clinical Psychiatry
Number of pages2
Place of PublicationThe Netherlands
PublisherOud Consultancy
Publication date2017
Pages94-95
ISBN (Electronic)978-90-827096-0-5
Publication statusPublished - 2017
Event10th European Congress on Violence in Clinical Psychiatry - Dublin, Ireland
Duration: 26. Oct 201728. Oct 2017
http://www.oudconsultancy.nl/dublin_10_ECVCP_2017/index.html

Conference

Conference10th European Congress on Violence in Clinical Psychiatry
CountryIreland
CityDublin
Period26/10/201728/10/2017
Internet address

Cite this

Højlund, M., Høgh, L., & Nørregaard, A-M. (2017). Which patients are in highest risk of coercive measures after admission to a general psychiatric ward? In Violence in Clinical Psychiatry: Proceedings of the 10th European Congress on Violence in Clinical Psychiatry (pp. 94-95). The Netherlands: Oud Consultancy.
Højlund, Mikkel ; Høgh, Lene ; Nørregaard, Anne-Mette. / Which patients are in highest risk of coercive measures after admission to a general psychiatric ward?. Violence in Clinical Psychiatry: Proceedings of the 10th European Congress on Violence in Clinical Psychiatry. The Netherlands : Oud Consultancy, 2017. pp. 94-95
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abstract = "BackgroundCoercive measures, especially mechanical restraint, are more frequently applied to some patients in general psychiatry. In order to tailor an intervention to reduce mechanical restraint we sought to create an evidence base speci c to our population in general psychiatry.AimsTo identify possible predictive markers for coercion among general psychiatric inpatients.MethodsSystematic analysis of all coercive episodes at ward P2, Department of Psychiatry Haderslev, Denmark during 2015. Data regarding admission, psychiatric diagnosis, substance abuse, type and time of coercive measures were sampled from case records.ResultsWe identi ed 18 coercive episodes in 16 different patients (admissions) from approximately 300 admissions to ward P2 during 2015. Of these 13 episodes (72{\%}) happened within the rst 24 hours following admission. In all episodes the patients were involuntarily admitted, and in 11 episodes (61{\%}) the patient suffered from a psychotic condition. In 9 episodes (50{\%}) the patients were under the in uence of psychoactive substances. Eight patients (44{\%}) had not been taking psychotropic medication in prescribed or suf cient doses, and the same 8 patients had not had regular contact with psychiatric outpatient services prior to admission.ConclusionsThe majority of coercive episodes happened within the rst 24 hours after admission, and in patients with concurrent psychotic disorder and substance abuse. We propose an intervention based upon these data which includes: Systematic evaluation of violence risk, individual plans for patients in increased risk of violence, systematic analysis of all episodes and near-episodes of coercion, group therapy during admission dedicated towards substance abuse, better staf ng levels and continuous training of staff. This intervention is currently being tested at the Department of Psychiatry in Aabenraa, Denmark and has until now lead to a decrease in episodes with mechanical restraint from 18 in 2015 to 9 in 2016, and only 1 episode in the rst half of 2017.",
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Højlund, M, Høgh, L & Nørregaard, A-M 2017, Which patients are in highest risk of coercive measures after admission to a general psychiatric ward? in Violence in Clinical Psychiatry: Proceedings of the 10th European Congress on Violence in Clinical Psychiatry. Oud Consultancy, The Netherlands, pp. 94-95, 10th European Congress on Violence in Clinical Psychiatry, Dublin, Ireland, 26/10/2017.

Which patients are in highest risk of coercive measures after admission to a general psychiatric ward? / Højlund, Mikkel; Høgh, Lene; Nørregaard, Anne-Mette.

Violence in Clinical Psychiatry: Proceedings of the 10th European Congress on Violence in Clinical Psychiatry. The Netherlands : Oud Consultancy, 2017. p. 94-95.

Research output: Chapter in Book/Report/Conference proceedingConference abstract in proceedingsResearchpeer-review

TY - ABST

T1 - Which patients are in highest risk of coercive measures after admission to a general psychiatric ward?

AU - Højlund, Mikkel

AU - Høgh, Lene

AU - Nørregaard, Anne-Mette

PY - 2017

Y1 - 2017

N2 - BackgroundCoercive measures, especially mechanical restraint, are more frequently applied to some patients in general psychiatry. In order to tailor an intervention to reduce mechanical restraint we sought to create an evidence base speci c to our population in general psychiatry.AimsTo identify possible predictive markers for coercion among general psychiatric inpatients.MethodsSystematic analysis of all coercive episodes at ward P2, Department of Psychiatry Haderslev, Denmark during 2015. Data regarding admission, psychiatric diagnosis, substance abuse, type and time of coercive measures were sampled from case records.ResultsWe identi ed 18 coercive episodes in 16 different patients (admissions) from approximately 300 admissions to ward P2 during 2015. Of these 13 episodes (72%) happened within the rst 24 hours following admission. In all episodes the patients were involuntarily admitted, and in 11 episodes (61%) the patient suffered from a psychotic condition. In 9 episodes (50%) the patients were under the in uence of psychoactive substances. Eight patients (44%) had not been taking psychotropic medication in prescribed or suf cient doses, and the same 8 patients had not had regular contact with psychiatric outpatient services prior to admission.ConclusionsThe majority of coercive episodes happened within the rst 24 hours after admission, and in patients with concurrent psychotic disorder and substance abuse. We propose an intervention based upon these data which includes: Systematic evaluation of violence risk, individual plans for patients in increased risk of violence, systematic analysis of all episodes and near-episodes of coercion, group therapy during admission dedicated towards substance abuse, better staf ng levels and continuous training of staff. This intervention is currently being tested at the Department of Psychiatry in Aabenraa, Denmark and has until now lead to a decrease in episodes with mechanical restraint from 18 in 2015 to 9 in 2016, and only 1 episode in the rst half of 2017.

AB - BackgroundCoercive measures, especially mechanical restraint, are more frequently applied to some patients in general psychiatry. In order to tailor an intervention to reduce mechanical restraint we sought to create an evidence base speci c to our population in general psychiatry.AimsTo identify possible predictive markers for coercion among general psychiatric inpatients.MethodsSystematic analysis of all coercive episodes at ward P2, Department of Psychiatry Haderslev, Denmark during 2015. Data regarding admission, psychiatric diagnosis, substance abuse, type and time of coercive measures were sampled from case records.ResultsWe identi ed 18 coercive episodes in 16 different patients (admissions) from approximately 300 admissions to ward P2 during 2015. Of these 13 episodes (72%) happened within the rst 24 hours following admission. In all episodes the patients were involuntarily admitted, and in 11 episodes (61%) the patient suffered from a psychotic condition. In 9 episodes (50%) the patients were under the in uence of psychoactive substances. Eight patients (44%) had not been taking psychotropic medication in prescribed or suf cient doses, and the same 8 patients had not had regular contact with psychiatric outpatient services prior to admission.ConclusionsThe majority of coercive episodes happened within the rst 24 hours after admission, and in patients with concurrent psychotic disorder and substance abuse. We propose an intervention based upon these data which includes: Systematic evaluation of violence risk, individual plans for patients in increased risk of violence, systematic analysis of all episodes and near-episodes of coercion, group therapy during admission dedicated towards substance abuse, better staf ng levels and continuous training of staff. This intervention is currently being tested at the Department of Psychiatry in Aabenraa, Denmark and has until now lead to a decrease in episodes with mechanical restraint from 18 in 2015 to 9 in 2016, and only 1 episode in the rst half of 2017.

M3 - Conference abstract in proceedings

SP - 94

EP - 95

BT - Violence in Clinical Psychiatry

PB - Oud Consultancy

CY - The Netherlands

ER -

Højlund M, Høgh L, Nørregaard A-M. Which patients are in highest risk of coercive measures after admission to a general psychiatric ward? In Violence in Clinical Psychiatry: Proceedings of the 10th European Congress on Violence in Clinical Psychiatry. The Netherlands: Oud Consultancy. 2017. p. 94-95