Quality statement 5: Safe physical environments

Quality statement

People who have self‑harmed are cared for in a safe physical environment while in the healthcare setting, in order to reduce the risk of further self‑harm.

Rationale

Caring for people who have self‑harmed in a safe physical environment within the healthcare setting can reduce distress, help them to feel supported and reduce the risk of further self‑harm in the healthcare setting.

Quality measure

Structure: Evidence of local arrangements to undertake environmental assessments of healthcare settings, including assessing the risks to people who have self‑harmed.

Outcome: Number of episodes of self‑harm occurring in healthcare settings.

What the quality statement means for each audience

Service providers ensure that they undertake environmental assessments to ensure that healthcare settings are safe for people who have self‑harmed and to reduce the risk of further self‑harm while in the healthcare setting.

Healthcare professionals ensure that people who have self‑harmed are cared for in a safe physical environment while in the healthcare setting to reduce the risk of further self‑harm.

Commissioners ensure that they commission services that provide safe physical environments in healthcare settings for people who have self‑harmed to reduce the risk of further self‑harm.

People who have self‑harmed are cared for in a safe physical environment that reduces the risk of harming themselves further while in hospital or another part of the healthcare service.

Source guidance

NICE clinical guideline 16 recommendation 1.4.2.3 (key priority for implementation).

Data source

Structure: Local data collection. NHS Litigation Authority risk management standards assess the process for managing the risks associated with the physical security of premises and assets.

Outcome: Local data collection. NHS Surveys ask questions about the environment of services; however, data on diagnosis are not collected. The National Reporting and Learning System contains national and local figures on patient safety incidents, including self‑harm.

Definitions

People who have self‑harmed

Children or young people (aged 8 years and older) and adults who have carried out an act of self‑poisoning or self‑injury, irrespective of motivation.

Safe physical environment

People who have self‑harmed should be offered an environment that is safe, supportive and minimises any distress.

Examples of environmental risks to people who self‑harm include, but are not limited to:

  • ligature points

  • open windows

  • access to sharps

  • access to medication.

Consideration should be given to the individual needs and safety requirements of each service user.

A safe physical environment refers to primary care settings, ambulance services, emergency departments and inpatient settings where people who have self‑harmed are being cared for.

Equality and diversity considerations

NICE clinical guideline 16 recommendation 1.9.1.1 states that children and young people under 16 years who have self‑harmed should be assessed and treated by appropriately trained children's nurses and doctors in a separate children's area of the emergency department.