About the trial
In Victoria, Safewards was trialled across 7 services (18 units) over one year.
Safewards was associated with reduced seclusion events overall and improvement was especially evident in adult and youth wards. Also, Safewards had a highly favourable impact in terms of staff and consumer perceptions of increased safety and more positive inpatient environments.
Trial evaluation
The Safewards Victoria trial was extensively evaluated by the Centre for Psychiatric Nursing, University of Melbourne with significant and positive results. For the full article, see Outcomes of the Victorian Safewards .
Method
The independent evaluation was built on a program logic map and conducted across project phases of training, trial and sustainability. It provided project partners with clear findings regarding acceptability, effectiveness and impact of Safewards. The program-logic defined the objectives of the trial project.
The evaluation used a mixed method design and multiple data sources, including:
- Safewards fidelity measures, based on observation by evaluators
- several staff and consumer surveys
- organisation-level diaries of project activity
- and state wide data regarding seclusion events in all inpatient settings.
The evaluation answered 6 major evaluation questions:
- Was Safewards effective in reducing containment (seclusion events) of consumers in the trial wards?
- How did Safewards impact on safety and conflict in participating wards?
- How acceptable was Safewards to consumers in the wards participating in the Victorian Safewards trial?
- How was Safewards implementation enabled and impeded?
- How acceptable and applicable was Safewards, according to staff participating in the Victorian Safewards trial?
- Did the participating wards achieve fidelity with the Safewards interventions, beyond the trial phase?
Outcomes and results
Effectiveness: Safewards was associated with a 36% reduction in seclusion rates, from baseline to follow-up.
Applicability: The Safewards model made sense to staff, most interventions were keenly taken up by staff (n=103), and consumers enthusiastically engaged with several interventions (n=72).
Acceptability: Safewards was highly acceptable to staff (n=103) and consumers (n= 72).
Sustainability: Fidelity was achieved to a very good standard in the trial period (n=18 X 3) and to an excellent standard by the end of the sustainability period (n=14 X 5).
The researchers concluded that further implementation should be supported by a refocused evaluation effort. The focus should be on four things:
- enhancing outcome evaluation for Safewards by developing feasible data collection for the primary outcome of conflict events
- measuring effects in wards where Safewards is continuing and where Safewards is newly implemented, via outcome measures and consumer feedback
- enabling ongoing monitoring of use of Safewards interventions across all wards, and via fidelity measurement
- reporting effectiveness of staff training via brief pre-and post- surveys and quizzes.
Safewards in Emergency Departments
Since October 2016, Safewards has been implemented at 18 mental health public services in Victoria, in 62 units, across all ages; and is currently embedded in the State as a best practice model and resource for reducing restrictive interventions. It has been included in the National Health Quality and Safety Standards, 2019, as a resource for predicting, preventing and managing aggression and violence.
In 2019, three emergency departments from Peninsula Health and Bendigo Health took part in the trial of Safewards in emergency departments. The project focused on addressing conflict and containment events, for all staff, and all patients attending the emergency department.
With the evaluation recently completed, key findings established the model and some interventions have applicability in the emergency department. The trial demonstrated a combined reduction rate of 30% in code grey events, improved communication skills and collaboration between staff and patients. Significantly fewer medications were administered to manage aggressive behaviour. While the trial did not significantly reduce the rate of mechanical restraint, it did produce a significant effect in the reduction of the duration rate of mechanical restraint.