EPA-0794 – Changed Legislation Referring to Coerced Medication: Influences on Affected Patients and Nursing Staff a Pre-Post-Comparison in an 18-Bedded Emergency Psychiatric Ward in Germany

Abstract

Introduction:

Avoiding coercive measures is one of the most important aims in emergency psychiatry.

Objectives:

There were far-reaching amendments to the German Civil Code in 2012 (XII ZB 99/12) and the Saxon Law on Aid and Accommodation for Mental Diseases in early 2013 (2 BvR 228/12) concerning the constraint of coerced medication.

Aims:

To analyze the process of change on our emergency psychiatric ward, we conducted a longitudinal measurement.

Methods:

We performed a pre-post-comparison (pre: 2010, post: 1st half of 2013) with regard to several patient- and nursing staff-related criteria by using descriptive and test statistics.

Results:

Socio-demographic patient data and unit-specific performance data remained unaltered. The distribution regarding the following main diagnoses [ICD 10] changed significantly: F19* (pre 11.0%, post 22.0%; p<0.001), F2*(pre 11.9%, post 17.6; p<0.01) and F1* excl. F19.* (pre 31.2%, post 18.8%; p<0.001). After the amendments a significant reduction of administered medication and a significant increase in the ratio of assaults/property damages/elopements/attempts of absconding per patient (pre 0.007, post 0.021; p<0.001) were measured. Both a significant increase in the ratio of physically restrained patients (pre 22.3%, post 28.7%; p<0.05) and changes regarding involuntary commitment practice impressed. In the course of changing conditions and workload, influences on staff absent time were noticeable. According to these results a partly restructuring of nursing staff was deployed by leadership.

Conclusions:

Both nursing management and treatment concepts may have to be reassessed and adapted by discussing several aspects (e.g. safety of staff, professional ethic, staffing structure and levels). Further analyses seem indispensable.