title: Describing the precursors to and management of medication nonadherence on acute psychiatric wards.
abstract: OBJECTIVE
  This study aims to (a) describe what conflict (aggression, absconding etc.) and containment (de-escalation, restraining etc.) events occur before and after events of medication nonadherence on acute psychiatric wards and (b) identify which patient characteristics are associated with medication nonadherence.
  
  
  METHODS
  Conflict and containment events for each shift over the first 2 weeks of admission were coded retrospectively from nursing records for a sample of 522 adult psychiatric inpatients. The frequency and order of the conflict and containment events were identified. Univariate logistic regression models were conducted to examine which patient characteristics were linked with medication noncompliance.
  
  
  RESULTS
  Medication refusals were commonly preceded by aggression whereas demands for pro re nata (PRN) (psychotropic) were commonly preceded by the same patient having been given PRN medication. Refusals and demands for medication were commonly followed by de-escalation and given PRN (psychotropic) medication. Only refusal of PRN medication was commonly followed by forced (intramuscular) medication. Ethnicity, previous self-harm and physical health problems were also linked to nonadherence.
  
  
  CONCLUSIONS
  Greater attention to the conflict and containment events that precede and follow medication nonadherence may reduce the likelihood of medication nonadherence.
authors.affiliation: Evidence for Policy and Practice Information and Coordinating (EPPI)-Centre, Social Science Research Unit, UCL Institute of Education, London, UK. Electronic address: m.richardson@ioe.ac.uk.
authors.forename: Michelle
authors.initials: M
authors.lastname: Richardson
authors.affiliation: Verita Consultants LLP, 53 Frith Street, London UK/Star Wards.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Brennan
authors.affiliation: The McPin Foundation, London.
authors.forename: Karen
authors.initials: K
authors.lastname: James
authors.affiliation: Verita Consultants LLP, 53 Frith Street, London UK/Star Wards.
authors.forename: Mary
authors.initials: M
authors.lastname: Lavelle
authors.affiliation: School of Nursing, Midwifery and Social Work, University of Manchester.
authors.forename: Laoise
authors.initials: L
authors.lastname: Renwick
authors.affiliation: School of Psychology, Social Work and Human Sciences, University of West London.
authors.forename: Duncan
authors.initials: D
authors.lastname: Stewart
authors.affiliation: Section of Mental Health Nursing, Health Services and Population Research, Institute of Psychiatry, King's College London.
authors.forename: Len
authors.initials: L
authors.lastname: Bowers
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence; D001523:Mental Disorders / Q000188:drug therapy*; D008875:Middle Aged; D009737:Nursing Records; D011567:Psychiatric Department, Hospital; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012189:Retrospective Studies
chemical_list: D011619:Psychotropic Drugs
keywords: Conflict; Containment; Medication; Nonadherence; Psychiatric