Oxford Healthcare Improvement

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Highly Reliable Ward

Reducing Self-Harm in Tier 4

Engagement and Observations

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Failure to return from leave project

On acute adult psychiatric wards, failing to return from leave from acute psychiatric wards can have a range of negative consequences for patients, relatives and staff. Positive risk taking is part of the recovery process so staff need to work to ensure that patients are as safe as possible when they leave wards on Section 17 leave or take time away. This project sought to improve the return rates at the agreed time to enhance the safety of people in their care.

Project Aim
For each adult acute ward to reduce failure to return on time from Section 17 leave or agreed time away by 50% within 12 months of the start of their project.

Project Focus
The project was initiated and lead at Oxford Health NHS Foundation Trust as part of their Improvement Programme:
Project Details

The failure to return from leave project addresses:
• Interruptions to care planning and disruption to the therapeutic ward environment
• Breakdown in working alliances
• Loss of trust
• Possible risks to the patient or others well being
• Increased workload for staff and other agencies in time spent ensuring the patients wellbeing and safe return.

Methodology
The project followed Institute for Health Improvement (IHI). The project tested a number of ideas generated by the staff and service users who worked on the pilot ward:
• Individualised Safer Leave forms for patients which capture key information and support the therapeutic planning of leave and time away from the ward
• Patient information leaflets detailing ward expectations
• The use of business cards with staff messages of care and contact numbers for the ward
• Intentional rounding
• Visual Information for staff to raise awareness of the procedures necessary to ensure leave and time away from the ward is safer.

Progress
The project is established in Oxford Health NHS Foundation Trust. At baseline, the rate for on-time return was 56.0%; this increased to 87.1% post-intervention, a statistically significant increase of 55.5%. SPC charts showed that the interventions were associated with improvements. The pilot ward is now achieving 96% return on time rate and the process is stable. The project earned the Matron Mental Health Nurse of the Year in the Journal of Clinical Nursing 2016.

Further information
• For more information, contact jill.bailey@oxfordhealth.nhs.uk or nokuthula.ndimande@oxfordhealth.nhs.uk
• The project featured in the AHSN national ‘Patient Safety Collaboratives: Making care safer for all’ report published in July 2016
• Published paper in November 2016 – Bailey J, Page B, Ndimande N, et al. Absconding: reducing failure to return in adult mental health wards. BMJ Quality Improvement Reports.