A Population-Based Care Improvement Initiative for Patients at Risk for Delirium, Alcohol Withdrawal, and Suicide Harm

An Interdisciplinary Clinical Approach for Workplace Violence Prevention and Injury Reduction in the General Hospital Setting: S.A.F.E. Response

“…Our goal was to prevent workplace violence from occurring during the provision of necessary clinical care in the acute care setting. A quality improvement project previously implemented to improve the care of patients at risk for delirium, alcohol withdrawal, and suicide harm (Lakatos et al, 2015) provided the clinical foundation. Evidence-informed and team-based approach to care (Lakatos, Kenefick, Mitchell, Etheredge, & Mylott, 2012) worked well within our organization and provided the structural foundation for building a program to impact safety.…”

“…De-escalation techniques (American Organization of Nurse Executives, 2014; Bowers, 2014; Hardin, 2012; Horn & Dubin, 2013; Nordstrom et al, 2012) focus on communication as one of the most impactful ways to diffuse a potentially dangerous situation, and the results of the survey identified that our staff did not feel competent in this area. We collaborated with the Crisis Prevention Institute (2016; Place, 2014) to develop an e-learning program combining de-escalation training along with our clinical best practice for patients with delirium, alcohol withdrawal, or suicide/harm called DASH (Lakatos et al, 2015). The clinical assessment tools used with DASH were embedded in the training and provided the clinical foundation for the S.A.F.E.…”

“…The clinical assessment tools used with DASH were embedded in the training and provided the clinical foundation for the S.A.F.E. The Cognitive Assessment Method for the Intensive Care Unit (CAM-ICU; Ely et al, 2001) was modified (with author permission; Ely et al, 2001; Lakatos et al, 2015) and is used to assess all patients for delirium every 8 hours. The Alcohol Use Disorders Identification Test (AUDIT-C), developed by the World Health Organization (Babor, Higgins-Biddle, Saunders, & Monteiro, 2001), is used to assess all patients admitted to the hospital for risk of alcohol withdrawal.…”

“…The response shifts the focus from security responding in isolation to a threat, to a team clinical response to identify an etiology and put a plan in place to address the threat. The clinical response includes an Assessment of risk that is guided by patient’s history and current assessment of mental status, including evaluation of delirium using CAM-ICU-Modified (Ely et al, 2001; Lakatos et al, 2015). The team responding to a S.A.F.E.…”