title: Wards features associated with high rates of medication refusal by patients: a large multi-centred survey.
abstract: OBJECTIVE
  This article aimed to explore the relationship of medication-related conflict [refusal of regular medication, refusal of pro re nata (prn) medication, demanding prn medication] to other conflict behaviours, the use of containment methods, service environment, physical environment, patient routines, staff demographics and staff group variables.
  
  
  METHODS
  The Patient-staff Conflict Checklist (PCC-SR), an end-of-shift report completed by nurses on the frequency of conflict and containment events, was collected for a 6-month period on 136 acute mental health wards in 67 hospitals within 26 NHS Trusts in England, in 2004-2005. Multilevel modelling was used to assess associations with medication-related conflict rates.
  
  
  RESULTS
  The mean daily rate (at ward level, standardised to 20 beds) of incidents of regular medication refusal was 0.89 (S.D. 0.52), prn medication refusal 0.30 (S.D. 0.19) and demanding prn medication 1.09 (S.D. 0.63). The frequency of these events was found to be associated with passive resistant patient behaviours, higher levels of containment (specifically locking the main ward door, the use of special observation, and time out) and unstable staffing profiles.
  
  
  CONCLUSIONS
  It may be possible to achieve greater medication concordance amongst patients in acute mental health wards through a more consensual approach to care. Paradoxically, fewer restrictions may promote better treatment acceptance and safer outcomes. Consistent nurse staffing and therefore better staff-patient relationships are also likely to improve cooperation and outcomes.
authors.affiliation: The School of Nursing, Midwifery and Social Work, The University of Manchester, M13 9PL Manchester, UK. john.a.baker@manchester.ac.uk
authors.forename: John A
authors.initials: JA
authors.lastname: Baker
authors.forename: Len
authors.initials: L
authors.lastname: Bowers
authors.forename: John A
authors.initials: JA
authors.lastname: Owiti
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004739:England; D005260:Female; D006779:Hospitals, Public; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy; D009723:Nurse-Patient Relations; D010349:Patient Compliance / Q000706:statistics & numerical data; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D013222:State Medicine
chemical_list: D011619:Psychotropic Drugs