Use of a Standardized Procedure to Improve Behavioral Health Patients’ Care: A Quality Improvement Initiative

Winokur, Elizabeth J.; Loucks, Jeannine; Raup, Glenn H.

doi:10.1016/j.jen.2017.07.008

Cited by 12 publications

(7 citation statements)

References 15 publications

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“…A recent performance improvement (PI) project by Winokur et al (2018) showed that developing and using a standardized procedure was effective in reducing staff physical assaults in ERs through early identification of anxious patients and reduction of time to first medication and time to restraints. The use of a standardized procedure led to a 50% decrease in restraint utilization and lowered the incidence of staff physical injuries from patient assaults by 3.6% (Winokur et al, 2018).…”

Section: Rationalementioning

confidence: 99%

Zero Staff Assaults in the Psychiatric Emergency Room: Impact of a Multifaceted Performance Improvement Project

Okundolor

Ahenkorah

Sarff

et al. 2020

J Am Psychiatr Nurses Assoc

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INTRODUCTION: Our psychiatric emergency room (ER) averages 18 patient-to-staff physical assaults annually, with some incidents resulting in multiple injuries. AIMS: The purpose of this performance improvement project was to develop, implement, and evaluate a multifaceted approach to reducing the number of physical assaults on staff. METHODS: We assessed the impact of these bundled interventions on staff assault rate: (1) increasing behavioral response team drills, (2) implementing shift doses, (3) screening for patients’ risk for violence, (4) posting signage to communicate patients’ violence propensity (Golden Hand), (5) implementing mitigating countermeasure interventions, (6) conducting postassault debriefing, and (7) providing postassault support. Psychiatric ER nurses completed questionnaires measuring their perceived self-efficacy in managing patients with a propensity for violence before, during, and after the bundled interventions. Physical assaults on staff were recorded and tracked monthly from May 2016 to September 2018 through a retrospective review of the hospital’s online incident report system. RESULTS: Staff perceived self-efficacy increased from 78% to 95% after attending at least two behavioral response team drills. The Golden Hand signage was rated useful as it flagged and communicated the presence of high-risk patients. Shift dose was evaluated as an informative tool and manageable at ≤5 minutes. The violence-screening tool was considered more accurate in identifying patients with violent tendencies than standard assaultive precautions. Physical assaults on staff by patients decreased to zero in our psychiatric ER, which was sustained for a year. CONCLUSIONS: This innovative, multifaceted, bundled approach provides an opportunity for nurse leaders to promote workplace safety while improving staff engagement and empowerment.

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Section: Rationalementioning

confidence: 99%

Zero Staff Assaults in the Psychiatric Emergency Room: Impact of a Multifaceted Performance Improvement Project

Okundolor

Ahenkorah

Sarff

et al. 2020

J Am Psychiatr Nurses Assoc

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“…6 -8 Increasingly recognized are the advantages to addressing the behavioral health concerns of both adult and pediatric patients in general health care contexts. 9,10…”

Section: Introductionmentioning

confidence: 99%

“…[6][7][8] Increasingly recognized are the advantages to addressing the behavioral health concerns of both adult and pediatric patients in general health care contexts. 9,10 Primary care is an optimal setting to discern and respond to behavioral health issues. There are at least 4 documented benefits: (1) behavioral health problems, like physical health problems, are more amenable to preventative interventions at earlier stages 11,12 ; (2) patients with behavioral health problems are more likely to surface in primary care than in specialty care 13 ; (3) patients prefer having behavioral health concerns addressed by their primary care team 14,15 ; and (4) health care costs, particularly in the use of specialty services (ED, hospital, and psychiatric care), are reduced.…”

Section: Introductionmentioning

confidence: 99%

The Association Between Depression and Substance Use Among Primary Care Patients With Comorbid Medical and Behavioral Health Conditions

McGovern,

Dunn,

Bonnell

et al. 2023

J Prim Care Community Health

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Introduction: The scope of primary care increasingly encompasses patient behavioral health problems, manifest typically through depression screening and treatment. Although substance use is highly comorbid with depression, it is not commonly identified and addressed in the primary care context. This study aimed to examine the association between the likelihood of substance use disorder and increased depression severity, both cross-sectionally and longitudinally, among a sample of 2409 patients from 41 geographically dispersed and diverse primary care clinics across the US. Methods: This is secondary analysis of data obtained from a multi-site parent study of integrated behavioral health in primary care, among patients with both chronic medical and behavioral health conditions. Patient reported outcome surveys were gathered from patients at 3 time points. The primary care practices were blind to which of their patients completed surveys. Included were standardized measures of depression severity (Patient Health Questionnaire—9) [PHQ-9] and substance use disorder likelihood (Global Appraisal of Individual Needs—Short Screener [GSS]). Results: Four percent of the study population screened positive for substance use disorder. PHQ-9 scores indicated depression among 43% of all patients. There was a significant association between the likelihood of substance use disorder and depression initially, at a 9-month follow-up, and over time. These associations remained significant after adjusting for age, gender, race, ethnicity, education, income, and other patient and contextual characteristics. Conclusions: The findings suggest that substance use disorder is associated with depression severity cross-sectionally and over time. Primary care clinics and health systems might consider implementing substance use screening in addition to the more common screening strategies for depression. Especially for patients with severe depression or those who do not respond to frontline depression treatments, the undermining presence of a substance use disorder should be explored.

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“…Through this research, unique and comparable findings have been uncovered regarding the presence of these patients in the emergency department. Although minimal in quantity, the existing research shows that HCPs generally do not feel competent to care for these patients, with lack of education seen as a primary factor [1][2][3][4][5]. Emergency department staff is frequently tasked with handling episodes of aggression and violence, with research showing that these frequently occur in the first hour of patient presentation [3].…”

Section: Introductionmentioning

confidence: 99%

“…Although minimal in quantity, the existing research shows that HCPs generally do not feel competent to care for these patients, with lack of education seen as a primary factor [1][2][3][4][5]. Emergency department staff is frequently tasked with handling episodes of aggression and violence, with research showing that these frequently occur in the first hour of patient presentation [3]. Without specialized education to help staff learn to properly handle these situations, feelings of powerlessness and incompetence have emerged [4].…”

Section: Introductionmentioning

confidence: 99%

Emergency Room Health Care Professionals Need Ongoing Education in Caring For the Mental Health Patient: A Literature Review

Mitchell¹

2019

JQHE

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The prevalence of mental health disorders shows how real this spectrum of illness is in the United States, with 44.7 million people estimated to be affected in 2016 (National Institute of Mental Health, 2017). The frequency of their presentation to emergency rooms and the need of healthcare providers to be properly prepared to care for these patients are increasing. Literature demonstrates that providers feel ill prepared and lack of confidence to care for the acutely mentally ill patient. This puts the patient and the provider at a safety risk. This paper is a brief literature review based on the need for healthcare providers to be educated on this population.

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Use of a Standardized Procedure to Improve Behavioral Health Patients’ Care: A Quality Improvement Initiative

Cited by 12 publications

References 15 publications

Zero Staff Assaults in the Psychiatric Emergency Room: Impact of a Multifaceted Performance Improvement Project

Zero Staff Assaults in the Psychiatric Emergency Room: Impact of a Multifaceted Performance Improvement Project

The Association Between Depression and Substance Use Among Primary Care Patients With Comorbid Medical and Behavioral Health Conditions

Emergency Room Health Care Professionals Need Ongoing Education in Caring For the Mental Health Patient: A Literature Review

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