Removing silverware takes bite out of mealtime risk

The team at Atascadero (CA) State Hospital initiated a number of safety initiatives to reduce the risk of violence and resulting injuries at mealtimes. Here are some highlights:

o Silverware was replaced with plasticware.

There had been an average of seven silverware attacks per year, on patients and staff, for the past 15 years. Silverware had been used instead of plasticware partly because silverware is seen as more normal than plastic, and normalizing the patient’s environment is a significant goal in the patient care plan. But patients made it clear they actually preferred plasticware, giving up a bit of normalcy in return for increased safety. No one has been attacked with the plasticware.

o Healthier patients were allowed to leave the dining room sooner.

The data showed that 35% of the violent incidents occurred while patients were waiting to leave after eating, so the policy was changed to allow healthier patients to leave when finished. The average time each unit’s patients spend in the dining room was reduced by 15 minutes.

o Patients were given more options instead of waiting.

Waiting tended to aggravate patients, pushing some over the brink and into a violent episode. To reduce the waiting time, particularly for patients waiting to leave the dining room after the meal, the facility opened the courtyard and gym to provide more options.

o Staff were educated about the initiatives and encouraged to be more courteous.

Patients had complained the dining room staff were discourteous, not a small complaint when it comes to 1,000 dangerously mentally ill men. What the patients perceived as discourteous behavior often was enough to prompt some into a violent rage, so the hospital held 20 inservice classes for the dining room staff. The classes focused on the problems and rewards of working with the mentally ill.