Quality improvement and patient safety in psychiatry (MEQ)

• (A) Medication near misses (hazard reached the preparation step but not the patient) — high-value learning signal for medication safety systems in psychiatry.^[8]
• (B) Rising seclusion hours — outcome/process hybrid metric of restrictive practice; also a quality and rights signal requiring balancing measures (assaults, staff injury).^[4][7]
• (C) Post-discharge suicide without follow-up plan — serious adverse outcome with clear process failure (discharge continuity); sits in the high-risk post-contact window described in national suicide surveys.^[6]
• (D) Fear of reporting — safety culture failure (blame climate) that will suppress learning and worsen latent risk.^[2][3]

Aim (example SMART): Within 6 months, achieve ≥95% of discharges from the acute unit having documented crisis plan plus attempted contact within 72 hours — a process reliability target aligned to post-contact suicide risk windows.^[6][7] Outcome: proportion of discharges with completed 72-hour follow-up contact; serious self-harm/suicide attempts within 7 days (rare event — pair with process reliability). Process: documented crisis plan + named follow-up owner before discharge; same-day community notification. Balancing: length of stay inflation; inappropriate delayed discharge; staff overtime; patient experience of overly restrictive leave. Then run PDSA cycles (e.g. discharge checklist test on one team for 2 weeks → study → adapt).^[7]