Smoke Free Campus and High Risk Behavior Management Planning Education for Non-Clinical Team Members

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1 Smoke Free Campus and High Risk Behavior Management Planning Education for Non-Clinical Team Members

2 Purpose of this Module Discuss Smoke Free facilities/campuses and what team members can do to help make them safer List High Risk Behaviors and the roles that the various team members play in the process to address these behaviors and patient safety Discuss the Specialized Treatment Plan

3 Why go Smoke Free? It s harmful to our patients health and impedes their healing process. It interferes with the patients ability to fully participate in their care; delaying their ability to go home as soon as they would like It s the right thing to do for our patients, our staff and our community!

4 Smoke Free Hospitals and Campuses Washington County Facilities are smoke-free. For their health and safety, patients are not permitted to smoke while hospitalized - this includes vaping and e-cigarettes. Smoking is not allowed in any common areas on campus such as sidewalks or parking lots. Visitors who wish to smoke must go to their cars or leave the campus to do so.

5 Smoke Free Hospitals and Campuses Patients are no longer authorized to go outside to smoke. (The Smoking Release Form is no longer applicable in Washington County.) Physicians expect patients to remain on their unit and in order to be an active partner in their care.

6 Patients Not Permitted to Smoke Patients will be reminded during the admission process that the facility is smoke free - this includes vaping and e-cigarettes. Patients who are nicotine-dependent will be offered nicotine replacement options while under facility care. For their own safety and the safety of other patients, patients are required to have their provider s permission to leave their unit. Patients will be asked not leave the building with any hospital property i.e. patient gowns, IV or central lines/ports, IV pumps, wheel chairs, or other hospital property.

7 Team Member Expectations It is everyone s responsibility to help make our facility and campus smoke free: o Remind patients and visitors that the campus is Smoke Free o Ask patients found wandering in the hospital or outside to return to their unit for their health and safety, and assist them in their return to their unit if needed o Ask visitors to refrain from smoking in areas other than their car o Escalate issues to security and leadership if not resolved with a discussion

8 UNDERSTANDING HIGH RISK BEHAVIORS AND THE ROLE OF THE HIGH RISK TEAM

9 What are High Risk Behaviors High Risk Behaviors are behaviors that can negatively affect the patient s health or hospital outcome. o Examples might include (but are not limited to): o Leaving the unit o Smoking o Tampering with/accessing their IV/central line o Taking medications not prescribed by the hospital provider

10 What is the High Risk Team? The High Risk Team addresses a patient with High Risk Behaviors. The High risk team is a multidisciplinary team meetings coordinated by House Supervisor with patient s care team If a team member or provider has a patient who is exhibiting a high risk behavior that cannot be resolved by an initial discussion with the patient, the House Supervisor should be contacted for assistance. The House Supervisor will initiate the procedures for involving the High Risk Team. Behavior Contracts may be used to address patients engaging in high risk behaviors.

11 Behavior Contracts The Behavior Contract Shall Include the Following: Identified High Risk Behavior(s) The provider s / hospital staff s expectations of the patient Risk / benefits of High Risk Behavior(s) and behavior modification Plan / Interventions for addressing the High Risk Behavior

12 What if the Patient does not Follow the Behavior Contract? Every effort will be made by the treating physicians, nursing staff and administration to develop a mutually agreed upon Behavior Contract with the patient. If the patient does not follow the agreed upon Behavior Contract, the High Risk Team will be called upon to meet again with the physician and decide next steps for the patient, up to and including discharging the patient AMA if their actions/continued hospitalization would be harmful or futile. For more information, please click on this link to access the High Risk Team Policy PC You will be asked to confirm you have read this policy at the end of this module.

13 Special Circumstances for Addressing High Risk Behavior

14 Other Important Policies Addressing High Risk Behavior Against Medical Advice (AMA), Off-Unit without Permission (OWOP) and OWOP at risk : Adult Patients Leaving Prior to Completion of Evaluation or Treatment Policy. This policy provides guidelines for managing situations where an adult patient leaves or attempts to leave the hospital after being admitted prior to completion of a medical and/or psychiatric evaluation and/or treatment. For additional information click on the link to access the Against Medical Advice (AMA), Off-Unit without Permission (OWOP) and OWOP at risk : Adult Patients Leaving Prior to Completion of Evaluation or Treatment Policy. You will be asked to confirm that you have reviewed this policy at the end of this module

15 AMA OWOP Policy Highlights Importance of patients adhering to their treatment plan and that they not leave their unit without provider permission Caregivers should communicate to patients the reasons for this expectation, which include, but are not limited to: o Ensuring patients are present for examination and treatment o Ensuring patients are available for medication administration, diagnostic tests, therapies and other procedures ordered by their Providers o Helping to reduce the spread of infection or other illness o Ensuring appropriate monitoring by clinical staff, promoting patient safety o Ensuring proper function of hospital equipment being utilized for patients care o Promoting the efficient operation of clinical services

16 AMA OWOP Policy Highlights This policy describes actions to be taken when a patient is discovered to be off-unit without permission (OWOP): OWOP/ Found in < 1hour OWOP/ Not found OWOP/Returns > 1 hour and after removal from Inpatient status

17 AMA OWOP Policy Highlights Describes what is to be done when a vulnerable patient is found to be OWOP: OWOP Vulnerable - Those patients who are missing from the unit without permission and have exhibited behavior indicating compromised mental status that may cause him/her to be in danger and requires further assessment. Follow Code Green Policy

18 AMA OWOP Policy Highlights o Describes what is to be done when patient leaves before completion of evaluation or treatment o Try to redirect o Notify House Supervisor/Security o Code 6 o Lack Capacity - Direct patient back to unit o Have Capacity Attempt to direct back to unit

19 AMA OWOP and Code Green What if a patient wants to leave the floor AMA or is refusing treatments? They make that decision if they have capacity and are informed of the risks If they have capacity to make medical decisions, we cannot prevent or prohibit them from leaving What if patients that may not be declared to lack capacity to make decisions, however are displaying questionable behavior and wanting to leave? Reasonable and appropriate measures will be taken to encourage these patients to remain until their course of treatment/discharge planning is complete

20 Where can you find more information about Smoke Free, High Risk Behavior and Specialized Treatment Plans? Policy Manager - Policies PC , PC and PC Forms Site - High Risk Behavior Contract Form MSHA Intranet Look under H for High Risk Washington County Site reference tools

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