Behavioral Rapid Response Team

Transcription

1 May 2017 Behavioral Rapid Response Team Inpatient Behavioral Health Unit (IBHU)

2 Presenters Michael Gallagher, BSN, NE-BC Director of Behavioral Health Services Michelle Gardner, BSN, RN-BC, NE-BC Clinical Manager Inpatient Behavioral Health Unit Lisa McCarthy, MBA, BSN, RN-BC Clinical Manager Inpatient Behavioral Health Unit

3 Our Discussion for Today Explore and discuss: o history of the Behavioral Rapid Response Team (BRRT) o roles of the BRRT members o criteria for the implementation of a BRRT o BRRT Education and Training

4 Our Organization o Southern New Hampshire Medical Center is a 188-bed acute care facility in Nashua, NH that includes a licensed 30-bed voluntary inpatient Behavioral Health Unit. o Our medical staff includes nearly 500 primary and specialty care providers serving more than100,000 patients each year from 32 towns within southern NH and northern MA.

5 Our IBHU Today The Inpatient Behavioral Health Unit is a short-stay, crisis-stabilization unit, which provides 24-hour care, 7 days a week. o 18-bed voluntary adult psychiatric unit o Average length of stay: 7.5 days o Physical layout consist of 3 hallways on the same level o Staffing ratio o Day Shift: o Evening Shift: o Night Shift: 3 RNs, 2 BHAs / RT, SW, MDs, security 3 RNs, 2 BHAs, security 2 RNs, 2 BHAs, security

6 Our Philosophy of Care o Promote a safe, restraint/seclusion-free environment o Consistently support respectful behaviors by intervening early, using negotiation skills, and providing least restrictive interventions o Facilitate a team approach that relies on excellent communication skills and consistent use of Management of Aggressive Behavior (MOAB)

7 Have you ever o been involved in a restraint and/or seclusion? o had to deal with an aggressive patient? o been the lead when dealing with an aggressive patient? o wished your intervention was more organized?

8 Our Challenge o Relocated unit o Limited structure to manage patients agitation and disruptive behaviors o Nursing staff felt unsafe

9 Our Starting Point In 2008: o IBHU was a 30 bed unit o 7 cases of restraints o 2 cases of locked door seclusion o 9 cases of minor assaults to staff o Adopted IHI Rapid Response Team approach o Implemented BRRT in IBHU

10 Our Strategy o Promote safety through early intervention o Assure use of least restrictive measures o Mitigate the use of restraints and seclusions o Eliminate assaults and injuries

11 Our Solution: Behavioral Rapid Response Team Behavioral Emergencies: any behavior which is escalating or potentially escalating and potentially harmful to self, others, and/or to property. Goal: To initiate early interventions, promote safety, and prevent escalation in any given situation. Team: The Behavioral Rapid Response Team is comprised of staff that bring critical assessment and intervention skills to the emergent situation.

12 Our Results o Increase in: o staff satisfaction o unit safety o patient satisfaction with treatment team o BRRT Interventions o Decrease in: o restraint and seclusion use o staffing requirements (1:1) o Number of assaults and injuries

13 BRRT Structure

14 Key Points o All BHU staff are included as part of the BRRT o Resource RN monitors and maintains safety for all o Roles are based on individual staff strengths o BRRT includes security and engages environmental and food services as needed

15 Where We Begin Shift assignments on the white board o o o o o Negotiation Team Medications Milieu Management Station Safety (Safety Team)

16 Negotiation Team o Demonstrates strength in communication and negotiation o Conducts front line interventions with patient o Connects with patient only one staff to speak at a time! o Addresses physical/psychological needs o Helps patient meet criteria for and recognizes the patient s readiness for continuing independence in the milieu o Offers/administers meds; obtains new med orders

17 Medication Team o Works with the negotiator o Offers/administer meds; obtain new orders

18 Milieu Management o Conducts 15-minute safety checks o Engages all other patients o Monitors patient s behavior from stable/calm to signs of anxiety/agitation o Moves other patients away from the situation to decrease stimuli/audience and maintain area safety o Engages other patients with bag of group activities

19 Station Safety Serves as communication liaison o Updates social workers, doctors, ancillary staff o Directs visitors o Coordinates with kitchen staff o Pages BRRT to BHU

20 Safety Team o Staff and Security MUST BE MOAB TRAINED o Visible presence o Maintain safety o Escort patient if required

21 Post BRRT Intervention Shift Huddle o Consistency o Unit safety o Treatment plan De-escalation & Debrief

22 BRRT Guidelines

23 Behavioral Rapid Response Team (BRRT) An Early BeRRT Keeps the Peace

24 Organizational Expectations o Hospital-wide zero tolerance for violence o Enhanced communication during shift handoff o Recognize and respond to behaviors with potential for escalation

25 Activation o Inter-shift report IPASS o Shift handoff huddle o Communication throughout the shift o Verbal notification of BRRT in progress o Individualized patient and milieu care

26 Education and Training

27 Education o Online BRRT Education o Simulation class o Annual review

28 Training o Inter-professional mock codes o Hospital-wide MOAB training

29 Thank You