Michelle Richardson1, Geoffrey Brennan2, Karen James3, Mary Lavelle2, Laoise Renwick4, Duncan Stewart5, Len Bowers6. 1. Evidence for Policy and Practice Information and Coordinating (EPPI)-Centre, Social Science Research Unit, UCL Institute of Education, London, UK. Electronic address: m.richardson@ioe.ac.uk. 2. Verita Consultants LLP, 53 Frith Street, London UK/Star Wards. 3. The McPin Foundation, London. 4. School of Nursing, Midwifery and Social Work, University of Manchester. 5. School of Psychology, Social Work and Human Sciences, University of West London. 6. Section of Mental Health Nursing, Health Services and Population Research, Institute of Psychiatry, King's College London.
Abstract
OBJECTIVE: This study aims to (a) describe what conflict (aggression, absconding etc.) and containment (de-escalation, restraining etc.) events occur before and after events of medication nonadherence on acute psychiatric wards and (b) identify which patient characteristics are associated with medication nonadherence. METHOD: Conflict and containment events for each shift over the first 2 weeks of admission were coded retrospectively from nursing records for a sample of 522 adult psychiatric inpatients. The frequency and order of the conflict and containment events were identified. Univariate logistic regression models were conducted to examine which patient characteristics were linked with medication noncompliance. RESULTS: Medication refusals were commonly preceded by aggression whereas demands for pro re nata (PRN) (psychotropic) were commonly preceded by the same patient having been given PRN medication. Refusals and demands for medication were commonly followed by de-escalation and given PRN (psychotropic) medication. Only refusal of PRN medication was commonly followed by forced (intramuscular) medication. Ethnicity, previous self-harm and physical health problems were also linked to nonadherence. CONCLUSIONS: Greater attention to the conflict and containment events that precede and follow medication nonadherence may reduce the likelihood of medication nonadherence.
OBJECTIVE: This study aims to (a) describe what conflict (aggression, absconding etc.) and containment (de-escalation, restraining etc.) events occur before and after events of medication nonadherence on acute psychiatric wards and (b) identify which patient characteristics are associated with medication nonadherence. METHOD: Conflict and containment events for each shift over the first 2 weeks of admission were coded retrospectively from nursing records for a sample of 522 adult psychiatric inpatients. The frequency and order of the conflict and containment events were identified. Univariate logistic regression models were conducted to examine which patient characteristics were linked with medication noncompliance. RESULTS: Medication refusals were commonly preceded by aggression whereas demands for pro re nata (PRN) (psychotropic) were commonly preceded by the same patient having been given PRN medication. Refusals and demands for medication were commonly followed by de-escalation and given PRN (psychotropic) medication. Only refusal of PRN medication was commonly followed by forced (intramuscular) medication. Ethnicity, previous self-harm and physical health problems were also linked to nonadherence. CONCLUSIONS: Greater attention to the conflict and containment events that precede and follow medication nonadherence may reduce the likelihood of medication nonadherence.