Authors (including presenting author) :
Wu CN (1), Wong SM (1)(2), Ip CK (2), Au LM (1), Luk KH (1), Tam HMV (1), Poon WM (1), Chan KL (1), Chiu KYK (1), Kwan TYL (1)
Affiliation :
(1)Department of Psychiatry, Shatin Hospital, (2)Department of Psychiatry, NTEC/Prince of Wales Hospital/Shatin Hospital
Introduction :
Patient violence is one of the serious challenges in psychiatric in-patient settings, such as caused by patient’s unstable mental condition, cognitive impairment and behavioural problems. Sometimes, staff IODs and sick leaves would be resulted.
After reviewing the department's IOD incidents, several factors were identified that need to be improved: staff training, team approach, and protective equipment. Apart from the mandatory staff training on the Management of Violence, McDonnell et al. (2023) suggested improving staff training outcomes by emphasizing the implementation, generalization, and maintenance of skills in the workplace with monitoring. According to the HA Safety Manual (2021), on-the-job skill training and classroom training are recommended.
Objectives :
1. To reduce the IOD rate related to the management of patient violence and the restraint process.
2. To enhance hands-on skill training on the management of patients with Learning Disabilities(LD) & patient violence.
3. To promote team approach and emergency support.
Methodology :
A five-month program was conducted in five psychiatric wards of Shatin Hospital starting in Aug 2024:
1) Nurse Consultant(NC) conducted hands-on skill training on managing LD patients. In total, NC conducted 4 sessions for nurses.
2) Hands-on skill training on managing patients with violence and physical restraint was conducted in all wards. All nurses and supporting staff have completed the training, with return demonstrations from Aug-Nov, 2024. The ward facilitator continued to offer workplace guidance to staff.
3) Meetings and violence drills have been conducted with the hospital security team. Security staff patrol rounds to wards have been increased to provide timely support during psychiatric emergencies.
4) Enhanced protective equipment provided to staff, e.g. cut-resistant gloves.
5) Post-incident reviews were conducted in department meetings with sharing in all wards.
Result & Outcome :
The staff IOD rate related to patient violence and restraint has dropped from 0.88% (from Jan-Jul 2024) to 0% (Aug-Dec 2024). Staff showed improved team approach and skills competency in managing violence and restraint procedures. This hands-on skill training is mandatory for all new staff (nurses and supporting staff) and is offered annually. For managing learning disability patients, hands-on skill training for nurses would be continued also. Regular violence drills would be conducted in wards with the participation of the security team to enhance collaboration.
