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.
The aim of the project was for each ward to reduce failure to return from Section 17 leave or agreed time away from the wards by 50% within 12 months. It provided a framework which supports staff and patients to collaboratively plan compassionate leave for both detained and informal patients, encouraging safe and timely return to the wards at the agreed time.
The project was initiated at Oxford Health NHS Foundation Trust and spread to the Central and North West London NHS FT and Berkshire Healthcare NHS FT.
Failure to return to wards from periods of leave has 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’ wellbeing
- increased workload for staff and other agencies in ensuring the patient’s wellbeing and safe return.
The project followed 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
- 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 closed in 2018 following a review. The Central and North West London Trust has partnered with the IHI and quality improvement work is continuing in the safer leave workstream in other wards in London.
- Contact: Eileen.email@example.com
- 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.