Quality assessment on closed psychiatric admission wards: An illustration of the
background Admission on a closed psychiatric ward is a most stressful experience. The tendency that patients with increasing serious psychiatric problems stay on the admission wards for shorter periods of time stresses the importance of a quality assessment.
aims An illustration of the application of the kwazop(an instrument to assess the quality of care on closed psychiatric admission wards) on the basis of a quality assessment on closed psychiatric admission wards. With the kwazop qualitative good and lesser aspects of care are determined and reported to the ward personnel. Subsequently suggestions for quality improvement can be given.
methods The kwazop consists of three parts: one for patients, one for the psychiatrist and one for the nurse. Patients assess the quality of care via an interview; the psychiatrist and nurse complete a questionnaire. From February to August 1997 132 patients were interviewed who were discharged from the closed admission wards of three psychiatric hospitals (z1, z2 en z3). One hundred and nine interviews (z1: 41 patients, z2: 31 en z3: 37) proved to be reliable. Psychiatrists returned 97 questionnaires and nurses 99.
results The patients assessed the scales (medical) treatment and reliability/safety predominantly as sufficient, the use of compulsory measures scored predominantly as insufficient. On scale level there were no significant differences in patient scores between the hospitals. The scale scores of the psychiatrists and nurses of the three hospitals differed significantly on the themes: 'continuity of care', 'nursing plan' and 'efficiency'. The scores on item level showed the items which accounted for the sufficient or insufficient scale scores. Based on these outcomes the quality of care could be improved. conclusions The staff on the wards considered the outcomes to be realistic and useful. As yet, objective standards or values of reference to compare the scales and item scores with, do not exist. The present application of the kwazop on more than 20 admission wards allows us to develop these standards for care. Moreover, the project enables evaluation of the association between ward characteristics (organisation, staffing) and quality assessment. In doing so, interpretation of the outcomes of a ward becomes more valuable.