Behavioral emergencies on a non-psychiatric unit
Introduction
- 1dentifying possible causes of the staff's problem applying FOCUS model
- Find the process improvement based on the given scenario
- Organize a Team That Knows the Process
- Clarify Current Knowledge of the Process
- Understand Causes of Process Variation
- Improvement to ensure appropriate response times and appropriate clinical interventions in the given situation, using a modified version of the PDCA model (PDC).
- Plan (development of a plan to address the situation and possible risk in the future
- Do – explanation of the implementation process
- Check – explanation of the evaluation process
- Act- explanation of how adjustments will be made to the original plan for improvement.
Abstract
This document contains a case study report outlining FOCUS model analysis application of the scenario offered. Besides, a PDCA intervention will be adapted to address behavioral emergencies on a non-psychiatric unit if such situations occur in the future because staff ought to be equipped with scientific skills to professionally respond to behavioral emergencies from a evidence based perspective.
Behavioral emergencies on a non-psychiatric unit
Introduction
Psychiatric emergencies in medical settings may be particularly challenging since the staff does not encounter them frequently and may not have experience dealing with behavioral crisis intervention. The purpose of this activity is to help staff improve understanding and coping with nonmedical emergencies that occur in medical settings using the PDCA cycle after making a FOCUS analysis of the case study.
- 1dentifying possible causes of the staff's problem applying FOCUS model
FOCUS –PDCA is a continuous quality improvement (CQI) tool adapted by many healthcare organizations to ensure efficiency in delivery, safety, timely interventions, and equitable distribution of care. It also embraces a patient-centered approach towards assessment, diagnosis, planning, implementation and evaluation of health care accessibility. Importantly, it does not discard traditional methods of quality improvement, but seeks ways to incorporate strategies blending them with modern evidence based techniques. As such, a process centered approach is advocated above an individualized pattern (Pinnacle Networks, 2013)
This encompasses recognition of external as well as internal participants and the impact they make on the organization’s function. Precisely, it requires that an organizational needs assessment be conducted that would enable managers to analyze the process they are expected to manage and improve. A needs assessment helps in understanding the organization, generally, and not making judgments from isolated incidents as depicted in the scenario projected in this case study. Therefore, adapting an evidenced based FOCUS model is most appropriate in resolving this apparent dysfunction (Pinnacle Networks, 2013).
Gaining a profound knowledge of the organization’s goals, objectives and policies pertaining to adequately responding in emergencies such as the one outlined in the case study would enable an efficient manager to identify possible causes of the staff' problems applying FOCUS model. Insidiously, inappropriate response to a single incident is merely a reflection of a more serious dysfunction occurring within the organization. Therefore, despite how astute a model the nursing admin specialist may adopt without prior needs assessment efforts at improvement can become futile (Pinnacle Networks, 2013).
Find the process improvement based on the given scenario
Objectives
Researching the existing process input
Outcome
Finding a process relevant with needs of the organization
Organize a Team That Knows the Process
Objectives
Researching the existing process input
Importantly, ‘the respiratory staff, physicians, physician's assistants, an ICU nurse, and unit staff are all standing there watching Mr. X scream for help. They all seem paralyzed. Finally, one of the staff nurses asks Mr. X to turn over so that respiratory staff can administer oxygen via a facial mask. He complies and at that time the ICU nurse hooks him up to the cardiac monitor as per protocol in a Rapid Response’ ( Student’s notes, 2013) .This is the pathetic scene whereby key members of the health care team are confounded by one patient’s reaction and cannot contain him neither control the environment. Therefore, the supervisors in all these units ought to be included in a team led by a subject matter expert (SME) (Fallon & McConnell, 2007)
Outcome
Collaborating skills from within the organization that have evidence based knowledge of the dilemma as well as accessing services of a subject matter expert influence in the team.
Clarify Current Knowledge of the Process
Objective
• To understand strategies embedded within the organization to respond to behavior emergencies
Research the existing process input
As reported in the scenario the only significant technique observed to intervene in an emergency behavior situation is recognized as the Rapid Response.
Outcome
- Offer a description of how the present process functions
- Develop criteria measurements.
- Assemble relevant data related to a needs assessment analysis
Understand Causes of Process Variation
Objective
Research the existing process input
According to the scenario all at once, Mr. X bolts from the room towards the elevator, which has just opened, and gets on. One of the nurses calls a security code, but it is too late; Mr. X has disappeared. The county police are called and hours later they find Mr. X at his nearby home. They try to encourage him to return to the hospital, but since he has not been deemed a danger to himself or others, they have no choice but to leave him alone (Student’s notes, 2013). It would appear from this encounter that the evaluator does not work to just open and a patient gets on. Then the security code is slow in responding to the emergency indicative that it might be outdated
Outcome
Develop an understanding of the root causes determining the efficient functioning of the present process to design more efficient strategies for improving the dysfunctions of the inappropriate obsolete structures.
Objective
Researching the existing process input
According to the case study offered for analysis the staff reacts negatively to Mr. X's behavior in front of him. The respiratory therapist says, if you think I'm going in to get an ABG from him, you're crazy. Speaking to Mr. X, the ICU nurse repeats over and over in a stern impatient voice, what don't you know? Mr. X seems overwhelmed and can't answer. The physician looks through the chart and asks the nurses questions about the patient. The other nurses stand there staring at Mr. X. The ICU nurse leaves a few minutes later stating that the patient's EKG is normal.
Outcome
Intensive staff training on how to react in behavior emergencies as well as redesigning of structures to facilitate change in employees behavior as they function within the organization(Wright, D (2006).
- Improvement to ensure appropriate response times and appropriate clinical interventions in the given situation, using a modified version of the PDCA model (PDC).
Studies conducted by researchers Michael H. Allen, Glenn W. Currier, Douglas H. Hughes,
Magali Reyes-Harde, John P. Docherty and Ruth W. Ross (2001) confirmed that behavioral emergencies occur often in health care settings and organizations must have efficient systems in place to deal with these crises since patents depend on the system for help as Mr. X was seeking, but unfortunately could not receive any significant assistance because the entire staff was not prepared to deal with a psychiatric emergency in a non-psychiatric environment/clinical setting. Some constraints to effective intervention were identified as inadequate operationalization of the concept behavior emergency. Therefore, health care workers find it difficult to recognize one when it occurs through inappropriate definition of the problem. Many patients die in the process. Fortunately, Mr. X did not.
These researchers designed a panel of ‘50 experts to define the following elements:
- The threshold for emergency interventions, the scope of assessment for varying levels of urgency and cooperation,
- Guiding principles in selecting interventions, and appropriate physical and medication strategies at different levels of diagnostic confidence and for a variety of etiologies and complicating conditions’ (Allen, et.al, 2001).
Plan (development of a plan to address the situation and possible risk in the future
Objective
According to Diana Browning Wright (2006) ‘A behavioral emergency is the demonstration of a serious behavior problem, requiring a physical intervention, which has not previously been observed and for which a behavior support plan (BSP) or a positive behavioral intervention plan (PBIP) has not been developed or for which a previously designed behavior plan component is not effective during the emergency’ (Wright, 2006, p 1).
Since emergency behavior usually occurs in situations where there is often no plan to address such irregularities; when planning it must be understood that no two situations will manifest in the same way. Therefore, a basic plan must encompass guidelines on how to act professionally in every situation ensuring safety of self, patient and visitors alike. Staff must remain calm and know how not to enhance the emergency by demonstrating panic in front of patients/clients/visitors. In the given scenario staff members did demonstrate unprofessional behavior by speaking unkind words in the presence of the Mr. X.
The plan must encompass measures to train all staff regarding the organization’s protocol concerning emergency behavior even though each case will present its peculiar challenges. It must be a standard for all categories of staff including doctors too. A of command must be established and posted for all staff to review. Plans must be made to practice emergency situations as when fire drills are conducted. The team managing this aspect of the intervention can arrange these drills and evaluate how staff responds in the scene and towards the patient.
Further, an evaluation of each exercise/mock activity will be conducted and the feedback communicated to human resource management by the subject matter expert who heads the intervention team.
Outcome
The development of a plan to implement changes aimed at improving emergency response behavior within the organization.
Do – explanation of the implementation process
Objective
Implementation process
Step 1
Human Resource management will be approached regarding conducting a needs assessment as to the actual content of a curriculum for training staff to understand a patient’s disposition that manifests beyond the medical diagnosis; empower nursing staff with appropriate skills in recognizing when patients/clients become uncomfortable with their environment as in Mr. X’s case and offering a professionally acceptable guidelines on how to identify an intervention process relevant with needs of the organization.
Step 11.
Obtain permission and funding from human resource management to begin monthly staff training pertaining to recognizing and adequately addressing behavior emergencies using Mr. X’s case as a reference.
Step 111.
Open staff awareness to the organization’s protocol for responding to such emergency behavior. Engage subject matter expert (SEM) services as facilitator for training along with the behavior emergency team who would be the first to engage in training for this intervention.
Step1V.
Engage behavior emergency team to periodically conduct emergency behavior drills among staff in different sections of the hospital to evaluate the effectiveness of workshop training.
Step V1
Allow workshop participants to evaluate each workshop and keep, data for analysis during evaluation process. For each emergency drill design a form whereby the facilitator will record specifics about how staff responded during the interaction.
Step V11.
Collaborate with human resource management to make infrastructural changes to accommodate training and emergency drills and future changes in the emergency behavior response practice.
Outcome
Changes have been made to the process of inappropriate responses to emergency behavior designed to improve professionalism in dealing with this unusual occurrence in a non-psychiatric clinical setting.
Check – explanation of the evaluation process
Objective
Intervention
Collect data from evaluations of each workshop and analyze the receptivity of staff to content. Also collect assessment reports from emergency behavior team regarding staff participation in emergency behavior drills. Drill responses will be analyzed in determining whether responses coincide with training content.
Outcome
Offer a description of the change occurring so far in emergency behavior responses among non- psychiatric staff. Outline the extent to which training and emergency behavior drills had corrected the inappropriate responses.
Act- explanation of how adjustments will be made to the original plan for improvement.
Objective
Intervention
Implement a system whereby emergency behavior team submits a monthly report giving a feedback on the program’s strengths and limitations. The subject matter expert (SME) will offer recommendations for improvement.
Outcome
Improve on achievements and maintain the momentum of change.
3. Unit protocol containing five directives for staff to follow in case of a behavioral emergency in a non-psychiatric setting.
Emergency behavior protocol non-psychiatric unit
Background
Psychiatric emergencies in medical settings may be particularly challenging since most of the staff do not encounter them frequently and may be ill prepared in responding to a behavioral crisis. The purpose of this protocol is to help staff improve understanding and coping skills with nonmedical emergencies that occur in medical settings by adherence to the five directives outlined therein.
Directives
- Follow carefully the chain of command attached to this protocol in accessing directions on how to respond in an emergency behavior crisis.
- Always observe a patient/client’s behavior and any abnormal reactions must be immediately reported to the clinical supervisor who must promptly initiate a review of the patient/client condition.
- Observe patient/client for violent behavior and inform security immediately for safety and activation of security code.
- Do not panic neither demonstrate disrespectful attitudes in front of client while seeking support from administration or other staff members.
- Any uncertainties regarding a patient’s behavior must be reported and recorded in the patient’s notes. If an emergency does occur a detailed incident reported must be completed and filed.
Emergency Behavior incident chain of command
(Bass, 2008)
References
Allen, M. Currier, G. Hughes, D. Reyes-Harde, M. Docherty, J., & Ross, R. (2001). The
Expert Consensus Guideline Series: Treatment of Behavioral Emergencies. A
Post Graduate Medicine Report
Bass & Bass (2008). The Bass Handbook of Leadership: Theory, Research, and Managerial Applications (4th edition) Free Press
Fallon, F, Jr., & McConnell, C. (2007). Human resource management in health care:
principles and practice. New York. Jones & Bartlett Learning
Pinnacle Networks (2013). Quality Improvement Tool Kit. Retrieved 7th June, 2013 from
https://www.cardiosource.org/~/media/Files/Science%20and%20Quality/Quality%20Programs/
QIToolkit/2_IntrotoQIa
Rooney, J., & Vanden Heuvel (2004). Root cause analysis for beginners. Retrieved on June
7th, 2013 from
https://servicelink.pinnacol.com/pinnacol_docs/lp/cdrom_web/safety/management/accident_inve
stigation/Root_Cause.pdf
Wright, D (2006). Sample behavioral emergency clarification. Retrieved on June 7th, 2013 from
http://www.pent.ca.gov/beh/rst/emergencyclarification.pdf
