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Objective: To investigate whether implementation recommendations derived from the German guidelines "Prevention of coercion" can be implemented on acute psychiatric wards by means of implementation consultants into ward work and if this contributes to an increased level of adherence to guideline intervention recommendations approved by the DGPPN (Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde)?, Material and Methods: Two medical or nursing experts advised ward teams on the implementation of three individually selected recommendations from the guidelines in a structured consulting process over 6 months. The degree of implementation of the recommendations was assessed before and after the intervention by the ward teams together with the implementation consultants using a tool developed for this purpose (PreVCo rating tool)., Results: A total of five wards responsible for compulsorily admitted patients took part in the pilot study; three of them completed the intervention. On all three wards, implementation of the guideline recommendations improved for both selected and unselected recommendations. The strategy of using implementation consultants as well as the application of the PreVCo rating tool were well accepted and considered feasible by both the treatment teams and the implementation consultants., Conclusion: This pilot study showed that an implementation of recommendations on psychiatric wards derived from the German guidelines "Prevention of coercion" supported by implementation consultants is feasible, well acceptable among treatment teams and can lead to positive changes. The sample of five wards with diverse patient profiles was convincing. The efficacy in terms of reduction of coercive measures is currently being investigated in a randomized controlled trial on 55 psychiatric wards in different parts of Germany, with an intervention based on this pilot study., (© 2021. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Objective: Examination of gender-related differences of aggressive incidents and the use coercive measures within a whole psychiatric hospital with a catchment area of 339.000 inhabitants over a period of fifteen years., Methods: Recording of aggressive incidents using the Staff Observation Aggression Scale-Revised (SOAS-R) as well as coercive measures by a clinically developed record sheet and analysing gender-related differences from 2005 to 2019., Results: 82 833 inpatients (male: 55.3 %; female: 44.7 %) are included. Between 2005 and 2019, 60.1 % of the aggressive events involved male patients and 39.9 % involved female patients; however, regarding cases of treatment no gender-related difference existed (odds ratio: 1.1). The SOAS-R-severity score of women was significantly higher, while aggressive incidents of men were subjectively graded more serious by staff. The number of coercive measures and the mean duration of restraint and seclusion episodes were significantly higher and longer, respectively, in male inpatients., Conclusion: Differences in frequency and duration of coercive measures between male and female patients could be influenced by the subjective perception of staff that male patients behave more aggressively., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Objective: Although coercive measures are one of the indicators for the quality of psychiatric in-patient care, reliable and valid data comparing the practices are hardly available. The purpose of this study was to analyse the incidence and duration of mechanical restraint and seclusion in psychiatric hospitals in Germany. We hypothesised that the duration of these coercive measures is associated not only with gender and diagnosis of the patients, but also with the clinics themselves., Methods: Incidence and duration of coercive measures (mechanical restraint and seclusion) among patients in the year 2004 were analysed in six German psychiatric hospitals. Furthermore, the association of the length of these coercive measures with diagnosis, gender, and hospital was analysed using non-parametric statistical tests., Results: 3.0% of 10,352 cases treated in 2004 were exposed to mechanical restraint and seclusion with a range from 1.9-7.4% on comparing the hospitals. On average, these measures were applied 3.7 times per patient (case) with each single intervention lasting 5.0 h (mean, range <0.1-290.8). The incidence and duration of coercive measures varied highly between different diagnostic groups and different hospitals. The length of these measures differed significantly between hospitals (p<0.001) and diagnoses (p<0.001). In patients with organic psychiatric disorders (ICD-10: F0) we observed the longest duration. Furthermore the duration of coercive measures in female patients was shorter than that for male patients (p<0.05)., Conclusion: Data interpretation should consider numerous confounding factors such as case mix and hospital characteristics. The handling of coercive measures is an important quality feature. Therefore standardised survey methods should be developed and nationwide implemented., (© Georg Thieme Verlag KG Stuttgart · New York.)

OBJECTIVE Since 1996 three, meanwhile eight, psychiatric hospitals have been working closely together in a multidisciplinary team aiming at improving quality management and reducing the frequency and duration of coercive measures, respectively. METHODS Development, aims, and functioning of the cooperation are described, and selected data of comparisons of documented restraints and of coercive measures in one of the hospitals (1998-2004) are presented. RESULTS This way of cooperation was conductive to changes in organizational policies and practices of coercive measures and, in parts, resulted in reducing coercive measures. CONCLUSIONS The cooperation was effective in improving quality management and implementation of changes in practice of coercive measures.

Since 1996 three psychiatric hospitals have been working together closely in a team aiming at improving the quality management of coercive measures. The first comparison of documented restraints showed conspicuous differences in incidence and duration. Due to this, the group decided to document and to compare the incidence, duration and reason of restraints and the legal status and sociodemographic variables in the three hospitals over one year. Considerable deviations were found with regard to the number and duration of restraints and number of patients concerned. Hospital A (2622 admissions) registered 103 restraints of 53 persons whereas hospital B (5802 admissions) reported 254 restraints of 121 persons, hospital C (4252 admissions) finally, documented 621 restraints of 120 persons. Hypotheses giving reason for these findings are discussed. Furthermore, developments and changes aiming at reducing coercive measures and at complete and comparative documentation by co-operation of the three hospitals, are reported.