title: Reducing conflict and containment rates on acute psychiatric wards: The Safewards cluster randomised controlled trial.
abstract: BACKGROUND
  Acute psychiatric wards manage patients whose actions may threaten safety (conflict). Staff act to avert or minimise harm (containment). The Safewards model enabled the identification of ten interventions to reduce the frequency of both.
  
  
  OBJECTIVE
  To test the efficacy of these interventions.
  
  
  METHODS
  A pragmatic cluster randomised controlled trial with psychiatric hospitals and wards as the units of randomisation. The main outcomes were rates of conflict and containment.
  
  
  METHODS
  Staff and patients in 31 randomly chosen wards at 15 randomly chosen hospitals.
  
  
  RESULTS
  For shifts with conflict or containment incidents, the experimental condition reduced the rate of conflict events by 15% (95% CI 5.7-23.7%) [corrected] relative to the control intervention. The rate of containment events for the experimental intervention was reduced by 23.2% (95% CI 9.9-35.5%). [corrected]
  
  
  CONCLUSIONS
  Simple interventions aiming to improve staff relationships with patients can reduce the frequency of conflict and containment.
  
  
  BACKGROUND
  IRSCTN38001825.
authors.affiliation: Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom. Electronic address: len.bowers@kcl.ac.uk.
authors.forename: Len
authors.initials: L
authors.lastname: Bowers
authors.affiliation: Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom.
authors.forename: Karen
authors.initials: K
authors.lastname: James
authors.affiliation: Royal College of Psychiatrists, 21 Prescot Street, London E1 8BB, United Kingdom.
authors.forename: Alan
authors.initials: A
authors.lastname: Quirk
authors.affiliation: City University London, Northampton Square, London EC1V 0HB, United Kingdom.
authors.forename: Alan
authors.initials: A
authors.lastname: Simpson
authors.affiliation: Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom.
authors.forename: Duncan
authors.initials: D
authors.lastname: Stewart
authors.affiliation: Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Hodsoll
mesh_terms: D016000:Cluster Analysis; D003220:Conflict, Psychological; D006801:Humans; D017008:Negotiating; D009741:Nursing Staff, Hospital; D011567:Psychiatric Department, Hospital; D013222:State Medicine; D006113:United Kingdom
keywords: Absconding; Inpatient; Psychiatry; Rapid tranquillisation; Restraint; Seclusion; Self harm; Special observation; Violence