Hermann-Alexander Jungfer1, Andres R Schneeberger2, Stefan Borgwardt3, Marc Walter3, Marc Vogel3, Stefanie K Gairing3, Undine E Lang3, Christian G Huber4. 1. Universitäre Psychiatrische Kliniken Basel, Wilhelm Klein-Str. 27, CH-4012 Basel, Switzerland; Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany. 2. Universitäre Psychiatrische Kliniken Basel, Wilhelm Klein-Str. 27, CH-4012 Basel, Switzerland; Psychiatrische Dienste Graubünden, Loëstrasse 220, CH-7000 Chur, Switzerland. 3. Universitäre Psychiatrische Kliniken Basel, Wilhelm Klein-Str. 27, CH-4012 Basel, Switzerland. 4. Universitäre Psychiatrische Kliniken Basel, Wilhelm Klein-Str. 27, CH-4012 Basel, Switzerland. Electronic address: christian.huber@upkbs.ch.
Abstract
PURPOSE: Change of treatment policy from closed to open ward settings has been shown to reduce coercive measures. The aim of the current study was to examine the effects of the change from closed to open wards on the frequency of seclusion and forced medication in a hospital-wide setting. SUBJECTS AND METHODS: 2-year, longitudinal observational study with 2838 inpatient cases. RESULTS: On a hospital-wide level, the percentage of patients with at least one seclusion was decreased significantly (χ(2)(1) = 5.8; p = .016), while there was no significant change in forced medication (χ(2)(1) = .08; p = .775). The frequency of seclusions and forced medication decreased significantly on newly opened wards, and there were no significant changes regarding seclusion on permanently closed or open wards, while the number of forced medications increased significantly on closed wards. The decrease in seclusions on newly opened wards remained statistically significant after controlling for diagnoses and severity of illness. DISCUSSION: Our results indicate that a reduction of overall seclusion can be successfully attained, and that, in particular, the frequency of seclusion and forced medication on newly opened wards was decreased significantly. These changes were not accompanied by a significant increase in seclusion on other wards. CONCLUSION: Open ward treatment was successfully implemented and was associated with a significant decrease of coercive measures in our study. It might therefore provide a good care model, strengthening the patient's right to autonomy and leading to a reduction of coercive measures.
PURPOSE: Change of treatment policy from closed to open ward settings has been shown to reduce coercive measures. The aim of the current study was to examine the effects of the change from closed to open wards on the frequency of seclusion and forced medication in a hospital-wide setting. SUBJECTS AND METHODS: 2-year, longitudinal observational study with 2838 inpatient cases. RESULTS: On a hospital-wide level, the percentage of patients with at least one seclusion was decreased significantly (χ(2)(1) = 5.8; p = .016), while there was no significant change in forced medication (χ(2)(1) = .08; p = .775). The frequency of seclusions and forced medication decreased significantly on newly opened wards, and there were no significant changes regarding seclusion on permanently closed or open wards, while the number of forced medications increased significantly on closed wards. The decrease in seclusions on newly opened wards remained statistically significant after controlling for diagnoses and severity of illness. DISCUSSION: Our results indicate that a reduction of overall seclusion can be successfully attained, and that, in particular, the frequency of seclusion and forced medication on newly opened wards was decreased significantly. These changes were not accompanied by a significant increase in seclusion on other wards. CONCLUSION: Open ward treatment was successfully implemented and was associated with a significant decrease of coercive measures in our study. It might therefore provide a good care model, strengthening the patient's right to autonomy and leading to a reduction of coercive measures.
Authors: Daniela Fröhlich; Franziska Rabenschlag; Susanne Schoppmann; Stefan Borgwardt; Undine E Lang; Christian G Huber Journal: Front Psychiatry Date: 2018-04-12 Impact factor: 4.157
Authors: Lisa Hochstrasser; Alexander Voulgaris; Julian Möller; Tatjana Zimmermann; Regine Steinauer; Stefan Borgwardt; Undine E Lang; Christian G Huber Journal: Front Psychiatry Date: 2018-02-26 Impact factor: 4.157
Authors: Lisa K Schreiber; Florian G Metzger; Tobias A Duncker; Andreas J Fallgatter; Tilman Steinert Journal: BMC Psychiatry Date: 2019-05-14 Impact factor: 3.630
Authors: Benjamin D Arnold; Julian Moeller; Lisa Hochstrasser; Andres R Schneeberger; Stefan Borgwardt; Undine E Lang; Christian G Huber Journal: Front Psychiatry Date: 2019-08-09 Impact factor: 4.157