An Emergency Department’s Journey: Implementation of Evidence Base Tools Reduce Restraint Usage

2.50
Hdl Handle:
http://hdl.handle.net/10755/306620
Category:
Abstract
Type:
Poster
Title:
An Emergency Department’s Journey: Implementation of Evidence Base Tools Reduce Restraint Usage
Author(s):
Luchs, Brenda; Bigowsky, Mary; George, Michelle; Pavetic, Senka
Lead Author STTI Affiliation:
Non-member
Author Details:
Brenda Luchs, MSN, RN, CEN, brenda_luchs@hmis.org; Mary Bigowsky, MSN, RN, NEA-BC; Michelle George, BSN, RN, CEN; Senka Pavetic, RN
Abstract:

Evidence-based Practice Abstract

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 who may become 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 patients in the emergency department.

Design: An interdisciplinary team was established to explore evidence-based practices in the management of behavioral health patients and to develop structures and processes to assure quality, patient and staff safety.

Setting: Urban tertiary level 1 trauma center, located in northeastern Ohio with 45,000 patient visits per year.

Participants: Emergency department physicians, emergency department and behavioral health nursing leadership, protective services, emergency department staff nurses and social workers.

Methods: Violence perpetrated against emergency department staff members, especially in areas involving behavioral health clients have become a common event, as emergency nurses relay that a general fear of potential violence from these patients plays a significant role in the quality of care they are able provide. The interdisciplinary team explored evidence based clinical tools that assists the emergency nurse to ascertain which behavioral health patients possess a likelihood for violence. The Brøset Violence Checklist is an assessment tool of six specific behaviors frequently used predicting the probability of violence in the next twenty four hours. The Broset Violence Risk Assessment was trialed in the emergency department five bed behavioral health unit on all adult patients for two months. During the trial, the use of behavioral restraints decreased, proposing that emergency department staff were able to intercede before restraints were indicated. The team supported and implemented staff education that included the Broset Violence Risk Assessment and Non-Abusive Psychological and Physical Intervention (NAPPI).

Results/Outcomes: The use of behavioral restraints decreased over 60 percent in the last two months of 2012, as compared to the last two months of 2011, despite an increase in our behavioral health patients. The incidence of violence has reduced in this population. The tool was widely accepted by the emergency nursing staff and physicians who attest to its ability to identify violence prone behavioral health patients. In addition, NAPPI education has provided staff with verbal tools to assist in de-escalation technique and has served to develop a common language among the ED and Protective Services staff.

Implications: The management of behavioral health patient’s in the emergency department is especially challenging. This team demonstrated that significant improvements in the management of behavioral health patients, improved the quality of care and the safety of both the patient and staff.

Keywords:
Improve safety of behavioral health patients
Repository Posting Date:
9-Dec-2013
Date of Publication:
9-Dec-2013
Conference Date:
2013
Conference Name:
2013 ENA Annual Conference
Conference Host:
Emergency Nurses Association
Conference Location:
Nashville, Tennessee, USA
Description:
2013 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at Gaylord Resort and Convention Center
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_GB
dc.type.categoryAbstracten_GB
dc.typePosteren_GB
dc.titleAn Emergency Department’s Journey: Implementation of Evidence Base Tools Reduce Restraint Usageen_GB
dc.contributor.authorLuchs, Brendaen_GB
dc.contributor.authorBigowsky, Maryen_GB
dc.contributor.authorGeorge, Michelleen_GB
dc.contributor.authorPavetic, Senkaen_GB
dc.contributor.departmentNon-memberen_GB
dc.author.detailsBrenda Luchs, MSN, RN, CEN, brenda_luchs@hmis.org; Mary Bigowsky, MSN, RN, NEA-BC; Michelle George, BSN, RN, CEN; Senka Pavetic, RNen_GB
dc.identifier.urihttp://hdl.handle.net/10755/306620-
dc.description.abstract<p>Evidence-based Practice Abstract</p><p>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 who may become 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 patients in the emergency department.</p><p>Design: An interdisciplinary team was established to explore evidence-based practices in the management of behavioral health patients and to develop structures and processes to assure quality, patient and staff safety.</p><p>Setting: Urban tertiary level 1 trauma center, located in northeastern Ohio with 45,000 patient visits per year.</p><p>Participants: Emergency department physicians, emergency department and behavioral health nursing leadership, protective services, emergency department staff nurses and social workers.</p><p>Methods: Violence perpetrated against emergency department staff members, especially in areas involving behavioral health clients have become a common event, as emergency nurses relay that a general fear of potential violence from these patients plays a significant role in the quality of care they are able provide. The interdisciplinary team explored evidence based clinical tools that assists the emergency nurse to ascertain which behavioral health patients possess a likelihood for violence. The Brøset Violence Checklist is an assessment tool of six specific behaviors frequently used predicting the probability of violence in the next twenty four hours. The Broset Violence Risk Assessment was trialed in the emergency department five bed behavioral health unit on all adult patients for two months. During the trial, the use of behavioral restraints decreased, proposing that emergency department staff were able to intercede before restraints were indicated. The team supported and implemented staff education that included the Broset Violence Risk Assessment and Non-Abusive Psychological and Physical Intervention (NAPPI).</p><p>Results/Outcomes: The use of behavioral restraints decreased over 60 percent in the last two months of 2012, as compared to the last two months of 2011, despite an increase in our behavioral health patients. The incidence of violence has reduced in this population. The tool was widely accepted by the emergency nursing staff and physicians who attest to its ability to identify violence prone behavioral health patients. In addition, NAPPI education has provided staff with verbal tools to assist in de-escalation technique and has served to develop a common language among the ED and Protective Services staff.</p><p>Implications: The management of behavioral health patient’s in the emergency department is especially challenging. This team demonstrated that significant improvements in the management of behavioral health patients, improved the quality of care and the safety of both the patient and staff.</p>en_GB
dc.subjectImprove safety of behavioral health patientsen_GB
dc.date.available2013-12-09T17:00:50Z-
dc.date.issued2013-12-09-
dc.date.accessioned2013-12-09T17:00:50Z-
dc.conference.date2013en_GB
dc.conference.name2013 ENA Annual Conferenceen_GB
dc.conference.hostEmergency Nurses Associationen_GB
dc.conference.locationNashville, Tennessee, USAen_GB
dc.description2013 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at Gaylord Resort and Convention Centeren_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission.en_GB
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