Developing and Evaluating a New Role in Medical Surgical Inpatient Units: Geriatric/Psychiatric Safety Specialists Carole Farley-Toombs, RN, MS, NEA-BC Associate Director: Psychiatric Mental Health Nursing Janet Harris, RN, MS, CNS/NPP Sr. Nurse Manager: GeroPsych Safety Specialist/ICU Flex Team Disclosure The presenter has no conflict of interest to disclose and has permission to present the content from Strong Memorial Hospital 2 The Setting 850 bed Regional Quaternary Care Hospital/Level I Trauma Center Acute Medical/Surgical Cardiac, Medical and Surgical Critical Care Pediatrics, Peds ICUs, NICU Transplant Cancer Center Obstetrics, Labor, Delivery Psychiatry: Adult, Child, Adolescent, Geriatric 3 1
Driving the Need for Change Cost: FY 2011 Agency 1:1 on non-psych units: $2.5 million Little return on investment for patients or nursing staff There must be a better way to care for our patients. 4 Nursing Practice Executive Council Chief Nursing Officer Associate Directors of Nursing: Med/Surg Pediatrics Psychiatry Emergency Critical Care Cardio Vascular PeriOperative Nursing Research Ambulatory Nursing Practice Finance Manager 5 The Charge to the GPS Team Replace the use of 1:1 Agency Staff with a new role modeled on the role of Psychiatric Technicians in Psychiatric Nursing at SMH to: 1. Improve patient care of patients who require a 1:1 due to behaviors that pose a risk to self or others by providing interventions such as engagement, interaction, distraction, re-orientation and assistance with self-care for patients whose behaviors pose a risk to self or others. 2. Improve RNsatisfaction by providing 1:1 staff who are clinically trained and prepared to provide these interventions as needed in collaborative manner with the RNs assigned. 3. Improve a return on investment and overall costs. 6 2
POSITION DESCRIPTION The GPS is an integral member of the Nursing Staff who possess a unique skill set and competency in the care of patients with behavioral needs related to co-morbid cognitive deficits or psychiatric disorders on non-psychiatric inpatient units. The GPS maintains a safe patient environment and therapeutic diversionary activities to assist the patient in adapting to the hospital environment and improving their status. 7 Who Are They? Thirty-Five GPS: 31 hold a current BS degree 7 in accelerated BSN programs 6 in Mental Health Counseling programs 2 are in MSW programs 1 is in a Master s in Psych Program 1 is in a PHD psych program 8 9 3
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13 14 Why did you apply for this position? 23 comments: As an aspiring psychiatric nurse, I felt like this position would prepare to handle that role, while also helping me to pay for that education. To gain direct patient experience for my future career. To gain experience in nursing while in school To get psych experience while in school I wanted to make a difference 15 5
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19 Outcomes: The RN Perspective on Patient Care Responses: 245 RNS from 27 discrete inpatient units Burn Trauma: 18 Peds ICU: 35 Rehab: 8 Acute Medicine: 41 Ortho: 12 Neuro and Neurosurgery: 16 Surgery: 26 Cardiovascular: 30 Critical Care: 45 20 21 7
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25 Comments 102 Comments Themes: Engagement; Interaction; Knowledgeable; Helpful; Inform nurses of what is going on; They interact, distract, assist with toileting and other ADLs.. GPS are more involved in interacting and caring for the patient GPS are always professional in their skill and patient s have complimented their skills More engaged and helpful More knowledgeable and helpful Very much involved with patients 26 27 9
28 Successes and Lessons Learned Clinically Adminstratively Communication ED pilot project References: This content is a foundational study with in the Strong Hospital and is original data 29 30 10