Design of a Behavioural Risk Monitoring Tool (RutiSafeNet) in an Acute Inpatient Mental Health Unit with Open-Doors Policy: A Qualitative Study

Introduction: Open-door policies for acute inpatient mental health units (AIMHU) have shown promising results in reducing coercive measures, but concerns remain among patients and staff regarding increased workload, constant surveillance, and potential safety risks associated with these policies. Objectives: This study aims to develop a monitoring tool to facilitate safety management in AIMHUs by monitoring behavioural risks and nursing workload. Methods: This study employed a qualitative approach using the content analysis method. Data were collected through three in-depth interviews and two focus groups involving staff (n=19) from the AIMHU of the hospital. Results: 34 items were identified to define behavioural risks related to self-harm and suicide, aggressiveness, and absconding, alongside factors affecting nursing workload. These items were categorised into three levels of risk: low, moderate, and high. Conclusions: The result is a risk monitoring tool based on observational items for daily use in AIMHU that can help to reduce the uncertainty about risk management, especially in open-door units. This innovative tool enables individualized patient monitoring, provides insights into the unit's status, prioritizes conflict prevention, and upholds the human rights of patients.