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Learning Objective 1: utilize established evidence based nurse: patient ratio for acute psychiatric hospitals
Learning Objective 2: translate the evidence from a rigorous randomized control trial to change the patient care delivery system in acute adult psychiatric wards
Internationally, there is no evidence based nurse:patient ratio for acute psychiatric wards . To establish evidence based ratio for acute psychiatric wards, a randomised controlled trial was conducted in 2010 in 8 acute adult psychiatric wards in Singapore. The aims of the study were to examine the impact of increased nursing headcounts, appropriate skill mix and the implementation of Primary Team Nursing on patient, nurse and organisational outcomes. A total of 1,018 eligible adult patients were enrolled in the study. The patients provided written informed consent. Ethics approval and consent were obtained. Patients were randomly assigned to receiving nursing care either at the four control wards (C), at the two experiment wards with increased nursing manpower based on patient acuity / manpower requirements as determined by Trendcare patient acuity system (M), or at the two experiment wards with increased nursing manpower based on Trendcare and implementation of Primary Team Nursing with minor changes to the ward infrastructure (P). The results showed a decrease in fall and assault rates in the experimental wards with increased nursing manpower and implementation of Primary Nursing Team when compared to the control wards with standard nursing care. The medication administration error rate per month was reduced in both the experimental wards. Comparing the use of physical restraint rate per 1,000 patient days in the control, a higher rate was observed in both experimental wards due to disturbed, aggressive and violent behaviour of a few patients. No choking incident was reported in all these wards. The nurses satisfaction data also showed that nurses were satisfied both with the delivery of PTN and also with the good quality care given to patients. The organization was also satisfied with a reduction in readmission rates. Clinical implication: using the evidence, all acute wards used evidence based nurse:patient ratio.
See more of: Oral Paper & Poster: Evidence-Based Practice Contest