The Ligature Assessment Tool: the development of a structured tool to improve quality of reporting of ligature incidents

Abstract

Of all deaths by suicide on psychiatric wards, 75% are due to hanging or strangulation by ligature. The act of tying a ligature is complex self harm risk behaviour and can be fatal. There is no consistent framework available to ensure that essential risk information is accurately captured following a patient tying a ligature. This leads to a variable quality of incident reports being generated in inpatient psychiatric wards, which can be challenging for the MDT to interpret second hand and understand the ligature risk in that case. Effective psychiatric care is underpinned by accurate and detailed documentation; thus comprehensive recording of ligature incidents is essential for recognising trends and risk factors, and in building a 'ligature tying profile'. A 'Ligature Assessment Tool' was developed to ensure that certain aspects of a ligature risk incident were recorded in a systematic way on the incident reporting system. The tool consists of 15 criteria and is in a semi-structured format. This was rolled out in a regional female medium secure unit. There was clear improvement in the quality of reports, with an increase in the detail included. For two patients, a 'ligature tying profile' was identified. Staff felt that the tool improved their documentation and was highly usable. Further work is ongoing; there is interest in use of the tool in general adult services and also in the national high secure service for women.