Marino Luise V, Peel Sophie-Jo, Iredale Lauren, Thiyagesh Subha, Khan Wajid, Whyte Vicki, Humble Victoria, McQuillan David
South West Yorkshire Partnership NHS Foundation Trust, Wakefield, UK
South West Yorkshire Partnership NHS Foundation Trust, Wakefield, UK.
BMJ Open Qual. 2025 Mar 18;14(1):e003122. doi: 10.1136/bmjoq-2024-003122.
Violence and aggression (V&A) are commonplace on mental-health wards and may lead to restrictive practice interventions (RPI), having a detrimental impact on patients and staff. In the 12 months preceding this quality improvement (QI) project, there was a mean V&A incidence of 52.7±113.0 and RPI of 37.6±84.1 per 1000 bed days.
Using QI methodology, a project involving creative practitioners was codeveloped to provide a range of activities delivered via a 7-day service, across 13 inpatient mental-health wards in five hospital settings, using levels of V&A and RPI as outcome measures. The creative practices used drew on successful projects arising from a linked charity, Creative Minds. Three plan-do-study-act cycles were completed. (1) Coproduction with ward staff, patients and creative practitioners of 4-week session plans, including an induction training package for creative practitioners. (2) Streamlined and centralised communication between creative practitioners and participating wards using a project coordinator. (3) Implementation of a creative-practitioner Rota to better support ward activity planning, staff and patient expectation setting.
During the 12-month project wards with creative practitioners experienced statistically significant reduction in V&A levels (F (1, 168)=5.72, p=0.017) and RPI (F (1, 168)=8.40, p=0.0042). Wards not involved in the project, V&A levels (F (1, 142) =3.34, p<0.069) and RPI (F (132, 142)=0.99, p=0.52) remained unchanged. Ward length-of-stay was used as a balancing measure with no difference pre 45.0±4.9 days and post 46.9±5.0 days intervention (p=0.18). At the project peak, creative practitioners delivered around 300 hours per week of creative activity, which appears to be associated with reduced number of V&A/RPI incidents.
Recommendations for the project's next steps are to secure sustained funding for creative practitioners to further enhance patients/staff well-being, as well as the coproduction of a creative-practitioner implementation guide to be tested in other mental-health inpatient settings as a part of a research study to better understand the impact of the type/timing of activities (ie, day/evening/weekends) on important patient outcomes and staff well-being.
暴力与攻击行为（V&A）在精神科病房屡见不鲜，可能导致限制措施干预（RPI），对患者和工作人员产生不利影响。在这个质量改进（QI）项目开展前的12个月里，每1000个床日的暴力与攻击行为平均发生率为52.7±113.0，限制措施干预发生率为37.6±84.1。
采用质量改进方法，与富有创造力的从业者共同制定了一个项目，通过为期7天的服务，在5家医院的13个精神科住院病房开展一系列活动，将暴力与攻击行为及限制措施干预的发生率作为结果指标。所采用的创造性实践借鉴了相关慈善机构“创意心灵”（Creative Minds）的成功项目。完成了三个计划-执行-研究-行动循环。（1）与病房工作人员、患者和创造性从业者共同制定为期4周的课程计划，包括为创造性从业者提供的入职培训包。（2）通过项目协调员简化并集中创造性从业者与参与项目的病房之间的沟通。（3）实施创造性从业者轮值制度，以更好地支持病房活动规划、工作人员和患者预期设定。
在为期12个月的项目期间，配备创造性从业者的病房在暴力与攻击行为发生率（F(1, 168)=5.72，p=0.017）和限制措施干预发生率（F(1, 168)=8.40，p=0.0042）方面有统计学意义的显著降低。未参与该项目的病房，暴力与攻击行为发生率（F(1, 142)=3.34，p<0.069）和限制措施干预发生率（F(132, 142)=0.99，p=0.52）保持不变。将住院时间作为平衡指标，干预前为45.0±4.9天，干预后为46.9±5.0天，无差异（p=0.18）。在项目高峰期，创造性从业者每周开展约300小时的创造性活动，这似乎与暴力与攻击行为/限制措施干预事件数量的减少有关。
对该项目下一步的建议是为创造性从业者争取持续资金，以进一步提升患者/工作人员的福祉，同时共同制定一份创造性从业者实施指南，作为一项研究的一部分，在其他精神科住院环境中进行测试，以更好地了解活动类型/时间（如白天/晚上/周末）对重要患者结局和工作人员福祉的影响。
