This model is derived from our own research and from the research efforts of many others around the world. We have been conducting research on how to reduce conflict and containment for many years. We started with studies into absconding by patients, rule breaking, official incident reports, manual restraint, attitudes to containment, the compulsory detention process and nurse attitudes to people with a personality disorder. We went on to conduct some of the largest ever studies of acute inpatient care, comparing 136 wards in the City- 128 study, examining change over a four year period in one Trust in the Tompkins Acute Ward Study, and testing an intervention in the City Nurses study. Since then we have collected information about 522 patients in the CONSEQ study, and explored patients subject to high levels of containment in the HICON study. Along the way we have developed questionnaires and checklists which are now used internationally and have been translated into many different languages. However the Safewards Model is also informed by research conducted by others internationally over many years. We have reviewed over a thousand previous studies by other people on aggression, absconding, substance use, self-harm, suicide, medication refusal, p.r.n. medication, special observation, coerced i.m. medication, seclusion, manual restraint, and mechanical restraint. These contained valuable lessons that enabled us to construct a much stronger model and design a much stronger intervention for people to use.
A fully referenced account of the evidence behind the Safewards model can be found here.
The Safewards cluster randomised controlled trial
Using the Safewards model we generated approximately 300 ideas for interventions that could be used to help ward staff reduce levels of conflict and containment, making their wards safer places. We then rated these, consolidated them, consulted service users, carers and expert professionals before coming up with a list of 16 potential interventions to test in a research trial. We then used these 16 in a pilot study on 4 wards at one hospital. The learning from this enabled us to drop 6 of the interventions and make improvements to the remaining 10. These 10 were then tested in a single blind cluster randomised controlled trial on 31 wards at 15 different hospitals. A control intervention was introduced on 15 wards, and the 10 experimental interventions on the others. The Safewards interventions produced at 15% decrease in the rate of conflict and a 24% decrease in the rate of containment.
A full report of the trial will be linked to here when it is available.
Making the case for Safewards in your ward, hospital or Trust
We provide some powerpoint slides here that we have used in presentations around the world. Feel free to use or adapt these when making presentations in your own Trust. Results of the Safewards Trial
Alternatively, here is a video of Professor Len Bowers presenting the results at Orygen in Melbourne Australia, which can be freely shown.