Visits in 2019 71 Østfold Hospital, Kalnes Østfold Hospital, Secure Psychiatric Section and Geriatric Psychiatric Section 9–11 October 2018 The NPM made two visits to Østfold Hospital on 9–11 October 2018 – one to the geriatric ­psychiatric section and one to the secure psychiatric section. The sections are part of the ­department of psychiatry and adult habilitation at Østfold Hospital. Weaknesses in the documentation of the use of restraint measures were identified during both visits. There was a general low incidence of use of coercion in the geriatric psychiatric section, ­although the Ombudsman also found that not all ­situations that involved restraining a patient against his or her will were registered as ­administrative decisions. There was ­uncertainty among the staff as to whether they could ­physically restrain a patient for a period before a decision had been made and, in such case, how long this period could last. As a result, the section did not have confirmed figures for the use of coercion and the patients’ right to appeal was not sufficiently safeguarded. In the security sections, mechanical restraints were used more often than what was found in other, similar institutions. In both sections, there were several instances of very prolonged use of restraints, and mobile restraints were also used extensively. The two security sections, which both have the same function and the same number of places, had very different practices when it came to use of coercion. The staff at all levels had little knowledge of these systematic differences between the ­sections. There was also little understanding of what and if the sections could take active ­measures to reduce the use of coercion. As a result of the NPM’s recommendations, Østfold Hospital set up a working committee to devise improvement measures. The working committee, whose deadline for finalising the work was 1 November 2019, was tasked with several areas to improve, such as mapping the applicable procedures for the use of coercive measures in all departments, reviewing house rules and developing new procedures and training measures. Based on this, the hospital has been given a deadline of January 2020 to submit a written response to the Ombudsman with the results of this major quality improvement work.