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Safewards – International

The ‘Safewards’ model is a program that aims to reduce the restraint and seclusion of people on psychiatric wards, as well as reducing conflict between service users and staff (Submission 25). The model provides staff with practices and concepts to help improve the culture of hospital settings, with attention to staff interactions with service users and family/friends, as well and the physical characteristics of wards.

According to one health department that is implementing Safewards, the objectives of the program are:

  • Better relationships between staff and patients;
  • Increased safety, reduced coercion;
  • Less time wasted on containment, more invested in engagement;
  • Fewer assaults, fewer injuries;
  • An environment that is peaceful and conducive to supporting people in their journey of recovery. (See Metro South Health website).

It further states that:

The Safewards program model proposes that conflict within a ward can arise when a consumer is faced with situations that increase their emotional distress or 'flash points'. The Safewards approach focusses on what staff can do before the consumer reaches a flashpoint by being aware of potential triggers and determining the best method to reduce the impact or best containment method for the situation. (See Metro South Health website).

The model helps us to work together with consumers to reduce conflict and containment as much as possible and make the inpatient units a more therapeutic and peaceful place.

There are 10 ‘Safewards Interventions’ under the model. These are:

 

  1. Discharge Messages – prior to discharge, patients are encouraged to write a positive and helpful message that is then placed on a message board/discharge tree. These messages can be viewed by visitors for reassurance and to increase feelings of hope.
  2. Mutual Help Meetings – starting the day in partnership, facilitated by staff, patients are encouraged to identify ways of helping and supporting each other during the day.
  3. Clear Mutual Expectations – our expectations of each other whilst on the inpatient unit (patients and staff).
  4. Calm Down Methods – creating an environment and the opportunity for low stimulus and serene time out. A box of equipment is offered before considering PRN medication.
  5. Talk Down (De-escalation) – a drawing together of the range of de-escalation techniques on a poster that is displayed in staff areas. Staff are given in-service follow-up on these techniques on a regular basis.
  6. Reassurance – following an anxiety provoking incident on the inpatient unit, patients are followed up either in small groups or alone to give reassurance and understanding of what happened. Staff maintain a higher visibility post-incident so patients feel more safe and secure.
  7. Positive Words – during each handover, staff make an effort to say something positive about each patient and/or identify contributing factors to difficult behaviours.
  8. Bad News mitigation – raising staff awareness during handovers and ward rounds, of potential 'bad news' events that patients may experience. Staff then follow-up by conveying the 'bad news' sympathetically to the patient and offering support.
  9. Soft Words – statements that are 1-2 sentences long are provided to staff on how to speak to patients in any of the three primary flashpoints: saying no; asking to stop behaviour; and asking patients to do something they don’t want to do.
  10. Know each other – each staff member provides non-controversial information about themselves that they are happy to be communicated to the patients. Patients are also encouraged to share similar information about themselves. (See Metro South Health website).

Factors which have facilitated the implementation of the practice, include support from senior and local managers, as well as people with lived experience of mental health conditions or psychosocial disabilities as champions to promote implementation (Submission 25). Barriers include lack of support from managers and local-level figures, scarce resources, need for translation of Safewards material to local languages, support from managers across the mental health sector (from directors to ward managers), the challenge of adjusting the Safewards interventions to the specific setting, and the challenge of applying the practices in aged care settings (Submission 25).

Len Bowers and colleagues undertook a cluster randomised control of the practice in 31 randomly chosen wards at 15 randomly chosen hospitals in the UK, and found that simple interventions aiming to improve staff relationships with patients can reduce the frequency of conflict and coercion (Bowers et al., 2015). Research also suggests the initiative creates financial benefits by diverting resources away from conflict and coercion (Bowers, n.d.).

For more information, the Safewards homepage provides advice on implementation, outlines supporting evidence, and offers materials translated from English to Spanish, German, Danish, Polish, Finish, Turkish, and Czech.