Safewards: making wards safe
Safewards is a program that encourages staff and clients including carers, family, and support people to work together and make wards more positive places.
Safewards gives a call to action to nurses, clinical and supporting staff to reduce conflict and containment practices.
Examples of conflict and containment (restrictive practice) are:
| Conflict | Containment |
|---|---|
| Aggression | Pro re nata (PRN) medication |
| Rule -breaking | Coerced intramuscular medication |
| Substance abuse | Special observations |
| Absconding/missing | Seclusion |
| Medication declining | Manual restraint |
| Self/harm/suicide |
The Safewards model and interventions are adaptable programs of evidence-based nursing interventions that were tested over a 20-year period by the Institute of Psychiatry at Kings College London.
While these interventions were originally developed for use in the mental health setting, they strengthen existing principles of good nursing practice from the Royal College of Nursing by:
- treating everyone in one’s care with dignity and humanity
- promoting care that puts people at the centre by involving patients service users, their families and their carers
- taking responsibility for the care we provide.
The use of the Safewards program in other Australian states and territories has been associated with reduced conflicts, with the most improvements seen in adult and youth mental health wards.
Staff and consumers have also reported feeling safer and more positive within inpatient environments that use the Safewards program.
ACT Safewards Model of Care Trial
Safewards was introduced in four wards across the ACT public health as a trial from November 2020 to June 2021 as part of the Nurses and Midwives: Towards a Safer Culture Strategy.
The model and interventions were a strong fit, with strategies aimed at limiting the occurrence and impacts of occupational violence (OV), as well as broader culture change strategies that sought to embed respect, inclusion, and collaboration across organisations.
The four inpatient wards chosen included:
- Canberra Hospital Ward 7B General Medical ward
- Canberra Hospital Adult Acute Mental Health Unit
- North Canberra Hospital Ward 4W General Medical Ward
- Banksia Inpatient unit
Safewards actions undertaken during the trial
Safewards outlines 10 actions staff and clients could do to reduce conflict and restrictive practices.
Download the Safewards 10 actions poster.
| Action | Description |
|---|---|
| Clear mutual expectations | Clients and staff agree on behaviour that is expected when on inpatient unit. |
| Know each other | Staff give information about themselves that they are happy to share (for example, favourite TV show, hobbies, pets). Clients are also encouraged to share these. |
| Soft words | Visual clues for staff about sensitive and respectful communication. |
| Talk through | Staff use their communication skills to help clients calm down when they are upset, agitated, or distressed. |
| Bad news mitigation | Making sure that staff are aware when clients have or may receive bad news, and make sure they are offered support and a quiet place to express their feelings. |
| Calm down | A box of items that clients can use to feel calmer and more relaxed. |
| Reassurance | Debriefing about incidents with clients in a group or one-or-one. |
| Positive words | Staff focus on client strengths using positive words during clinical handover. |
| Discharge messages | A display of positive and helpful messages written by clients and their carers before discharge. |
| Mutual help meetings | Regular meetings on the unit where clients and staff are encouraged to identify ways of helping and supporting each other. |
Safewards Model of Care Post Implementation Review
The Safewards Model of Care Post Implementation Review was conducted in 2021 and considered the impact the trial had in supporting staff and patients to work together to achieve improved health outcomes.
It looked at training, acceptability, implementation, and outcomes.
The review was published in November 2021. It was based on a survey of more than 290 nurses and midwives and data from training workshops, participant focus groups, and stakeholder interviews.
Findings from the Safewards trial review will now be used to consider broad implementation across the ACT public health system.
Research opportunities
There are many aspects of Safewards that can be explored in greater detail, for example how nurses, midwives, and consumers perceive Safewards, which factors in the work environment provide the strongest support, and what are the best educational and training models.
For anyone interested in undertaking research into Safewards in their service or more broadly, contact Professor Michael Roche via the SYNERGY Nursing and Midwifery Research Centre.
Resources
- Nurses and midwives: Towards a Safer Culture Strategy
- The Safewards Model of Care Trial in the ACT Post Implementation Review
Internal Stakeholders Event 2022 presentations
- Introduction and address from Minister for Health Rachel Stephen-Smith
- Patrice Murray and Lisa Spong presentation
Safewards presentations
- Raoul Craemer presentation
- Lisa Spong presentation
- Questions and answers
- Michael Roche presentation
- Lisa Spong presentation and questions and answers
More information
If you are interested in more information about the Safewards trial, contact the project implementation team on NM.SaferCulture@act.gov.au.