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Implementing Safewards Interventions – Clear Mutual Expectations
Glenbourne Unit - Livewell Southwest

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3. What is Safewards?
Safewards is an evidence based clinical model that introduces a number of interventions that increase safety and reduce coercion, improves relationships between staff and patients, resulting in fewer assaults, making wards more peaceful places.

4. Clear Mutual Expectations
An intervention formulated to reduce conflict that may be caused about a lack of clarity about how patients are expected to behave, or a lack of consistency between the staff. These expectations work both ways – staff have expectations of patients, and patients have expectations of staff.

6. Development – Patient Input
Discussion was held at a patient community meeting about what their ideas were around expectations. They highlighted that they expected to be treated with respect, and that their care was not discussed in communal areas.

7. Development – Staff Input
A discussion was then held between staff around what they believed to be the inconsistencies that cause the most conflict on the ward. This included giving out lighters, the availability of staff for periods of escorted leave, items going missing and prohibited items being found in patients possession.

8. Clear Mutual Expectations
Everyone that comes onto the ward can be expected to be treated with respect. Patients can expect that the staff will be polite and respectful to them, and that other patients will also be respectful. Verbal abuse, threats, racist or homophobic comments, bullying and violence have no place on our ward and will be reported to the police. Shouting at or making others uncomfortable in any way is not acceptable.
We can all expect others to be tolerant of our behaviour when we are ill, and be patient with us. Offer support to each other, but be mindful that some people may wish to be left alone, in which case, please do not be offended.
Staff will respect your right to confidentiality and will not discuss patient’s care in patient areas.
Everybody needs to look after themselves and assist in keeping the ward clean and tidy.
The nursing staff will deal with patients requests in a timely and efficient way. Staff will ensure that rationale for any decision is explained to you. Any delay in dealing with a request will also be explained.
Patients are asked to be aware of their actions whilst off the ward may have an impact on their treatment plan. Especially with regards to the use of drugs and alcohol.
We ask that patients do not bring in any prohibited items onto the ward. Patients will not bring drugs or alcohol onto the ward, consume them here, or give them to another patient for them to consume. All patients will be searched on their arrival to the ward, and following any periods of leave. Any drugs or alcohol will be disposed of as per trust policy. Staff will report drug possession to the police.
We ask everyone not to smoke on the ward. The designated smoking area for patients is the garden. There is a wall mounted lighter available. No lighters will be given out.
We will all respect each other’s property, not taking or borrowing anything without permission, not damaging anything belonging to anyone else, including the ward furniture, fittings and equipment. Patients prohibited items will be kept in a store cupboard near their bedspace. All electronics need to be charged in designated area (cupboard in the main reception area).
If someone wants to watch the television, please ask those around you whether it is okay to change the channel.
Protected time is between 12:30 and 3:00pm. This is when there is more staff present to support patients off the ward. If you would like to take leave then please request this in the morning, so that proper arrangements can be made.

9. The clear mutual expectations have been printed on coloured paper, and placed in important areas around the ward including the main entrance to the ward, the main communal area and patients bedspace. These expectations will be discussed with patients early on in their admission.

10. Strengths of Intervention
Clear expectations, that are easily accessible for all staff and patients.
Everyone is aware of what is expected of them.
Increase consistency between staff.

11. Weakness’ of Intervention
Staff and patients are not always consistent in implementing agreed expectations.
Intervention takes time to implement and adopt into ward culture.

12. Results
Since implementing the mutual expectations at the beginning of the month, we have noted a reduction in verbal aggression towards staff. The ward are currently documenting each incident of aggression/self-harm using a “safety cross”.

13. Our clear mutual expectations were posted onto our Twitter account
Our clear mutual expectations were posted onto our Twitter account. We received feedback from Safewards who identified that restraint could be see as an act of violence that is not reported to the police. As a result of this we plan to amend the wording of this in our mutual expectations.

14. Next Steps
Introduce mutual expectations into the welcome pack available for patients, carers and visitors.
Introduce mutual expectations into the operational policy for the unit in order to adopt this as part of the units culture for all staff working there.