|
A
|
Clinical risks
|
General statements about clinical risks without the mention of a specific risk
|
1 of 11
|
1 of 11
|
1
|
2
| |
|
A1
|
Clinical risks specific to mental health care
|
Clinical risks specific to mental health care, i.e. risks that occur only (or predominantly), or are typical, in mental health care
|
1 of 11
|
3 of 11
|
1
|
5
|
· Admission interview generally considered important
|
|
A1.1*
|
Violence / aggression
|
General statements about risk themes regarding violence or aggression (physical/psychological). Specific risks are listed in the sub-categories
|
8 of 11
|
10 of 11
|
12
|
42
|
· Aggression management training
|
|
· Violence risk assessment (e.g. Brøset -Checklist)
|
|
· Compulsory measures, sensory deprivation, seclusion
|
|
· Structural preventive measures
|
|
· When too dangerous: prison and external supervision
|
|
A1.1.1
|
Self-destructive behavior
|
Self-destructive behavior of a patient (e.g. suicide, suicide attempts, self-injury and self-harm: cutting.)
|
9 of 11
|
11 of 11
|
11
|
51
|
· Good anamnesis, pre-admission interview
|
|
· Clarify during admission interview and other consultations
|
|
· Intensive support/monitoring
|
|
· No-suicide contract
|
|
· Closing of the ward
|
|
· Good follow-up care and debriefing
|
|
A1.1.2*
|
Compulsory measures
|
Seclusion, restraint, etc. when mentioned as a risk or as a measure against a risk
|
4 of 11
|
9 of 11
|
4
|
31
|
· Training
|
|
· Standardized procedures
|
|
· Inform beforehand
|
|
· Observation and/or seclusion room
|
|
· Debriefing
|
|
A1.1.3*
|
Next of kin, risks from the outside
|
Assault/threats from next of kin or from outside
|
1 of 11
|
2 of 11
|
1
|
4
| |
|
A1.1.4*
|
Violence with or towards objects
|
Any form of violence with objects (e.g. weapons, lighters); also violence towards objects (e.g. to destroy furniture)
|
0
|
2 of 11
|
0
|
5
|
· No dangerous objects and infrastructure
|
|
· Nonflammable material in the rooms
|
|
A1.1.5*
|
Physical vs. verbal abuse
|
General statements specific to verbal abuse (threats) or physical abuse
|
0
|
2 of 11
|
0
|
3
| |
|
A1.2
|
Treatment errors
|
Treatment errors / treatment risks during treatment procedure, psychotherapy
|
4 of 11
|
11 of 11
|
6
|
33
|
· Standard procedures for consultations
|
|
· Interdisciplinarity
|
|
· Avoid one-to-one consultations
|
|
· Anamnesis with pro-active risk assessment
|
|
· Sufficient staff
|
|
· An ombudsman service that a patient can turn to
|
|
A1.2.1
|
Assaults by staff on patients during the therapeutic process
|
Assault by a staff member on a patient, especially during the therapeutic setting, that also include, for example, consensual sexual contacts or abuse of power by the therapist
|
2 of 11
|
3 of 11
|
2
|
6
|
· Special training
|
|
· Inform patients specifically about this issue
|
|
· Intervision (peer consulting) and supervision
|
|
see also A1.2
|
|
A1.2.2
|
Diagnostic errors
|
Establishing a diagnosis of a mental illness instead of an underlying physical illness or the misdiagnosis of psychiatric illness, which could result in incorrect treatment
|
1 of 11
|
2 of 11
|
2
|
3
|
· Differential diagnosis
|
|
· Additional tools to evaluate physical risks.
|
|
A1.2.3
|
Specific medication risks occurring mainly in psychiatry
|
All risks related to medication that are (mainly) psychiatric specific, especially: 1) side effects of medication. An important reason why patients do not take their medication. Risk of non-compliance. 2) accumulation, hoarding of medication (e.g. for suicide, substance abuse)
|
1 of 11
|
4 of 11
|
1
|
7
|
· Clarify patient’s needs
|
|
· Information about effects and side-effects
|
|
· Information on exercising and nutrition
|
|
· Monitor medication intake
|
|
A1.3
|
Risks associated with mental illnesses
|
Statements about individual illnesses (e.g. addiction, schizophrenia, acute psychosis, mania, depression, anxiety attacks, personality disorder…), that could increase certain risks
|
4 of 11
|
10 of 11
|
6
|
21
|
· Assessment tools
|
|
· Evaluate contractual capacity
|
|
· Intensive support
|
|
A1.3.1
|
Hospitalization against the will of the patient
|
Hospitalization against the will of the patient and/or against the will of next-of-kin. Also lack of insight regarding illness
|
3 of 11
|
8 of 11
|
3
|
12
|
· Non-voluntary hospitalization, compulsory measures
|
|
· Admit voluntary patients only
|
|
· Involuntary commitment
|
|
A1.3.2
|
Substance abuse
|
Drugs, smuggling of substances
|
1 of 11
|
4 of 11
|
1
|
4
|
· Search patients
|
|
· Sign addiction contract
|
|
A1.4
|
Absconding
|
Patient escapes from psychiatric clinic. This can happen for various reasons, e.g. hears imperative voices, suicidal tendency
|
3 of 11
|
6 of 11
|
4
|
9
|
· Internal transfer of patient
|
|
· Closing of ward
|
|
· Search by police
|
|
A2
|
Common clinical risks
|
Common clinical risks occurring in mental health care, but that are not specific, e.g. medication errors, infections. There are also grey areas such as with falls
| | | | | |
|
A2.1
|
Medication risks
|
Common medication risks not specific to mental health care, e.g. confusing medication.
|
5 of 11
|
9 of 11
|
7
|
33
| |
|
A2.2*
|
Infections and hygiene
|
Infections, disease transmission.
|
5 of 11
|
7 of 11
|
5
|
26
|
· Hygiene, hygiene standards, everything that protects against infection
|
|
A2.3
|
Falls
|
Falls and their consequences. Likely to be very important with withdrawal symptoms and in geronto-psychiatry
|
1 of 11
|
5 of 11
|
1
|
12
| |
|
A2.4*
|
Staff risks
|
Lack of staff, high workload. Staff absenteeism due to illness (maybe especially high in mental health care?) Shift change, etc. → a latent condition that can increase risk of errors
|
1 of 11
|
9 of 11
|
2
|
28
|
· Absence management, reintegration, training
|
|
· Hire sufficient staff
|
|
· Attractive training programs
|
|
A2.5
|
Technology and equipment
|
Technical equipment used in the treatment of patients
|
2 of 11
|
3 of 11
|
2
|
4
|
· Control procedures and repair of electronic equipment
|
|
· Correct application and periodic maintenance
|
|
A2.6
|
High rate of internal patient transfers
|
Patient transfers that represent risks at the interface (change of primary caregiver, organization of transfer, etc.)
|
0
|
2 of 11
|
0
|
3
| |
|
B*
|
Other risks (non-clinical)
|
Common, non-clinical risks (e.g. financial, structural risks, risks relating to image, etc.) e.g. fire, data protection, that represent only an indirect clinical risk
|
6 of 11
|
11 of 11
|
14
|
47
| |
|
C*
|
Risks for the staff (Staff safety)
|
Explicit risks that mainly concern staff members
|
1 of 11
|
11 of 11
|
2
|
38
|
· Preventive measures (e.g. raising awareness, staff training)
|
|
· Active measures (e.g. de-escalation techniques, compulsory measures)
|
|
· Follow-up measures (e.g. debriefing, care teams)
|
