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Original papers: Helen L. Campbell and Nicole K. Fung How safe are patient interview rooms? Psychiatr Bull 2007; 31: 10-13 [Abstract] [Full text] [PDF]

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Compromised safety of patient interview rooms

Joji George   (8 January 2007)

Response letter on How safe are patient interview rooms?Psychiatr Bull 2007; 31: 10-13

Raafat S Labib Mishriky   (16 January 2007)

Safety of psychiatry professionals should not be compromised

Reji Jayan, Walsall   (16 February 2007)

SAFETY AT WORKPLACE

Ovais Wadoo, A.J.Shah,Z.Z.Ahmad   (16 February 2007)

Are we safe?

Julian Bustin, Dr Rohan Van der Speck, Specialist Registrar in Learning Disability and General Adult Psychiatry. West of Scotland Rotation Glasgow, UK   (16 February 2007)

Compromised safety of patient interview rooms 8 January 2007
Joji George, Queen Elizabeth Psychiatric Hospital Birmingham MRCPsych Send letter to journal: Re: Compromised safety of patient interview rooms joji{at}doctors.org.uk Joji George	It was such a coincidence to read the cross-sectional survey: “How Safe are patient interview rooms?” by Helen Campbell and Nicole Fung (Psychiatric Bulletin January 2007, 31, 10-13) the day after my colleague was assaulted in an inpatient ward. There is increasing incidence in violence and aggression against NHS Staff and this is three times more common in mental health and community trusts. Even though the Department of health had set targets to reduce the incidence of violence it is clearly evident that it is on the increase. It was not surprising to know that more than a quarter of the rooms were used for multiple purposes but was astonishing to know that none of the inpatient rooms had fixed alarms. This survey throws light onto the simple measures which are overlooked. These include avoiding clutter and loose furniture, provisions of alarms and telephones, and modification of room characteristics. Even though there are many strategies to promote the safety at workplace, I agree with the authors that interview room safety is one of the simplest ways to achieve safety in workplace. Other measure like risk assessments, personal safety training and provisions of safety alarms should be considered. Annual updating of the personnel safety training is one of the mandatory training and should be incorporated in the annual appraisal of all the clinical staffs. This survey also highlights the various factors which could be addressed by the service managers to improve safety at work. DEPARTMENT OF HEALTH (2003) 2002/2003 Survey of Violence, Accidents and Harassment in the NHS. Department of Health. NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE (2005) Violence – The Short-term Management of Disturbed/Violent Behavior in In-patient Psychiatric Settings and Emergency Departments. NICE. DEPARTMENT OF HEALTH (2002) Mental Health Policy Implementation Guide: National Minimum Standards for General Adult Services in Psychiatric Intensive Care Units (PICU) and Low Secure Environments. Department of Health.
Response letter on How safe are patient interview rooms?Psychiatr Bull 2007; 31: 10-13 16 January 2007
Raafat S Labib Mishriky, SHO in Psychiatry Combined North staffordshire NHS trust Send letter to journal: Re: Response letter on How safe are patient interview rooms?Psychiatr Bull 2007; 31: 10-13 raafatmishriky{at}hotmail.com Raafat S Labib Mishriky	Reply letter How safe are patient interview rooms? Psychiatr Bull 2007; 31: 10-13 Sir It was suggested in the cross sectional survey that more than a quarter of the rooms (27%) were being used for multiple purposes, including art therapy, group activities and multidisciplinary team meetings. I agree with the authors that rooms which are originally used for purposes other than an interview should not be used as interview rooms. But this does not mean that interview rooms should not be used for other purposes if there are shortages in the number of rooms. Having a group meeting at a different time in the interview room may not necessarily affect the safety measures in these rooms. It was also mentioned that the median number of furniture were 7 and 9 for outpatients and inpatients respectively. This reflected a statistical significant of P < 0.005. In addition Davies W (1989) proposed a suitable layout for furniture to maximize safety. It is still unclear whether the more the number of furniture in itself can have a direct effect on the safety. I wonder if the median number of furniture has a relevant clinical significance in relation to violence. Finaly although it will be ideal to have a proper phone in the room for several reasons, there may not be time in some situations to make a phone call at all. This is especially if the patient attacked the interviewer suddenly. In this situation other measures can be taken. Name and Address: Raafat Labib Mishriky SHO, General Adult Psychiatry Combined North Staffordshire NHS Trust Lymbrook Mental Health center Bradwell Hospital site Talke Road NewCastle-under-Lyme ST5 7TL Phone: 07725127013 Email: raafatmishriky@hotmail.com
Safety of psychiatry professionals should not be compromised 16 February 2007
Reji Jayan, Senior House Officer Dorothy Pattison Hospital, Walsall Send letter to journal: Re: Safety of psychiatry professionals should not be compromised rejijayan{at}hotmail.com Reji Jayan, et al.	Dear Editor, This study has been an excellent overview of the current situation affecting psychiatry professionals and their safety issues. It should be acknowledged that most psychiatric hospitals have well maintained interview rooms. However this is not the case when a psychiatry doctor or the crisis team assess patients in the emergency medical unit (EMU), where they are often called. Most of the time they are asked to assess patients in an available room without the help of a staff nurse and no proper system to monitor the interview. Such rooms in EMU do not have an alarm system and no closed circuit television monitoring. This definitely compromises the safety of the professionals involved. The 4 hour waiting rules in accident and emergency (A&E)have created a situation where patients coming with overdose and alcoholic intoxication are referred to psychiatry oncalls within a short span of time, necessitating their assessment as soon as possible in a less than ideal setup. I think it is high time that we demand such facilities before we could interview patients in accident and emergency and medical units.
SAFETY AT WORKPLACE 16 February 2007
Ovais Wadoo, SHO Sheffield Care Trust, A.J.Shah,Z.Z.Ahmad Send letter to journal: Re: SAFETY AT WORKPLACE owadoo{at}gmail.com Ovais Wadoo, et al.	Violence in the workplace is of increasing concern to junior doctors in general and trainee psychiatrist in particular(1).Research also suggests that staff safety in interview rooms in all mental healthcare settings remains inadequate in many situations(2).Although the college has tried to address issues around trainees safety and has issued a number of clear recommendations regarding safety training, induction courses, local policy and procedures and safety standards for interview rooms(3), this study (4) has revealed that the issue of interview room safety in everyday practice still remains a concern. As trainees, we share the concern and feel vulnerable. It draws our attention to safety awareness and safety at workplace, particularly at a time of major reforms in the postgraduate medical training in UK. It is the time when the Royal College of Psychiatrists, PMETB need to do more to put strategies in place which would promote safety in the workplace so that training takes place in safe environment. References (1)Bhugra, D., Smith, J. & Junaid,O.(1990) Doctors�safety:Who cares? BMJ, 301, 43. (2) Sipos, A., Balmer, R. & Tattan, T. (2003) Better safe than sorry: a survey of safety awareness and safety provisions in the workplace among specialist registrars in the South West. Psychiatric Bulletin, 27, 354�357 (3) Cormac, I., Crean, J. & Motreja, S. (1999) Report of the CTC Working Party on the Safety ofTrainees. London: Royal College of Psychiatrists. (4) Campbell and Fung Psychiatric Bulletin (2007) 31: 10-13
Are we safe? 16 February 2007
Julian Bustin, Specialist Registrar in Old Age Psychiatry The Royal London and Barts Training Scheme, London, UK, Dr Rohan Van der Speck, Specialist Registrar in Learning Disability and General Adult Psychiatry. West of Scotland Rotation Glasgow, UK Send letter to journal: Re: Are we safe? julianbustin{at}gmail.com Julian Bustin, et al.	Campbell and Fung (Psychiatric Bulletin, January 2007, 31: 10-13) raise concerns about the safety of interview rooms and the lack of emphasis that is placed on this aspect of clinical practice. They highlight problems such as overcrowding with furniture, the presence of loose objects, the use of rooms for multiple purposes and inaccessibility to alarms and exits. Similar concerns were first raised five years ago in your journal by Osborn and Tang (Psychiatric Bulletin, March 2001, 25:92- 94) In January 2006, we undertook an audit to look at the safety of rooms used by doctors for interviewing adult patients in South Liverpool. This included rooms in inpatient units, outpatient clinics and day hospitals. We used the twelve standards as devised by Osborn and Tang.(Psychiatric Bulletin, March 2001, 25:92-94) These standards were based on the recommendations made by Davies in 1989 and The Royal College of Psychiatrist in 1998. Rooms were identified by asking the nurse in charge or receptionist which rooms were used by doctors to interview patients. Nurses and receptionist were blinded to the objectives of the audit. We looked at all 67 rooms used by psychiatrists and trainees in South Liverpool. Of these, 3 rooms (4%) fulfilled all 12 standards; 55 (81%) rooms had an alarm, but only 29 (43%) rooms had an alarm which could be accessed in an emergency; 19 (29%) rooms were isolated and 35 (53%) did not have a viewing window; 39 (59%) of rooms did not have a clear exit; 56 (84%) of rooms had at least one object which could be used as a weapon. We also found that many interview rooms had multiple purposes and that inappropriate rooms, such as clinic rooms, were being used in some units. 2 units did not have any designated interview rooms. Our findings led us to a similar conclusion to that of previous authors. Little emphasis is placed on safety of interview rooms in everyday practice. At present, we are not interviewing in safe conditions. The evidence for this has been accumulating during the last five years and urgent measures are needed to address it. Bibliography: Campbell, HL and Fung, NK (2007). How safe are patients interview rooms? Psychiatric Bulletin, 31: 10-13) Davies,W. (1989) The prevention of assault on professional helpers. In Clinical Approaches to Violence (eds K. Howells & C. R. Hollin) Chichester: John Wiley & Sons. Osborn, D.P.J. and Tang, S. (2001) Effectiveness of audit in improving interview room safety. .Psychiatric Bulletin, 25: 92-95 ROYAL COLLEGE OF PSYCHIATRISTS (1998) Management of Imminent Violence: Clinical Practice Guidelines to Support Mental Health Services. Occasional Paper OP41. London: Royal College of Psychiatrists.