TORONTO, October 6, 2016 - A global open-source approach to safe care for mental health clients, known as Safewards, is being introduced by CAMH’s Complex Care and Recovery Program as part of the hospital’s Safe & Well strategy.
Based on review of more than 1,000 studies, Safewards recommends approaches to “make psychiatric wards more peaceful places.” It focuses on engagement rather than containment, enhancing relationships between staff and patients to reduce risk of aggression and injury.
“The strength of Safewards is its menu of ideas and options,” said Program Director Jacqueline Phan. “We have the opportunity to pinpoint ideas from Safewards to build on, or modify, our existing comprehensive safety and violence prevention programs.”
Positive Words: Project Manager Aileen Sprott, Registered Nurse Julia Duzdevic and Advanced Practice Nurse Remar Mangaoil.
This summer, Registered Nurse Julia Duzdevic and Advanced Practice Nurse Remar Mangaoil hosted a two-day Safewards education program for front-line and support staff from four CAMH programs.
“The ideas and approach of Safewards were compelling to us, with results showing significant decreases in containment and conflict,” said Julia.
The Safewards model connects key patient and staff factors in conflict and containment, looking at flashpoints to aggression and where these may originate. Specific interventions include clear mutual expectations, soft words and reassurance for patients, mutual help meetings, bad news mitigation, positive language, calm-down methods, discharge messages and knowing each other.
Focusing on positive words
“Participants engaged in conversations acknowledging patients’ strengths, values and positive attributes,” Julia said. Positive words used at the start of a day or at shift change set a positive tone and reinforce CAMH’s care principles, she added.
She gives the example of a rapid rounds report that stated: The patient was loud, singing and dancing in the lounge areas. Required redirection several times.
“When we looked at the big picture, we added some important context to that report,” she says: The patient assisted a peer by opening their milk carton at lunch. His dance moves were wonderful and he was able to get some of his peers and staff to join him.
“We want to create a 360-degree picture of the patient,” says Julia. “Recognizing a patient’s strengths and talents is just as important as the challenges we may all face.”
From left: Participants Esther Pacheco, Registered Nurse (at white board), Antonio Gomes, Maintenance Specialist, Millicent Roberts, and Veronica Mangallanes, Registered Nurse.
The training itself generates a feeling of “culture shift,” said Julia, who has been a point-of-care clinician at CAMH for 20 years, much of it in acute care settings. “I was blown away by the skills, expertise, experience and compassion in the room.” Safewards complements CAMH’s Vision 2020 and Safe & Well CAMH approach, enhancing safety, patient recovery, quality of work life and leadership, Julia said.
Participant Catherine Lau, a Behavior Therapist in the Forensic Assessment and Triage Unit, said the Getting-to-know-you exercise is “a great conversation starter and way to find common ground -- this will be incredibly valuable in helping staff and patients build relationships.”
Participant Veronica Magallanes, a Registered Nurse in the same unit, said Safewards “is a model that can make a difference. It may sometimes take more effort to focus on engagement rather than containment but the result is improved patient care. It’s also a chance to shine a spotlight on great examples of how we care for patients.”
“It's really important that there are mutual client/patient expectations,” says Jennifer Chambers, Coordinator of the Empowerment Council, a voice for clients of mental health and addictions services. “Developing a list of common standards, an awareness of power relations, and some independence in the facilitation will also be key.” To that end, Jennifer is visiting CAMH programs to ask the patients what expectations they have of staff and each other.
Last fall, CAMH invited the Forensic Directors Group from Ontario’s health sector to a presentation about Safewards by Len Bowers, Professor of Psychiatric Nursing, South Maudsley NHS, UK.
“As you learn, you also contribute.” Professor Len Bowers spoke about Safewards at a fall 2015 session hosted by CAMH.
“Safewards supplements but does not replace a functioning and fluid stepped care system,” Professor Bowers told the forum at CAMH. “It’s an open-source program – nobody is dictating, and the model reflects many valuable approaches. We are encouraging hospitals to take that extra step. The only expectation is that as you learn, you also contribute.”
He leads a team of researchers investigating inpatient care and ways to reduce conflict and containment at the UK Institute of Psychiatry, Psychology and Neuroscience, and has advised the UK government on policy and psychiatric nursing practice.
Participants and instructors at the 2016 Safewards training at CAMH.
“Ultimately we are aiming to continue to improve the climate in our programs, to decrease containment and conflict, to create peaceful places that facilitate recovery,” says Julia.
At CAMH, top-quality care -- and the safety of both patients and staff -- go hand in hand. “These are CAMH’s highest priorities,” says CAMH Chief of Nursing and Professional Practice Dr. Rani Srivastava.
Dr. Rani Srivastava
In addition to the Safewards implementation, new initiatives include:
- an expansion of CAMH’s cornerstone program to prevent and manage aggressive behavior (PMAB). The updated program includes a stronger focus on prevention.
- new safe practices rolling out in the hospital’s Complex Care and Recovery Program.
- Improved teamwork and communication – such as “Rapid rounds” where clinical teams review clients’ status, assess risk scores, pinpoint concerns and adjust care plans.
- Data-informed decision making and accountability: Measurement and data analysis is key to improvement, along with leadership accountability for improved scores.
Says Rani: “We continue to innovate and collaborate for a Safe and Well CAMH.”