RESUMEN
Limited resources to support persons with mental illness create a crisis in our health care system. There is a shortage of inpatient beds, and emergency departments are overwhelmed by the number of persons experiencing a mental illness crisis. This article describes the design of a program to address the gaps in treatment. The goal of the program was to decrease the length of stay for inpatient mental health care and to divert emergency department patients. We describe the multidisciplinary brainstorming session that envisioned this program, how it differs from previous programs, the staffing model, curriculum, outcomes, and future plans.
Asunto(s)
Transición de la Salud , Servicios de Salud Mental , Pacientes Ambulatorios , Desarrollo de Programa , Intervención en la Crisis (Psiquiatría) , Servicio de Urgencia en Hospital , Humanos , Pacientes Internos , Tiempo de Internación , Trastornos MentalesRESUMEN
BACKGROUND: Unexpected situations of workplace violence are occurring in the United States at increasing rates in health care environments, warranting increased attention to processes supporting safety for health care workers. At a large, academic hospital, two patient safety incidents had occurred in a two-year period in which a patient had become violent at the time of admission from the emergency department (ED) to the medical unit. METHODS: A multidisciplinary quality improvement (QI) team was formed to address the risk of violent patient events. Using two iterative Plan-Do-Study-Act (PDSA) cycles, the QI team designed and tested a huddle handoff communication tool, the Potentially Aggressive/Violent Huddle Form. An ED nurse would initiate the huddle process by informing the admitting unit that a patient at risk for violence was being admitted. The admitting care team would then call the ED team so that both teams participated in the handoff call together. The huddle process occurred for 21 transfers in the first PDSA cycle and for 18 transfers in the second. RESULTS: RNs from the ED and the six medical units reported feeling safe during the transfer process 100% of the time during both tests of change PDSAs (vs. 54.7% at baseline). In the ED, from the first test of change to the second test of change, satisfaction with the process improved from 53.3% to 75.0%. CONCLUSION: The huddle handoff communication tool and other methods to facilitate the transfer of potentially violent patients have the potential to decrease the number and severity of violent incidents in the health care workplace.
Asunto(s)
Servicio de Urgencia en Hospital/organización & administración , Personal de Enfermería en Hospital/organización & administración , Grupo de Atención al Paciente/organización & administración , Mejoramiento de la Calidad/organización & administración , Violencia Laboral , Centros Médicos Académicos/organización & administración , Comunicación , Servicio de Urgencia en Hospital/normas , Humanos , Personal de Enfermería en Hospital/normas , Seguridad del Paciente , Estados UnidosRESUMEN
New nurses are traditionally oriented into their professional role by a registered nurse preceptor. This article describes the process of renovating and centralizing RN preceptor programs within the Department of Nursing in a multispecialty medical center in the Midwest. Outcomes of centralizing the preceptor program included involvement of nursing leaders, identification of methods of RN preceptor recognition, implementation of methods of improving institution-wide RN preceptor professional development, identification of opportunities for specialized RN preceptor classes and forums, creation of a tool to measure workload productivity, and finally, the formulation of a database to track performance and completion of orientation programs.