Interdisciplinary Collaboration: Section H Improves Care and Provides Safety for Behavioral Health Patients

2.50
Hdl Handle:
http://hdl.handle.net/10755/162421
Type:
Presentation
Title:
Interdisciplinary Collaboration: Section H Improves Care and Provides Safety for Behavioral Health Patients
Abstract:
Interdisciplinary Collaboration: Section H Improves Care and Provides Safety for Behavioral Health Patients
Conference Sponsor:Emergency Nurses Association
Conference Year:2011
Author:Bigowsky, Mary, RN, MSN, NEA-BC
P.I. Institution Name:St. Elizabeth Health Center
Title:Director of Nursing
Contact Address:1044 Belmont Avenue, Youngstown, OH, 44501, USA
Contact Telephone:330-480-3853
[ENA Leadership Conference] Evidence-based Practice Presentation: Interdisciplinary Collaboration: Section H Improves Care and Provides Safety for Behavioral Health Patients

Purpose: The purpose of our team was to improve the care and maintain the safety of behavioral health patients who presented to a Level 1 trauma center. Faced with the closure of the only other behavioral health unit in a tri-county area, our facility was challenged with an influx of behavioral health patients many who became violent and assaultive. Behavioral health patients were often triaged at a level 3 or 4, therefore, given lesser priority to be seen by the physician. . Many patients became violent or assaultive toward staff resulting in the application of behavioral restraints. In addition, the violent behavior was concerning to both staff and other acutely ill patient in the ED.

Design: Interdisciplinary team was established to evaluate current practices in the management of behavioral health patients and to develop structures and processes to assure patient and staff safety.

Setting: Urban tertiary care, level 1 trauma center, located in northeastern Ohio with 42,000 patient visits per year.

Participants: ED physician, psychiatrist, ED nursing leadership, ED staff nurses, ED social workers, Behavioral Health Clinical Specialist, Vice President of Support Services.

Methods: The interdisciplinary team conducted a literature review to identify best practices, reviewed federal and state regulations and Joint Commission standards.

Our facilities management team completed an assessment using the Patient Safety Standards Materials and System Guidelines. Based on their finding and the best practices identified in the literature, the team recommended the establishment of Section G as a behavioral health section. This section, located within the main ED, was separated by a wall and short hallway. Our goal was to place the behavior health patients away from the activity of main ED to an area of less stimulation once stabilized. Section G was remodeled to meet the safety standards required for behavioral health units. An additional security guard was hired and metal detectors were installed. We developed criteria for Section G and adopted a mental health triage scale to facilitate quick placement in the ED. The culture began to change as aggressive and violent behavioral health patients were identified as Triage Level 1 and 2àbehavioral health emergencies.

Key to our work was the behavioral health clinical nurse specialist who provided expert knowledge in the development of policies and procedures and in the education of staff. Education included: Behavioral Risk Assessment, suicide safety measures, "Handling the Disruptive Persons: Using Trauma Informed Principles to Keep Patients and Staff Safe" and the appropriate use of behavioral restraints.

Results/Outcomes: The use of behavioral restraints decreased from an average of 17 per month in 2008 to an average of 10 per month in 2010 despite a 100% increase in our behavioral health patients. Nurses report positive work experiences when assigned to Section G.

Implications: The management of behavioral health patients in the ED is especially challenging. Findings and interventions supported by this team can be applied in both the ED and acute care non-behavioral health units.
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.titleInterdisciplinary Collaboration: Section H Improves Care and Provides Safety for Behavioral Health Patientsen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162421-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Interdisciplinary Collaboration: Section H Improves Care and Provides Safety for Behavioral Health Patients</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">Bigowsky, Mary, RN, MSN, NEA-BC</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">St. Elizabeth Health Center</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Director of Nursing</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">1044 Belmont Avenue, Youngstown, OH, 44501, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">330-480-3853</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">mary_bigowsky@hmis.org</td></tr><tr><td colspan="2" class="item-abstract">[ENA Leadership Conference] Evidence-based Practice Presentation: Interdisciplinary Collaboration: Section H Improves Care and Provides Safety for Behavioral Health Patients<br/> <br/> Purpose: The purpose of our team was to improve the care and maintain the safety of behavioral health patients who presented to a Level 1 trauma center. Faced with the closure of the only other behavioral health unit in a tri-county area, our facility was challenged with an influx of behavioral health patients many who became violent and assaultive. Behavioral health patients were often triaged at a level 3 or 4, therefore, given lesser priority to be seen by the physician. . Many patients became violent or assaultive toward staff resulting in the application of behavioral restraints. In addition, the violent behavior was concerning to both staff and other acutely ill patient in the ED.<br/><br/>Design: Interdisciplinary team was established to evaluate current practices in the management of behavioral health patients and to develop structures and processes to assure patient and staff safety.<br/><br/>Setting: Urban tertiary care, level 1 trauma center, located in northeastern Ohio with 42,000 patient visits per year.<br/><br/>Participants: ED physician, psychiatrist, ED nursing leadership, ED staff nurses, ED social workers, Behavioral Health Clinical Specialist, Vice President of Support Services.<br/><br/>Methods: The interdisciplinary team conducted a literature review to identify best practices, reviewed federal and state regulations and Joint Commission standards.<br/><br/>Our facilities management team completed an assessment using the Patient Safety Standards Materials and System Guidelines. Based on their finding and the best practices identified in the literature, the team recommended the establishment of Section G as a behavioral health section. This section, located within the main ED, was separated by a wall and short hallway. Our goal was to place the behavior health patients away from the activity of main ED to an area of less stimulation once stabilized. Section G was remodeled to meet the safety standards required for behavioral health units. An additional security guard was hired and metal detectors were installed. We developed criteria for Section G and adopted a mental health triage scale to facilitate quick placement in the ED. The culture began to change as aggressive and violent behavioral health patients were identified as Triage Level 1 and 2&agrave;behavioral health emergencies. <br/><br/>Key to our work was the behavioral health clinical nurse specialist who provided expert knowledge in the development of policies and procedures and in the education of staff. Education included: Behavioral Risk Assessment, suicide safety measures, &quot;Handling the Disruptive Persons: Using Trauma Informed Principles to Keep Patients and Staff Safe&quot; and the appropriate use of behavioral restraints. <br/> <br/>Results/Outcomes: The use of behavioral restraints decreased from an average of 17 per month in 2008 to an average of 10 per month in 2010 despite a 100% increase in our behavioral health patients. Nurses report positive work experiences when assigned to Section G.<br/> <br/>Implications: The management of behavioral health patients in the ED is especially challenging. Findings and interventions supported by this team can be applied in both the ED and acute care non-behavioral health units. <br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:27:56Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:27:56Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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