Quality Improvement

Although empirical evidence specific to inpatient psychiatric settings remains more limited than in other areas of healthcare, ongoing quality improvement efforts have meaningfully advanced our understanding of patient safety and strategies to reduce harm and prevent errors. In psychiatric settings, risks—both physical and psychological—often arise from the complex interaction between patients and the care environment. Common safety concerns include medication errors, patient falls, assaultive behavior, violence, and suicide.

This section highlights research that includes evidence-based practices and quality improvement initiatives that have demonstrated effectiveness in addressing safety risks commonly encountered in inpatient psychiatric care. These findings not only reinforce the value of established safety interventions but also shed light on outdated or ineffective practices. Some of these outdated or ineffective practices may inadvertently increase the risk of aggression or self-harm, underscoring the need for continuous evaluation and adaptation.

Sustainable quality improvement must be supported by a broader organizational framework. Leadership engagement is critical to creating a culture of safety. Key components include adequate staffing, appropriately trained staff, active nurse engagement, training in proactive violence prevention and suicide risk assessment, and the development of a therapeutic milieu that fosters psychological safety. These elements must be intentionally designed, aligned, and regularly reviewed as interconnected parts of a comprehensive quality improvement strategy that prioritizes patient safety at every level of care.

References

Prevalence, consequences, and contributing factors beyond verbal and physical workplace violence against nurses in peripheral hospitals.
Alnaeem, M. M., Hasan Suleiman, K., Alzoubi, M. M., Sumaqa, Y. A., Al-Mugheed, K., Saeed Alabdullah, A. A., & Farghaly Abdelaliem, S. M. (2025). Prevalence, consequences, and contributing factors beyond verbal and physical workplace violence against nurses in peripheral hospitals. Frontiers in Public Health, 12, 1418813. https://doi.org/10.3389/fpubh.2024.1418813

Falls prevention in an older adult mental health ward through a quality improvement initiative.
Oyeneyin, B., Beech, H., Marshall, A., & Head, K. (2024). Falls prevention in an older adult mental health ward through a quality improvement initiative. BMJ Open Quality, 13(4). https://bmjopenquality.bmj.com/content/13/4/e002794?form=MG0AV3

Measuring the Severity of Objective and Subjective Patient-to-Staff Violence in Psychogeriatric and Adult Psychiatric Wards: A Retrospective Study of Four Swiss Hospitals.
Abbiati, M., Golay, P., De Maria, L. F., & Palix, J. (2023). Measuring the Severity of Objective and Subjective Patient-to-Staff Violence in Psychogeriatric and Adult Psychiatric Wards: A Retrospective Study of Four Swiss Hospitals. Issues in Mental Health Nursing, 44(11), 1142–1149. https://doi.org/10.1080/01612840.2023.2246560

Measuring the Severity of Objective and Subjective Patient-to-Staff Violence in Psychogeriatric and Adult Psychiatric Wards: A Retrospective Study of Four Swiss Hospitals.
Abu Khait, A., Mrayyan, M. T., & Algunmeeyn, A. (2023). Thematic analysis of mental health nurses’ views of contributing factors fueling workplace violence in psychiatric hospitals: Insights from unsung soldiers. Journal of the American Psychiatric Nurses Association. Advance online publication. https://doi.org/10783903231199114

Patient safety strategies in psychiatry and how they construct the notion of preventable harm: A scoping review.
Svensson, J. (2022). Patient safety strategies in psychiatry and how they construct the notion of preventable harm: A scoping review. Journal of Patient Safety, 18(3), 245. https://journals.lww.com/journalpatientsafety/fulltext/2022/04000/patient_safety_strategies_in_psychiatry_and_how.13.aspx

Instruments for Measuring Violence on Acute Inpatient Psychiatric Units: Review & Recommendations.
Mistler, L., & Friedman, M. (2022). Instruments for Measuring Violence on Acute Inpatient Psychiatric Units: Review & Recommendations. Psychiatric Services, 73(6). https://psychiatryonline.org/doi/pdf/10.1176/appi.ps.202000297

The impact of workplace violence toward psychiatric mental health nurses: Identifying the facilitators and barriers to supportive resources.
Dean, L., Butler, A., & Cuddigan, J. (2021). The impact of workplace violence toward psychiatric mental health nurses: Identifying the facilitators and barriers to supportive resources. Journal of the American Psychiatric Nurses Association, 27(3), 189–202. https://doi.org/10.1177/10783903211010945

Delineating quality indicators of inpatient psychiatric hospitalization.
Delaney, K. R., Loucks, J., Ray, R., Blair, E., Nadler-Moodie, M., Batscha, C., Sharp, D., & Milliken, D. (2020). Delineating quality indicators of inpatient psychiatric hospitalization. Journal of the American Psychiatric Nurses Association, 28(5), 391–401. https://doi.org/10.1177/1078390320971367

A Call to Action from the APNA Council for Safe Environments: Defining Violence and Aggression for Research and Practice Improvement Purposes.
Allen, D. E., Mistler, L. A., Ray, R., Batscha, C., Delaney, K., Loucks, J., Nadler-Moodie, M., & Sharp, D. (2019). A Call to Action from the APNA Council for Safe Environments: Defining Violence and Aggression for Research and Practice Improvement Purposes. Journal of the American Psychiatric Nurses Association, 25(1), 7–10. https://doi.org/10.1177/1078390318809159