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Clinical Updates

Mental health patients not kept safe from ‘unwanted sexual behaviour’

The CQC discovered there were a total of 1,120 sexual incidents involving staff, patients and visitors.



patient and the hospital

The Care Quality Commission has published a report into the sexual safety of mental health wards.

Following concerns raised on an inspection of a mental health trust, the Care Quality Commission (CQC) has today released a report on the sexual safety of mental health wards.

After analysing nearly 60,000 incident reports across 54 trusts between April and June 2017 the CQC flagged up a total of 1,120 sexual incidents involving staff, patients and visitors.


People do not always feel safe.

The CQC’s report flagged up a number of concerns about sexual safety, including:

  • People who use mental health services do not always feel that they are kept safe from unwanted sexual behaviour.
  • Ward environments do not always promote the sexual safety of people using the service.
  • Staff do not have the skills to promote sexual safety or to respond appropriately to incidents
  • Managers do not always know what is good practice in promoting the sexual safety of people using the service and of their staff.
  • Staff may under-report incidents and reports may not reflect the true impact on the person who is affected.

The healthcare regulator has set out a series of recommendations to improve the sexual safety of patients which include the creation of new national guidelines and training for staff.

Everyone must feel safe.

Catherine Gamble, RCN Professional Lead for Mental Health, said: “It is of great concern that the CQC’s report describes sexual incidents on mental health wards as ‘commonplace’.  It’s vital that everyone, both patients and staff, can feel safe in mental health settings.  The CQC is right to identify lack of trained staff as a factor that leads to unsafe environments – staff and the public know that patients are safer when they have access to sufficient, trained mental health nurses who have regular, consistent clinical supervision.  That is why the RCN is campaigning for safe staffing levels throughout the health and care system.  In addition, as the CQC points out, many patients are being cared for in outdated, unsuitable buildings that are simply not appropriate for the 21st century.

“The RCN has today written to all Directors of Nursing to draw this important report to their attention.  We look forward to working in partnership with the Royal College of Psychiatrists, NHS Improvement and NHS England to produce joint guidance on sexual safety on mental health wards, and have asked Directors of Nursing today to take that work forward with us”.

Clinical Care

Hourly rounding ‘may not be the best way for nurses to deliver care’, finds study

Hourly rounding places an emphasis on ‘tick box’ care.



Nurse with patient in bed

Hourly rounding made a minor contribution, if at all, to the way nurses engage with patients.

A new report by researchers at King’s College London has found that the widespread practice of hourly or intentional rounding, may not be the best way for nurses to deliver care to patients.

The report also found that rounding makes a minor contribution, if at all, to the way nurses engage with patients.


Hourly or intentional rounding involves standardised regular checks with individual patients at set intervals and was introduced in hospitals in England in 2013, with 97% of NHS acute Trusts in England implementing it in some way.

The majority of NHS trusts adopted the ‘4Ps’ (Position, Pain, Personal needs, Placement of items) model of rounding.

The research was commissioned and funded by the National Institute for Health Research (NIHR) and was led by Professor Ruth Harris in the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care.

Hourly rounding places an emphasis on ‘tick box’ care.

The NIHR report – Intentional rounding in hospital wards to improve regular interaction and engagement between nurses and patients: a realist evaluation – is the first study of its kind in the world.

The study found that rounding placed an emphasis on transactional ‘tick box’ care delivery, rather than individualised care. However, patients were found to value their interactions with nursing staff, which the study argues could be delivered during other care activities and rather than through intentional rounding.

The report also found that rounding was implemented without consultation, careful planning and piloting in the interests of political expediency following the Francis Inquiry Report into care failures in the NHS.

Ruth Harris, Professor of Health Care for Older Adults at King’s College London, said; “Checking patients regularly to make sure that they are OK is really important but intentional rounding tends to prompt nurses to focus on completion of the rounding documentation rather than on the relational aspects of care delivery.

“Few frontline nursing staff or senior nursing staff felt intentional rounding improved either the quality or the frequency of their interactions with patients and their family.”

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Clinical Updates

Nurses’ ‘worry’ better than most early warning scores, finds study

Nurses were asked to grade patients between ‘no concern’ and ‘extreme concern’. 




A sense of worry can provide important information for the detection of acute physiological deterioration.

Nurses’ worry has a “higher accuracy” than most published early warning scores (EWS) at predicting if a patient is becoming more unwell, according to a recent study.

The study looked at 31,159 patient-shifts for 3185 patients during 3551 hospitalisations across two surgical and two medical wards. Researchers compared if the nurses were worried about a patients potential for deterioration using ‘the Worry Factor’ with early warning score indicators.


Nurses were asked to grade each patient between “no concern” and “extreme concern”.

The Worry Score

Out of 492 potential deterioration events identified, researchers found that when nurses had an increasing worry factor the patient was more likely to require emergency medical treatment – 7 cardiac arrest calls, 86 medical emergency calls and 76 transfers to the intensive care unit.

The study also revealed that accuracy rates were significantly higher in nurses with over a year of experience.

The researchers concluded that “nurses’ pattern recognition and sense of worry can provide important information for the detection of acute physiological deterioration” and was often more reliable than traditional early warning systems.

They also noted that the worry score could be used alone or easily incorporated into existing EWS to potentially improve their performance.

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