Another study examined how a personal digital assistant device could be used to reduce medication errors that occur during the patient discharge process from a psychiatric unit. Previously, discharge medication lists were a handwritten transcription of a psychiatrist’s medication order, a process that often resulted in human error. The study revealed that automating the medication discharge list via the personal digital assistant resulted in fewer medication errors. Another study, one of the largest recent efforts to investigate this phenomenon, was conducted over a five-year period and involved more than 65,000 patient days of hospitalization. It revealed that another information technology (IT) solution reduced medication errors in psychiatric settings. The twofold solution provided a dedicated medication error portal for reporting, along with a dedicated provider prescribing system. Together, the solutions demonstrated a meaningful reduction in medication errors (Alshehri et al., 2017; Jayaram et al., 2011). Psychiatric Inpatient Safety: The Larger Picture Patient safety remains a persistent problem in psychiatric acute care hospitalization. Researchers have pointed to the generally slower adoption of patient safety protocols by the behavioral health field generally, and within inpatient psychiatry specifically. Citing a 2018 study of 14 general hospital psychiatric units, data revealed an adverse patient event frequency of 14.5% of all hospitalizations. Shields and colleagues (2018) also describe the broader milieu that ultimately affects patient safety efforts within inpatient psychiatry, namely unaddressed public concern about safety; understaffing; inappropriate seclusion and restraint practices; imperfect regulatory mechanisms; and sparse research, including a marked lack of necessary funding for such research. Additionally, the issue of staff burnout combined with a lack of professional training in trauma- informed care, researchers argue, critically contribute to this complex environment that can result in too many adverse events for patients. Invalidation of the Patient Acute psychiatric hospitalization is a stressful life event for patients, even if hospitalization is the intervention they need. Professional clinical experience and reviews from former patients greatly inform the perception of psychiatric care: A litany of problems combine to create an unhelpful and stressful hospitalization. Experts such as Shields and colleagues (2018) argue that the impersonal nature of acute care can lead patients to experience depersonalization, an intensely negative affective state. Other research (Frueh et al., 2005) has identified the differences in perceptions between staff and patients, namely that staff assign incidents of aggression as being solely caused by a patient’s mental illness and not associated with the behaviors or attitudes of staff. Naturally, research reveals that patients often report significant negative experiences while hospitalized. Additionally, staff attitudes and behaviors can be professionally inappropriate, leading to patients feeling intimidated or humiliated, which can often occur with the use of containment measures, chiefly chemical or physical restraint (Beckett et al., 2017). Psychiatric Staff Training: Trauma-Informed Care A growing corpus of research and clinical evidence has identified trauma as one of the leading experiences that cause individuals to seek behavioral treatment. However, despite this finding, critics have argued that behavioral health organizations have been slow to incorporate trauma- informed care principles within their treatment training and delivery. Research has demonstrated that the utilization of trauma-informed care practices reduces the rate of use of seclusion and restraint practices. Since the year 2000, trauma-informed care models have increasingly emerged
within the behavioral community; however, the inclusion of this form of care is not yet ubiquitous in psychiatric hospitalization settings. Paradoxically, however, it is common for significant numbers of patients admitted onto psychiatric units to suffer from problems related to complex trauma, defined as the personal experience of multiple or extended trauma events. Researchers point out that trauma-informed practice has the potential to improve an organization’s context, creating a more informed, empathetic-driven ethic of care for patients. This in contrast to what psychiatric nursing staff and patients have negatively identified as treatment that is largely focused on only medical approaches (Beckett et al., 2017). Shields and colleagues (2018) maintain that trauma- informed care can reinforce principles of patient safety and quality care, reporting that “providing care that is psychologically safe requires that patients feel safe, have a sense of control over their lives, and have a sense of connection to staff members who are perceived to be available and who see their needs as legitimate” (p. 1854). An interesting study conducted in Australia uncovered positive results associated with trauma-informed education for psychiatric nursing staff. Through a series of ongoing workshops, several key domains of clinical practice were targeted for improvements (Beckett et al., 2017). ● Reducing seclusion and restraint ● Increasing staff confidence by improving skills in deescalation and physical safety ● Ensuring best practice for pharmacological interventions ● Introducing strengths-based philosophy and practices ● Providing sexual safety training and awareness ● Improving access to therapeutic activities on the unit In the three years following the workshops, significant improvements were reported. First, seclusion rates were reduced by 80%. Moreover, the amount of time patients spent in seclusion decreased to less than 60 minutes. Importantly, nursing staff reported feeling more confident and more willing to stay connected and engaged with patients who were displaying high amounts of negative Researchers argue that the quality and safety of care is harmed by specific market failures and features within our behavioral healthcare systems. First, providers and healthcare staff possess the majority of information that affects the quality and safety of patient care, thereby limiting family members’ awareness of and involvement with care while a patient is in psychiatric acute care. For example, family members often visit or meet the hospitalized patient outside of the treatment milieu, effectively shielding the family members from observing any significant facets of the treatment experience. This is typically quite different from general hospitalization, where family members can visit patients in their rooms within their units of care. This critical difference can limit the family’s ability to advocate for the patient if the need to do so arises (Shields et al., 2018). Another constraining example is the lack of patient choice. Often, patients are ambivalent or opposed to psychiatric hospitalization and may be admitted, sometime involuntarily, outside of their community because a bed is unavailable in their first-choice hospital. Another negative factor is the influence of state Medicaid plans or other health plans on the patient’s care. These entities operate as de facto agents on behalf of patients and can have organizational goals that are misaligned with the needs of the patient, thus negatively affecting the quality and safety of the patient’s care. Another dynamic is the possibility that patients may struggle with self-advocacy affect and distress (Beckett et al., 2017). The Negative Impact of Market Failures
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Book Code: PCUS1525
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