Background
Aim
Methods
Eligibility criteria
-
“Mental Health” defined as a field comprising various professions, such as psychiatry and clinical psychology that deal with the promotion of mental and psychological well-being and the prevention, diagnosis or treatment of mental disorders as listed in the Diagnostic and Statistical Manual fifth edition [15]
-
“Patient Safety” defined as “The avoidance, prevention and amelioration of adverse outcomes or injuries stemming from the process of healthcare” [1]
-
“Research” defined as diligent and systematic inquiry or investigation into a subject in order to produce generalisable knowledge and to discover or revise facts, theories, applications, etc.
-
“Inpatient Setting” defined as hospital settings which provide continuous care for a period of over 24 h
-
Population: Article must report on patients being treated within mental health services (“Mental Health” being defined as a field comprising various professions, such as psychiatry and social work, that deals with the promotion of mental and psychological well-being and the prevention, diagnosis or treatment of mental disorders as listed in the Diagnostic and Statistical Manual fifth edition [15]) or having a diagnosis of mental disorder.
-
Intervention/outcomes: Articles must report on interventions or data related to “Patient Safety” (defined as “The avoidance, prevention and amelioration of adverse outcomes or injuries stemming from the process of healthcare” [12]).
-
Comparators: There are no restrictions on articles regarding the use or lack of comparison groups
-
Timing: Article must be published in, or after, the year 1999.
-
Setting: Article must report on the “Inpatient Setting” (defined as hospital settings which provide continuous care for a period of over 24 h).
-
Population: Articles based purely on physical healthcare patients with no connection to mental health and well-being (not mental health)
-
Intervention/outcomes: Articles based purely upon non-safety-related issues, e.g. general patient experience or clinical effectiveness of specific treatments (not patient safety)
-
Comparators: There are no restrictions on articles regarding the use or lack of comparison groups
-
Timing: Articles published before 1999
-
Setting: Articles based purely upon primary care, community care or social care (not inpatient setting)
-
Articles not in English
-
Conference abstracts/protocols/book chapters
-
Articles that present opinion/editorials/commentaries/clinical case reviews (not research)
-
Population: Articles that amalgamate data from both inpatient and outpatient settings such that data for an inpatient only sample is not available
-
Interventions/outcomes: Articles that solely examine the reliability or validity of risk assessment tools, with no relation to the management of the risk that the tool is measuring
-
Articles that are reviews of any kind (including literature and systematic reviews)
-
Articles that are not empirical research (i.e. articles that do not have a clearly defined hypothesis or research question that aims to generate new knowledge in this field of research)
Study design
-
Run search and restrict terms to title and abstract only (searches may need to be run individually in each database in order to include the appropriate MeSH terms and specifications etc.)
-
Combine searches from all databases and remove duplicates using both an electronic and manual approach
-
Title and abstract screening according to inclusion and exclusion criteria
-
Full-text screening according to inclusion and exclusion criteria. Hand searching will also be conducted based on reference lists
-
Quality and risk of bias assessment
-
Data extraction against key research questions
-
Synthesis, assessment of the strength of the body of evidence and write up
-
Dissemination (i.e. publication and presentation) and application (i.e. through the development of research studies)
Search strategy
Mental Health | Patient Safety | Research | Inpatient Setting |
---|---|---|---|
Mental health.ti,ab. Mental wellbeing.ti,ab. Mental well being.ti,ab. Psychological well being.ti,ab. Psychological wellbeing.ti,ab. Mental disorder*1.ti,ab Mental illness*2.ti,ab. Mental disease*1.ti,ab. Psychiatr*.ti,ab. Anxiety disorder*1.ti,ab. Delirium.ti,ab. Dementia.ti,ab. Dissociative disorder*1.ti,ab. Factitious disorder*1.ti,ab. Impulse control disorder*1.ti,ab. Mood disorder*1.ti,ab. Affective disorder*1.ti,ab. Psychotic disorder*1.ti,ab. Depressive disorder*1.ti,ab. Neurotic disorder*1.ti,ab. Personality disorder*1.ti,ab. Conduct disorder*1.ti,ab. Schizophreni*.ti,ab. Somatoform disorder*1.ti,ab. Substance related disorder*1.ti,ab. Clinical Psychology.ti,ab. Impulsive behavio?r.ti,ab. Adjustment disorder*1.ti,ab. Eating disorder*1.ti,ab. Sleep disorder*1.ti,ab. Neuros#s.ti,ab. Psychos#s.ti,ab. Delusion*.ti,ab. Paranoia.ti,ab. Hallucination*1.ti,ab. Addiction*1.ti,ab. Dependence.ti,ab. Misuse.ti,ab. New psychoactive substance*1.ti,ab. Legal high*1.ti,ab. Depression.ti,ab. Panic disorder*1.ti,ab. Phobia*1.ti,ab. Health anxiet*.ti,ab. Bipolar disorder*1.ti,ab. Alcohol abuse.ti,ab. Alcoholism.ti,ab. Obsessive compulsive disorder*1.ti,ab. Obsessive thought*1.ti,ab. Intrusive thought*1.ti,ab. Post traumatic stress disorder*1.ti,ab. Post-traumatic stress disorder*1.ti,ab. Cognitive Behavio?ral Therap*.ti,ab. Psychotherap*.ti,ab. Person centred therap*.ti,ab. Person-centred therap*.ti,ab. Counselling.ti,ab. Antidepressant medication*1.ti,ab. Antipsychotic medication*1.ti,ab. Antianxiety medication*1.ti,ab. Psychotropic medication*1.ti,ab. Mindfulness based cognitive therap*.ti,ab. Mindfulness-based cognitive therap*.ti,ab. Mindfulness based relapse prevention.ti,ab. Mindfulness-based relapse prevention.ti,ab. Mindfulness based stress reduction.ti,ab. Mindfulness-based stress reduction.ti,ab. Electroconvulsive therap*.ti,ab. Verbal deescalation.ti,ab. Therapeutic.ti,ab. Functional Analys#s.ti,ab. Dialectical Behavio?r Therap*.ti,ab. Dysexecutive syndrome.ti,ab. | Patient safety.ti,ab. Adverse event*1.ti,ab. Adverse drug event*1.ti,ab. Sentinel event*1.ti,ab. Incident*1.ti,ab. Error*1.ti,ab. Near miss*2.ti,ab. Close call*1.ti,ab. Never event*1.ti,ab. Critical outcome*1.ti,ab. Adverse outcome*1.ti,ab. Unanticipated outcome*1.ti,ab. Suicide*1.ti,ab. Self-harm.ti,ab. Self harm.ti,ab. Behavio?r control.ti,ab. Restraint.ti,ab. Seclusion.ti,ab. Safety management.ti,ab. Failure to diagnose.ti,ab. Failure of diagnos#s.ti,ab. Under diagnosis.ti,ab. Over diagnosis.ti,ab. Misdiagnosis.ti,ab. Dual diagnos#s.ti,ab. Delay in diagnos#s.ti,ab. Wrong diagnos#s.ti,ab. Incorrect diagnos#s.ti,ab. Safety culture.ti,ab. Safety climate.ti,ab. Fall*1.ti,ab. Slip*1.ti,ab. Trip*1.ti,ab. Falling.ti,ab. Slipping.ti,ab. Tripping.ti,ab. Accident prevention.ti,ab. Patient accident*1.ti,ab. Patient in road traffic accident*1.ti,ab. Collision with an object.ti,ab. Contact with an object.ti,ab. Contact with sharp*1.ti,ab. Collision with sharp*1.ti,ab. Exposure to hazardous substance*1.ti,ab. Inappropriate patient handling.ti,ab. Inappropriate patient positioning.ti,ab. Elope.ti,ab. Wander.ti,ab. Runaway.ti,ab. Abscond*.ti,ab. Escorted leave.ti,ab. Unescorted leave.ti,ab. Aggressi*.ti,ab. Violence.ti,ab. Assault*1.ti,ab. Abus*.ti,ab. Disruptive behavio?r.ti,ab. Racial attack*1.ti,ab. Sexual attack*1.ti,ab. Sexually inappropriate.ti,ab. Physical attack*1.ti,ab. Verbal attack*1.ti,ab. Missing patient*1.ti,ab. Failure in access.ti,ab. Unexpected readmission*1.ti,ab. Reattendance*1.ti,ab. Unplanned admission*1.ti,ab. Transfer to specialist care unit*1.ti,ab. Delay in discharge.ti,ab. Failure to discharge.ti,ab. Inappropriate discharge.ti,ab. Planning failure.ti,ab. Self discharge.ti,ab. Self-discharge.ti,ab. Discharge against medical advice.ti,ab. Failure in referral process*.ti,ab. Failure to return from authorised leave.ti,ab. Transfer delay*1.ti,ab. Transfer failure*1.ti,ab. Inappropriate transfer*1.ti,ab. Unsafe transfer*1.ti,ab. Unsafe clinical environment*1.ti,ab. Inappropriate clinical environment*1.ti,ab. Inappropriate admission of a minor to an adult setting.ti,ab. Inappropriate transfer of a minor to an adult setting.ti,ab. Poor clinical assessment*1.ti,ab. Lack of clinical assessment*1.ti,ab. Lack of risk assessment*1.ti,ab. Wrong scan*1.ti,ab. Wrong x-ray*1.ti,ab. Wrong specimen*1.ti,ab. Inadequate scan*1.ti,ab. Inadequate x-ray*1.ti,ab. Inadequate specimen*1.ti,ab. Incomplete scan*1.ti,ab. Incomplete x-ray*1.ti,ab. Incomplete specimen*1.ti,ab. Mislabelled scan*1.ti,ab. Mislabelled x-ray*1.ti,ab. Mislabelled specimen*1.ti,ab. Unlabelled scan*1.ti,ab. Unlabelled x-ray*1.ti,ab. Unlabelled specimen*1.ti,ab. Missing scan*1.ti,ab. Missing x-ray*1.ti,ab. Missing specimen*1.ti,ab. Failure to interpret test result*1.ti,ab. Delay to interpret test result*1.ti,ab. Failure to act on test result*1.ti,ab. Delay to act on test result*1.ti,ab. Failure to receive test result*1.ti,ab. Delay to receive test result*1.ti,ab. Incorrect test result*1.ti,ab. Incorrect report*1.ti,ab. Missing test result*1.ti,ab. Missing report*1.ti,ab. Failure to undertake test*.ti,ab. Delay to undertake test*.ti,ab. Patient confidentiality.ti,ab. Communication failure*1.ti,ab. Failed communication*1.ti,ab. Failure in communication*1.ti,ab. Failure to receive informed consent.ti,ab. Inadequate handover.ti,ab. Documentation delay*1.ti,ab. Mislabelled documentation.ti,ab. Missing documentation.ti,ab. Inadequate documentation.ti,ab. Wrong documentation.ti,ab. Illegible documentation.ti,ab. Mislabelled healthcare record*1.ti,ab. Inadequate healthcare record*1.ti,ab. Missing healthcare record*1.ti,ab. Wrong healthcare record*1.ti,ab. Illegible healthcare record*1.ti,ab. Mislabelled referral letter*1.ti,ab. Inadequate referral letter*1.ti,ab. Missing referral letter*1.ti,ab. Wrong referral letter*1.ti,ab. Illegible referral letter*1.ti,ab. Misfiled documentation.ti,ab. No access to documentation.ti,ab. Patient incorrectly identified.ti,ab. Delay in obtaining clinical assistance.ti,ab. Difficulty in obtaining clinical assistance.ti,ab. Delay in recogni#ing complication*1 of treatment.ti,ab. Failure in recogni#ing complication*1 of treatment.ti,ab. Delay in monitoring.ti,ab. Failure to monitor.ti,ab. Failure to follow up.ti,ab. Infection Control.ti,ab. Failure of sterili#ation of equipment.ti,ab. Contamination of equipment.ti,ab. Health care acquired infection*1.ti,ab. Healthcare acquired infection*1.ti,ab. Health care associated infection*1.ti,ab. Healthcare associated infection*1.ti,ab. Wound infection*1.ti,ab. Surgical site infection*1.ti,ab. Unsafe environment*1.ti,ab. Inappropriate environment*1.ti,ab. Unsafe equipment.ti,ab. Inappropriate equipment.ti,ab. Availability of equipment.ti,ab. Availability of bed*1.ti,ab. Availability of IT.ti,ab. Staff shortage*1.ti,ab. Unavailability of staff.ti,ab. Lack of skilled staff.ti,ab. Unskilled staff.ti,ab. Lack of suitably trained staff.ti,ab. Failure of device*1.ti,ab. Failure of equipment.ti,ab. Unavailability of device*1.ti,ab. Extended stay.ti,ab. Extended episode*1 of care.ti,ab. Failure to discontinue treatment*1.ti,ab. Infusion injur*.ti,ab. Missing needle*1.ti,ab. Missing swab*1.ti,ab. Missing instrument*1.ti,ab. Retained needle*1.ti,ab. Retained swab*1.ti,ab. Retained instrument*1.ti,ab. Theatre list details incorrect.ti,ab. Inappropriate treatment*1.ti,ab. Wrong treatment*1.ti,ab. Unplanned return to theatre.ti,ab. Maternal death*1.ti,ab. Anaesthetic complication*1.ti,ab. Intensive Therapy Unit Admission*1.ti,ab. Intensive Treatment Unit Admission*1.ti,ab. Intensive Care Unit Admission*1.ti,ab. Venous thromboembolism*1.ti,ab. Pulmonary embolism*1.ti,ab. Readmission of mother.ti,ab. Stillbirth*1.ti,ab. Neonatal death*1.ti,ab. Birth trauma*1.ti,ab. Term baby admitted to neonatal unit.ti,ab. Undiagnosed f?etal abnormalit*.ti,ab. Pressure ulcer*1.ti,ab. Padded room*1.ti,ab. Ligature point*1.ti,ab. Self-neglect.ti,ab. Self neglect.ti,ab. Splint*1.ti,ab. Head bang*.ti,ab. Head-bang*.ti,ab. | Research.ti,ab. Academic work.ti,ab. Academic understanding.ti,ab. Theor*.ti,ab. Randomised controlled trial*1.ti,ab. Controlled clinical trial*1.ti,ab. Random allocation.ti,ab. Double blind method.ti,ab. Single blind method.ti,ab. Single blind stud*.ti,ab. Double blind stud*.ti,ab. Triple blind stud*.ti,ab. Multicentre stud*.ti,ab. Random sample*1.ti,ab. Evidence base*1.ti,ab. Evidence scan*1.ti,ab. Systematic review*1.ti,ab. Scoping review*1.ti,ab. Narrative review*1.ti,ab. Literature review*1.ti,ab. Meta narrative*1.ti,ab. Meta synthesi*.ti,ab. Meta-analys*.ti,ab. Clinical trial*1.ti,ab. Placebo*1.ti,ab. Comparative stud*.ti,ab. Evaluation stud*.ti,ab. Evaluative stud*.ti,ab. Descriptive stud*.ti,ab. Community trial*1.ti,ab. Follow up stud*.ti,ab. Prospective stud*.ti,ab. Longitudinal stud*.ti,ab. Qualitative.ti,ab. Quantitative.ti,ab. Focus group*1.ti,ab. Semi-structured interview*1.ti,ab. Quality improvement project*1.ti,ab. Data collection.ti,ab. Data analysis.ti,ab. Survey*1.ti,ab. Observation*1.ti,ab. Ethnograph*.ti,ab. Intervention*1.ti,ab. Investigation*1.ti,ab. Experiment*.ti,ab. Case stud*.ti,ab. Delphi.ti,ab. Nominal group technique*1.ti,ab. Nominal group stud*.ti,ab. Consensus stud*.ti,ab. | Hospital*.ti,ab. Acute care.ti,ab. Secondary care.ti,ab. Tertiary care.ti,ab. Unit*1.ti,ab. Ward*1.ti,ab. Low secure.ti,ab. Medium secure.ti,ab. High secure.ti,ab. Secure facilit*.ti,ab. Forensic*1.ti,ab. Inpatient*1.ti,ab. Triage.ti,ab. |
Databases
-
MEDLINE
-
Embase
-
Health Management Information Consortium (HMIC)
-
PsychInfo
-
Web of Science
-
Cumulative Index to Nursing and Allied Health Literature (CINAHL)
Grey literature and hand searching
Screening
Critical appraisal
Data extraction
Author, year | Study design | Setting | Participants | Aims/objectives | Outcomes/data related to patient safety | Study quality |
---|---|---|---|---|---|---|
Mezey, Hassell & Batlett (2005) | Qualitative Interview | Medium-secure NHS psychiatric units (England and Wales) | 31 female inpatients 58 staff (9 consultant forensic psychiatrists, 9 ward managers, 18 staff nurses, 9 nursing support workers, 3 social workers, 5 psychologists and 5 occupational therapist). 53% women, 47% men. | To examine the impact of gender segregation on the safety of women patients detained in medium-secure psychiatric facilities. | Women patients in both types of units reported high levels of actual and threatened physical and sexual violence. Women in single-sex units reported intimidation, threats and abuse by other women patients, although they were less vulnerable to sexual abuse and exploitation and serious physical assault. | Will be assessed and scored from ‘Good’ to ‘Very Poor’ based upon Hawker et al. (2002) |
Meehan, Morrison & McDougall (1999) | Mixed methods Case review and interview | Acute psychiatric unit on the grounds of a public hospital | Case review: All participants who were recorded as AWOL in the unit’s register within a 6-month study period. Interviews: 14 patients (9 males, 5 females; 19–58 years old) who were interviewed within 48 h of returning from being AWOL. | To identify patient and environmental characteristics associated with absconding behaviour and to gain an understanding of the behaviour form the patient’s perspective. | Those who absconded were male (58%), under 40 years of age (74%), admitted involuntarily (78%), and had a diagnosis of schizophrenia (42%). One third of all AWOL incidents resulted from repeated absconding by the same individuals. The first 7 days post admission was a high-risk period for absconding behaviour. Identified situational and environmental factors likely to increase the risk of absconding included: staff skills, communication and management strategies. |