title: An Assessment of Levels of Safety in Psychiatric Units.
abstract: OBJECTIVE
  This article aims to understand the incident patterns in relation to different types of spaces within a psychiatric unit, which are discussed using the five levels of safety framework.
  
  
  BACKGROUND
  Implementing measures to improve patient safety is essential particularly in a psychiatric hospital, where limited research has been conducted on inpatient safety. Therefore, this article aims to understand the incident patterns from the lens of the five levels of safety framework, which categorizes spaces according to the level of patient supervision in psychiatric facilities, as follows: service areas, corridors, dayrooms, patient rooms and bathrooms, seclusions and admissions.
  
  
  METHODS
  In an 81-bed psychiatric hospital, this mixed-method study drew 7 years of incident reports and caregivers' perceptions gathered through focus groups. Incident reports on physical safety were analyzed based on the five levels of safety framework ( N = 1,316). Focus groups ( n = 9) explored the caregivers' viewpoints on patient safety and five categories of spaces.
  
  
  RESULTS
  Overall findings support the five levels of safety pattern, confirming that most incidents occurred in patient rooms and bathrooms; moreover, relatively fewer incidents happened in dayrooms and corridors. Elopements are higher in hallways and dayrooms. Suicide is most common in patient rooms and bathrooms, and violence is more frequent in dayrooms. Focus groups results yielded insightful recommendations.
  
  
  CONCLUSIONS
  Levels of safety framework can be adapted to seven categories where seclusion room and admission area would be two of the spaces with least incidents.
authors.affiliation: 1 University of Kentucky, Lexington, KY, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Bayramzadeh
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D017028:Caregivers / Q000523:psychology*; D017144:Focus Groups; D006801:Humans; D007297:Inpatients / Q000523:psychology; D061214:Patient Safety; D000066550:Physical Abuse / Q000706:statistics & numerical data; D011567:Psychiatric Department, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D013405:Suicide / Q000706:statistics & numerical data; D016312:Treatment Refusal / Q000706:statistics & numerical data
keywords: behavioral health; mental health; patient safety; patient-centered design; psychiatric hospital