1. 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

2. 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 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.

3. 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.

5. 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

6. Dynamic Appraisal of Situational Aggression (DASA)

7. Dynamic Appraisal of Situational Aggression (DASA)
DATA pre and post DASA
Incident group Pre DASA Post DASA % Change
Aggression %
Assault %
Self Harm %
Behaviour %
Overall Restraint was reduced by 46%
All incidents together reduced by 7%

8. 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)

9. Dynamic Appraisal of Situational Aggression (DASA)

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

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

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

13. THANK YOU FOR LISTENING ANY QUESTIONS?
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