Using Technology to move from reactive to proactive care within a forensic mental health setting Mark Thorpe, RMN – Program Lead for the Centre of Perfect Care Dr Panchu F Xavier – Consultant Forensic Psychiatrist

SAFETY PROJECT “From reactive to proactive nursing” Background Aim of the project Team – Project Manager, Forensic Psychiatrist and Ward Based Nurse The main focus – Anticipation and preparedness “Will care be safe in the future?” Background 1. Health Foundation – is an independent charity which supports people in the UK to improve health and healthcare for people. 2. Project March 2015 12 month programme 1-2 – Test sites Improvement projects Improve service delivery Builds peoples skills and knowledge Development opportunities/funding 3. Aim – To test a safety, measuring and monitoring framework by reducing aggression on the wards to make them safer. 4. Main Domain – Anticipation and preparedness “will care be safe in the future”. 5. Focus to review existing data. Collected data to identify areas of aggression.

SAFETY PROJECT “From reactive to proactive nursing” Incident data Two year period Ward experience questionnaire Days of week/areas/ time of day Identified “Aggression by patient on staff or other” was over highest indicator 1711 incidents over a 2 year period (October 2013, 2015 December). We looked at locations – Area of ward - patients seclusion room and night area were the highest scores. Days of the week – Wednesday highest scores Times of day – during handover was the lowest and after handover was the highest.

Dynamic Appraisal of Situational Aggression (DASA) Research by Prof Daffern and colleagues, Australia (2006) DASA developed by combining items from other risk assessments DASA predicts the likelihood of aggression occurring in the 24hours DASA is scored by nursing staff on the ward every 24 hours DASA scores are used in nursing handovers and to inform safety planning

Dynamic Appraisal of Situational Aggression (DASA)

Dynamic Appraisal of Situational Aggression (DASA) DATA pre and post DASA Incident group Pre DASA Post DASA % Change Aggression 262 212 -19% Assault 66 57 -14% Self Harm 14 6 -57% Behaviour 161 185 +15% Overall Restraint was reduced by 46% All incidents together reduced by 7%

Dynamic Appraisal of Situational Aggression (DASA) DASA data collected and collated manually Missing data - discussions hampered Technology used to improve fill rates and visually represent progress Ashworth Hospital has in-house EPR system PACIS DASA ‘app’ written by IT experts in-house ( front-end written using Gupta Team Developer with the underlying database in SQLBase)

Dynamic Appraisal of Situational Aggression (DASA)

Dynamic Appraisal of Situational Aggression (DASA) Change in medication 04/09 Unresponsive to treatment

SAFETY PROJECT “From reactive to proactive nursing” Sickness absence rates before and after the implementation of DASA

Physical Restraints, by ward Physical restraints before and after the implementation of DASA

THANK YOU FOR LISTENING ANY QUESTIONS? CONTACT DETAILS: mark.thorpe@merseycare.nhs.uk @CPC_MerseyCare http://centreforperfectcare.com/