Ensuring leave is safe for patients with mental health needs who are both detained and voluntary is a key patient safety priority. Planned leave is an important part of a compassionate and patient centred recovery process. Leaving a ward without permission or failing to return at an agreed time raises concerns about the health and wellbeing of the patient.
For each ward to reduce failure to return from Section 17 leave or agreed time away from the wards by 50% within 12 months of the start of their project.
The project was initiated and successful at Oxford Health NHS Foundation Trust and is currently being spread and adopted in the Campbell Centre, Milton Keynes, Topas Ward in Bletchley and Park Royal in Brent, Central North West London Trust.
The safer leave project provides a framework which supports staff and patients to collaboratively plan compassionate leave for both detained and informal patients which encourages safe and timely return to the wards at the agreed time.
This is important because failure to return to wards from periods of leave has several consequences for patients, their families, staff, the public and other agencies, including
- 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
The project follows Institute for Health Improvement (IHI) methodology to test interventions directed towards the introduction of:
- Individual 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 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
The project is established in Oxford Health NHS FT and Berkshire Health NHS FT where the target to achieve a 50% reduction in failure to return from leave is sustained.
The Patient Safety Collaborative undertook a review of the safer leave project at the Campbell Centre and Topas Ward in May 2018 and have now formally closed the project.
However, Central North West London Trust (CNWL) are currently partnered with the Institute for Health Improvement (IHI) and quality improvement work is continuing in the safer leave workstream in other wards in London.
- This project featured in the national ‘Patient Safety Collaboratives: Making care safer for all’ report published in July 2016
- A paper was publised in BMJ Open November 2016 – Absconding: reducing failure to return in adult mental health wards.
- Find out more in this video and this case study.