2.50
Hdl Handle:
http://hdl.handle.net/10755/162418
Type:
Presentation
Title:
A New Model for Treating Psychiatric Patients in the ED
Abstract:
A New Model for Treating Psychiatric Patients in the ED
Conference Sponsor:Emergency Nurses Association
Conference Year:2011
Author:Arnold, Jeanne, RN, ND, CNS, CEN
P.I. Institution Name:Exempla Lutheran Medical Center
Title:Clinical Nurse Specialist
Contact Address:8300 W. 38th Avenue-ED Administration, Wheatridge, CO, 80033, USA
Contact Telephone:303-425-2084
[ENA Leadership Conference] Evidence-based Practice Presentation: A New Model for Treating Psychiatric Patients in the ED

Purpose: Emergency Departments have routinely utilized contracted security services to provide for staff and patient safety. However, many psychiatric and intoxicated patients are agitated by the presence of a uniformed security guard. Security officers are not trained to perform clinical tasks and have limited knowledge in dealing with psychiatric conditions. Frequently, security officers are utilized on patient watches in the ED, compromising the safety of the remaining hospital grounds. The purpose of the Behavioral Health Tech program was to improve care of the psychiatric patient population, resulting in decreased restraint use, decreased elopement, improved documentation, and increased patient satisfaction.

Design: A Performance Improvement project was implemented eliminating security from the ED and replacing them with Behavioral Health Techs who can perform patient care tasks, and who are trained in addictions, psychiatric care and crisis management.

Setting: A Community Level III Trauma Center with 52 beds seeing 75,000 patients annually.

Subjects: All patients presenting to the Emergency Department with a psychiatric or substance use complaint.

Methods: The Emergency Department leadership team developed the job description by modifying the Mental Health Counselor role at our inpatient psychiatric and detox unit to reflect the anticipated skills needed in the ED. A total of 10 Behavioral Health Techs were recruited; with preferred qualifications to include Certified Addictions Counselor, EMT or CNA and a minimum of 1 year experience in a behavioral health setting. BHTs were trained in de-escalation, suicide risk assessment, restraints, Clinical Institute Withdrawal Assessment for Alcohol (CIWA) scoring, phlebotomy and or IV access and electronic documentation. The BHTs oriented with the inpatient Mental Health Counselors as well as with RNs and EMTs in the ED. Security continued to do frequent rounds in the ED to assess for security needs; however they no longer performed "Patient Watches". This allowed security more man power to police the remaining hospital campus, and the Emergency Department was re-allocated the cost of the security personnel to be utilized in salaries for the Behavioral Health Techs.

Results/Outcomes: Although initially there was significant staff resistance to the program and the decreased security presence in the ED, the Behavioral Health Tech program has developed into a well-respected component of the ED. Utilizing their clinical expertise, the group established protocols to utilize CIWA scores to decrease complications associated with alcohol withdrawal and to decrease the length of stay on these patients. The BHTs have developed highly skilled de-escalation techniques resulting in decreased patient time in restraints, decreased patient violence and increased patient satisfaction. The BHTs are also involved in implementing the SBIRT program in the ED.

Implications: As Emergency Department leadership looks for new ways to manage the increasing numbers of psychiatric and substance abuse patients, the implementation of a Behavioral Health Tech program can provide better patient care and an avenue to meet all the required Joint Commission and CMS standards for care of this challenging population.
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleA New Model for Treating Psychiatric Patients in the EDen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162418-
dc.description.abstract<table><tr><td colspan="2" class="item-title">A New Model for Treating Psychiatric Patients in the ED</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2011</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Arnold, Jeanne, RN, ND, CNS, CEN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Exempla Lutheran Medical Center</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Clinical Nurse Specialist</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">8300 W. 38th Avenue-ED Administration, Wheatridge, CO, 80033, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">303-425-2084</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">arnoldje@exempla.org</td></tr><tr><td colspan="2" class="item-abstract">[ENA Leadership Conference] Evidence-based Practice Presentation: A New Model for Treating Psychiatric Patients in the ED<br/><br/>Purpose: Emergency Departments have routinely utilized contracted security services to provide for staff and patient safety. However, many psychiatric and intoxicated patients are agitated by the presence of a uniformed security guard. Security officers are not trained to perform clinical tasks and have limited knowledge in dealing with psychiatric conditions. Frequently, security officers are utilized on patient watches in the ED, compromising the safety of the remaining hospital grounds. The purpose of the Behavioral Health Tech program was to improve care of the psychiatric patient population, resulting in decreased restraint use, decreased elopement, improved documentation, and increased patient satisfaction. <br/><br/>Design: A Performance Improvement project was implemented eliminating security from the ED and replacing them with Behavioral Health Techs who can perform patient care tasks, and who are trained in addictions, psychiatric care and crisis management. <br/><br/>Setting: A Community Level III Trauma Center with 52 beds seeing 75,000 patients annually. <br/><br/>Subjects: All patients presenting to the Emergency Department with a psychiatric or substance use complaint.<br/><br/>Methods: The Emergency Department leadership team developed the job description by modifying the Mental Health Counselor role at our inpatient psychiatric and detox unit to reflect the anticipated skills needed in the ED. A total of 10 Behavioral Health Techs were recruited; with preferred qualifications to include Certified Addictions Counselor, EMT or CNA and a minimum of 1 year experience in a behavioral health setting. BHTs were trained in de-escalation, suicide risk assessment, restraints, Clinical Institute Withdrawal Assessment for Alcohol (CIWA) scoring, phlebotomy and or IV access and electronic documentation. The BHTs oriented with the inpatient Mental Health Counselors as well as with RNs and EMTs in the ED. Security continued to do frequent rounds in the ED to assess for security needs; however they no longer performed &quot;Patient Watches&quot;. This allowed security more man power to police the remaining hospital campus, and the Emergency Department was re-allocated the cost of the security personnel to be utilized in salaries for the Behavioral Health Techs. <br/><br/>Results/Outcomes: Although initially there was significant staff resistance to the program and the decreased security presence in the ED, the Behavioral Health Tech program has developed into a well-respected component of the ED. Utilizing their clinical expertise, the group established protocols to utilize CIWA scores to decrease complications associated with alcohol withdrawal and to decrease the length of stay on these patients. The BHTs have developed highly skilled de-escalation techniques resulting in decreased patient time in restraints, decreased patient violence and increased patient satisfaction. The BHTs are also involved in implementing the SBIRT program in the ED. <br/><br/>Implications: As Emergency Department leadership looks for new ways to manage the increasing numbers of psychiatric and substance abuse patients, the implementation of a Behavioral Health Tech program can provide better patient care and an avenue to meet all the required Joint Commission and CMS standards for care of this challenging population.<br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:27:53Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:27:53Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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