Creating ‘Safewards’

Creating ‘Safewards’

Mental health wards at Southern DHB are using a new approach to inpatient care.

Safewards, is a model of care that originated out of research undertaken in the UK, and has been introduced by the Mental Health Addictions and Intellectual Disability Directorate (MHAID).  It is a model of care which offers a number of different ways to help wards understand conflict, which at times can be the reality of mental healthcare.

Safewards works by using a set of 10 interventions whose aim is to reduce conflict and improve the way staff respond to conflict. These interventions can be as simple as setting clear mutual expectations, using soft words, mitigating bad news, mutual help and increasing mutual understanding, using calm down methods and providing reassurance – approaches the teams use in their day to day practice.

Interventions which have been implemented so far in MHAID inpatient areas are Know each Other; Message/Hope Trees; Mutual Help Meetings and Clear Mutual Expectations.

Wards have successfully introduced digital photo frames to replace traditional photo boards for the ‘Know each Other’ intervention. These provide general information about staff members such as qualifications; years of experience working in the area; previous jobs before working for the DHB; hobbies/interests; favourite TV programme or preferred music.

“Staff often know the background and interests of people using services, which gives them information to start a conversation. The same can work in reverse, where the service user has information about individual staff members to start a conversation and find areas of common interest.

“The mutual familiarity and knowledge can help form faster relationships which leads on to several benefits, such as people feeling more comfortable and reassured during their admission,” said Southern DHB Mental Health Addictions and Intellectual Disability Directorate Nursing Director, Heather Casey.

Message/Hope Trees have also been introduced where, prior to discharge or any other point in recovery people are encouraged to write a positive and helpful message that is then placed on the message board/discharge tree. These messages can be viewed by people being admitted and visitors for reassurance and to increase feelings of hope.

“The aim is make inpatient wards a more therapeutic and peaceful place and to create a safe environment for everyone. We’re doing this by enhancing relationships and reducing conflict and containment as much as possible,” said Ms Casey.

More about Safewards

Safewards Objectives

  • Better relationships between staff and patients.
  • Increased safety, reduced use of restrictive practices.
  • ​​Less time wasted on containment, more invested in engagement.
  • ​Fewer staff and patient injuries.
  • An environment that is peaceful and conducive to supporting people in their journey of recovery.

Safewards Interventions

There are 10 Safewards Interventions under the model. These include:

  1. Discharge Messages/Messages of Hope – prior to discharge or at any appropriate time, patients are encouraged to write a positive and helpful message that is then placed on a Message/Hope Tree. These messages can be viewed by visitors for reassurance and to increase feelings of hope
  2. Mutual Help Meetings – starting the day in partnership, facilitated by staff, patients are encouraged to identify ways of helping and supporting each other during the day
  3. Clear Mutual Expectations – our expectations of each other whilst on the inpatient unit (patients and staff)
  4. Calm Down Methods (Sensory Modulation) – creating an environment and the opportunity for low stimulus and serene time out. A box of equipment is offered before considering additional medication
  5. De-escalation Tips – a drawing together of the range of de-escalation techniques on a poster that is displayed in staff areas. Staff are given in-service follow-up on these techniques on a regular basis
  6. Reassurance – following an anxiety provoking incident on the inpatient unit, patients are followed up either in small groups or alone to give reassurance and understanding of what happened. Staff maintain a higher visibility post-incident so patients feel more safe and secure
  7. Positive Words – staff provide positive feedback about the people being cared for to highlight the good things that happen and that we all have strengths
  8. Bad News mitigation – raising staff awareness during handovers and ward rounds, of potential 'bad news' events that patients may experience. Staff then follow-up by conveying the 'bad news' sympathetically to the patient and offering support
  9. Soft Words – statements that are 1-2 sentences long are provided to patients in any of the three primary flashpoints: saying no; asking to stop behaviour; and asking patients to do something they don’t want to do
  10. Know each other – each staff member provides non-controversial information about themselves that they are happy to be communicated to the patients. Patients are also encouraged to share similar information about themselves.




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