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IHI Expedition Expedition: Making Mental Health Care Safer in the Hospital Setting
Session 6: Being Proactive and Avoiding Crises
February 24, 2015
James F. O’Dea, PhD, MBAMichael Claeys, MBA, LPCKelly McCutcheon Adams, LICSW
Today’s Host2
Dorian Burks, Project Coordinator, Institute for Healthcare Improvement, is a current coordinator for web-based Expeditions. He also contributes to the IHI work in the Triple Aim and Improvement Capability focus areas, as well as the Leading Quality Improvement series. Dorian is a member of the Diversity and Inclusion Council at IHI, where he and fellow staff members develop strategies to enhance IHI’s inclusive culture, both internally and externally. Dorian graduated from Massachusetts Institute of Technology in Cambridge, MA where he received his Bachelor of Science degree in Biology and humanities concentration in Anthropology.
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Expedition Director8
Kelly McCutcheon Adams, LICSW has been a Director at the Institute for Healthcare Improvement since 2004. Her primary areas of work with IHI have been in Critical Care and End of Life Care. She is an experienced medical social worker with experience in emergency department, ICU, nursing home, sub-acute rehabilitation, and hospice settings. Ms. McCutcheon Adams served on the faculty of the U.S. Department of Health and Human Services Organ Donation and Transplantation Collaboratives and serves on the faculty of the Gift of Life Institute in Philadelphia. She has a B.A. in Political Science from Wellesley College and an MSW from Boston College.
Today’s Agenda9
Welcome
Action Period Assignment Debrief
Being Proactive and Avoiding Crises
Closing
Thank you!
Expedition Objectives
At the conclusion of this Expedition, participants will be able to:
Explain the importance of partnering with patients and their families to improve safety for patients with mental health conditions
Identify different areas to improve mental health care safety
Describe examples of improvement efforts at other organizations
Plan tests of change to begin or continue patient safety improvement
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Schedule of Calls
Session 1 – Partnering with Patients and FamiliesDate: Tuesday, December 2, 1:00 - 2:30 PM Eastern Time
Session 2 – Making the Physical Environment SaferDate: Tuesday, December 16, 1:00 - 2:00 PM Eastern Time
Session 3 – Why Flow MattersDate: Tuesday, January 13, 1:00 - 2:00 PM Eastern Time
Session 4 – Medication SafetyDate: Tuesday, January 27, 1:00 - 2:00 PM Eastern Time
Session 5 – Ensuring Staff PreparednessDate: Tuesday, February 10, 1:00 - 2:00 PM Eastern Time
Session 6 – Being Proactive and Avoiding CrisesDate: Tuesday, February 24, 1:00 - 2:00 PM Eastern Time
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Action Period Assignment Debrief
Sharing examples of changing staff hiring/orientation/training/preparedness to improve mental health safety.
Being Proactive and Avoiding CrisesJames O’Dea and Michael Claeys
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Faculty14
James F. O’Dea, PhD, MBA is a clinical psychologist and has been employed at Backus Hospital since 1989. He is currently the administrator for the hospital’s Level III trauma program as well as the Regional Director of the Behavioral Health services for the Hartford Healthcare East Region. Dr. O’Dea came to Backus Hospital in 1989 to practice clinical psychology in the Department of Psychiatric Services. He has been active in the development of the hospital’s bariatric surgery program, heart failure program, stroke program, and its new peripheral vascular program. Dr. O’Dea has also been actively involved in patient safety and quality initiatives, heading up the Patient Safety and Quality department for the last 15 months. In 2008, Dr. O’Dea assumed a leadership position in the award-winning Backus Cancer program. He continues in this leadership position and most recently was named the Regional Director for Cancer Services for the Hartford Healthcare East Region. He has worked closely with the Eastern Connecticut Hematology and Oncology practice and multiple physician practices on strategic and operational planning for the cancer service line. He has recently been named to a leadership position in the Hartford Healthcare Cancer Institute (HHCCI), which is currently developing the strategic and operational affiliation with Memorial Sloan-Kettering (MSK), one of the premier cancer programs in the world.
Faculty15
Michael Claeys is a Licensed Professional Counselor and possesses a Master’s in Business Administration. He developed one of Georgia’s first crisis centers along with alternatives to state hospitalization at the Clayton Center CSB in 1996. From 1999 to 2009 as Executive Director of APS Healthcare, Mr. Claeys was responsible for a statewide external quality review unit for mental health providers that included extensive provider training, provider profiling, and integration of consumer recovery activities. Since 2009 Mr. Claeys has served as Executive Director of Grady Health System’s Behavioral Health services. Grady Health System is a large urban safety net hospital in Atlanta Georgia with over 117,000 emergency room visits a year. Behavioral Health Services at Grady consist of a full array of crisis, inpatient, Assertive Community Treatment, and outpatient services.
Safety and SecurityBehavioral Health Services
Michael Claeys, MBA, LPCExecutive Director
Grady Health System
Hospital Overview
• Urban, safety net hospital with Level 1 Trauma Unit
• People with behavioral health needs are served throughout the hospital and community– Emergency room– Med/Surg floors– Psychiatric specific services
The “Rights” of Safety
• The Right mix of services• The Right service at the Right time: Get the
person to the correct service level quickly• The Right environmental safety features• The Right safety protocols
Grady’s Mix of Services• Emergent:
– EMS– Emergency Room– Psych Crisis Intervention Service
• Urgent:– Psych Inpatient– Psych Consult Services on Med/Surg floors– Assertive Community Treatment
• Routine:– Outpatient Clinic– Case Management– Psychosocial Rehabilitation– Peer Support Services
Grady Emergency ServicesPositives:EMS with one unit staffed by paramedic and licensed behavioral health professional to prevent unnecessary ER visits• Dedicated rooms for
psych within ER• Initial Property Search
and Securing Belongings
• Licensed BH professionals and limited coverage by psychiatrists
• Disposition decisions within 7 hours
Risks:• Risk of flight, leaving AMA• Environmental and physical risks are present• No body search• Increase use of restraints as no continuous
monitoring
Coming August 2015 – Psych ED
• Physical plant design with specific features to ensure safety and harm reduction
• 24 hour coverage by Psychiatry Attending physicians and BH trained techs
• Supported by Licensed BH professionals• Medical screening conducted by psychiatrists
Psych Services on Med/Surg UnitsPositives:• Consults based on medical team
referral, request• Guidelines in place to suggest
when to “consult” psychiatry• Psychiatric Consults completed by
psychiatrists, psych residents, Physician Assistants
• Provide diagnostic assessment, medication management, behavioral planning and referral to after care services including inpatient and/or outpatient care, as appropriate
Risks:• Environmental and
physical risks are present • No property or body
search• Increased use of
restraints for uncooperative patients
• No continuous monitoring
Crisis Intervention (CIS) and Psych Inpatient
• Initial Property and Body Search to find contraband (i.e. weapons, drugs, lighters)
• Dedicated security staff 24/7• Limited access through badge
swipe
CIS and Inpatient- Environmental• Minimize risk of harm• 100% completion of
Suicide Risk
Monitor at appropriate intervals (i.e. 15 minute, line of sight, 1-1)
Maintain adequate staffing ratios
Safe Furniture ChoicesImmovable chairs andottomans on CIS
TVs covered and mounted high on wall
Hard plastic beds (No sharp edges and bolted to floor)
CIS and Inpatient - Environmental
Anti-ligature technology on doors
Soap dispensers and hand sanitizers are fully protected, tamper proof and anti-ligature
Monitor for damage
Reducing Environmental Risks
Doors with no hinges
Replace plastic liners with paper
Retro Fit – Existing EnvironmentFill space between wall andhandrails
Replace beds, current model has no sharp edges, bolted to floor
Monitoring for Safety
Real time monitoring as well recorded review of incidents and activity on unit
Behavioral Management
Stimulus Reduction Room With Recliner (on CIS)
Construction Safety
Temporary walls with same safety features such as anti-ligaturehandles.
Monitor tools and materials.
Readmission Prevention Strategies
• Individualized discharge plans• After discharge phone calls to assure
understanding of medications, follow up appointments
• Step-down aftercare program provides same day access post discharge from crisis/IP services
• Case Management & Assertive Community Tx
Making Mental Health Care SaferBeing Proactive and Avoiding Crises
James F. O’Dea, Ph.D., MBARegional Director, Hartford Healthcare
Behavioral Health Network
Hartford Healthcare Behavioral Health Network
Largest provider of behavioral healthcare in state of Connecticut• Institute of Living – IOL• Rushford Center• Natchaug Hospital• William W. Backus Hospital• The Hospital of Central Connecticut• MidState Hospital• Windham Hospital
The Platform High Reliability Organizations
• The science of safety• Learnings from other industries – aviation and
nuclear power• Safety tools – work smarter, not harder• Near misses, precursor events, safety events• Open, transparent culture
People
• Partnership with staff and patients• Engaged, enthusiastic staff are keys to success• Affirmation and accountability• Every meeting starts with recognition of staff –
“wins”
Training and Education
• Management of Aggressive Behavior (MOAB)
• Therapeutic Crisis Team Intervention (TCTI)
Policies and procedures
• Level system• Assessment process• Re-assessment process• Safety rounds
Safety Huddle
• Review last 24 hours• Plan for next 24 hours• Shorter versions in change of shift meetings
Questions/Discussion41
Raise your hand
Use the chat
Checking-in
Going deeper on these topics?
Future topics?
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Thank you
Thank you for participating!
Thank you our many great faculty.
Thank you to our host, Dorian Burks.
We hope to see you on another Expedition soon.
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Expedition Communications
Listserv for session communications: [email protected]
To add colleagues, email us at [email protected]
Pose questions, share resources, discuss barriers or successes
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