Effectiveness of audit in improving interview room safety

Psychiatric training – a dangerous pursuit

We performed a review of the international literature, Royal College of Psychiatrists guidelines and Irish legislation concerning psychiatric trainees and their experience of violence. Physical violence in the workplace was reported by 16% of trainees in Ireland and 67% of specialist registrars in the UK; 72% of trainees in Belgium reported verbal violence. Personal characteristics of trainees which increase the risk of experiencing violence are under-researched, although it is observed that the duration of clinical experience seems to be somewhat protective. the advent of community psychiatry brings new risks to trainees. the Royal College of Psychiatrists issued guidelines and reports that are useful in developing facilities and promoting trainee safety. Although legislation provides some protection to trainees, it also places responsibility on them as employees.

How safe are patient interview rooms?

Aims and Method

A cross-sectional survey was conducted to investigate the safety of rooms used by medical staff to interview patients in out-patient and in-patient settings of a mental health trust. An assessment tool was designed, and examined the features of an interview room that were likely to promote safety.

Results

The survey included 112 rooms and demonstrated shortcomings that compromised interview room safety. Rooms were frequently overcrowded with furniture (n=30), cluttered with loose objects (n=101, 90%) and used for multiple purposes (n=82, 73%). Room layout often compromised either access to alarm systems (n=51, 46%) or exit from rooms (n=99, 88%). Necessary facilities for summoning assistance were found to be lacking.

Clinical Implications

The safety of interview rooms has not been emphasised sufficiently within everyday working practice and should be revisited.

The management of violence in general psychiatry

There is increasing concern about the level of violence within mental healthcare settings. In this article I review what is known on this subject, discuss the relationship between mental disorder and violence and summarise the different ways to prevent and manage violence. When planning strategies to prevent violence in such settings it is important to consider not only patient risk factors but also risk factors in the environment. Staff need to have all the possible techniques for managing violent behaviour available to them in order to weigh up the risks and benefits for any specific patient in any particular situation.