RETROSPECTIVE SURVEY OF ELECTRONIC RECORDS OF SERIOUS VIOLENCE ON A MALE PICU 2012
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1 RETROSPECTIVE SURVEY OF ELECTRONIC RECORDS OF SERIOUS VIOLENCE ON A MALE PICU 1 Dr Reuven Magnes Consultant Psychiatrist (PICU) Central and North West London NHS FoundaAon Trust
2 Ra#onale for this study: 1. Violence is costly in terms of - high absence high stress low morale high vacancy es#mated that verbal abuse costs UK million per annum aggression to object > 3million, physical assault > 5million understanding violence help staff to be beher skilled at recognizing and preven#ng triggers Figures on aggression in acute wards extremely variable, with figures between % and % cited in the literature (Dack et al. Acta Psychiatr Scand 13: 17: 55 )
3 . Violence is situa#on specific & may be preventable Table 1. The antecedents of violence and aggression within psychiatric in- paaent sejngs Papadopoulos et al. Acta Psychiatr Scand 1: 15: 5 39
4 Table. WiH K, van Dorn R, Fazel S (13) Risk Factors for Violence in Psychosis: Systema#c Review and Meta- Regression Analysis of 1 Studies. PLoS ONE (): e559. doi:.1371/journal.pone.559
5 Table 3. WiT K, van Dorn R, Fazel S (13) Risk Factors for Violence in Psychosis: SystemaAc Review and Meta- Regression Analysis of 1 Studies. PLoS ONE (): e559. doi:.1371/journal.pone.559
6 Method 1. Given a list of all admissions in 1.. Screened electronic records of 7 pa#ents using search terms incident, violent incident, violence, seclusion, ignoring behaviour such as verbal aggression that did not result in seclusion with / without rapid tranquilisa#on. 3. Pa#ents were divided into violent and non- violent groups and analysed according to age, length of stay, incidents per week and years in contact with mental health services.. Examined histories of non- violent and repeat violent groups for common themes.
7 All paaents Nonviolent paaents Violent paaents Admissions 1 7 3(%) (5%) Average age Average length of stay (days) 53 Average years in contact with mental health services Number of serious incidents Seclusion + / - RT 9(7%) Other (non seclusion + / RT) (13%) MulAple serious incidents 53(7%) Number of paaents with mulaple violent incidents 1(%) Average mulaple serious incidents / paaent 3 Table. A retrospec#ve survey of electronic records of admissions to a local male 13 bedded PICU during 1, inves#ga#ng outcomes of threats or actual serious violence on pa#ents or staff or hospital property.
8 Figure 1. Age distribu#on of pa#ents admihed in More Age of all pa#ents admihed in More Age of non violent pa#ents admihed in More violent pa#ents admihed 1
9 Age distribuaon of violent paaents violent paaents in seclusion Figure. ages of pa#ents in seclusion 1
10 Figure 3. Length of stay in PICU during 1 (days) More Length of stay of all paaents More Length of stay of non- violent paaents More Length of stay of violent paaents
11 Figure. Total number of incidents per week post admission to PICU in 1
12 Figure 5. Years in contact with mental health services all admissions in non violent paaents admited in violent paaents admited 1
13 Table 5. Common themes comparing violent and non violent groups Non violence group (random sample 13) Drugs ever used /13 = % Forensic history 5/13 = 3% Assault /13 = % CAMHS /13 = 15% Sexual disinhibi#on /13 = 3% Damage to property /13 = 15% Weapons 1/13 = % Arson 1/13 = % Suicide 1/13 = % Repeated Violence group Drugs ever used 1/1 = % Forensic History /1 = 5% Assault /1 = 3% CAMHS 5/1 = 3% Sexual disinhibi#on 3/1 = 19% Damage to property 7/1 = % Weapons /1 = 3% Arson 3/1 = 19% Suicide /1 = 5%
14 Summary of results 1. Violence in 5% of all admissions in 1. Seclusion +/- RT occurred in 7% of serious violence in 1 3. Mul#ple incidents occurred in 7% of all serious violence. Mul#ple violent incidents (av. 3 per pa#ent) ins#gated by % of pa#ents in 1 5. Peak age range of all admissions in 1 was 3s to s but violent pa#ents are younger with peak in 3s. Length of stay for all admissions in 1, peak at 3 days but violent pa#ents stay twice as long as non violent > days 7. Incidents fell by % aoer week one and by 3% by week two but showed a rise by week eight and beyond. First episode psychosis diagnosed in % of admissions and 3% of admissions were in contact with mental health services > 15 years 9. History of drug abuse, damage to property, assault, prison, weapons, disturbed childhood may be significant risk factors for repeated violence
15 Points for discussion 1. Training for de- escala#on. Use of enhanced observa#on 3. Use of outreach service. The long stay PICU pa#ent End
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