Essay: Behavioral Emergencies Focus/Pdc Planning

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[. . .] Therefore, the staff needs to be trained regarding the various psychiatric (and specifically behavioral) diagnoses, and how people will respond to these diagnoses. The training has to include training specific to the area of the hospital because there can be triggers associated with a specific medication or physical diagnosis (Tesar & Stern, 1986).

Implementation

A hospital ICU generally has a large staff because many members are needed to make sure that all of the patient's needs are met. This means that there will be different departments that may be involved in the actual training because respiratory therapists, psychiatric staff, and others will often find themselves dealing with patients assigned to the ICU. Also, the ICU training may be more difficult than it is for some departments because of the level of care that happens in the unit.

Trained staff can be hired from another location that has previously conducted like training, or it can be developed by the behavioral health staff. This will depend on the cost of the program, and whether the behavioral health staff has members who can effectively conduct the training. Finances should not outweigh the effectiveness of the program it will be a matter of what process will best serve the staff, and, in the end, the patients that are served by the ICU. It is recommended that unless the cost is unnaturally exorbitant that an outside training firm which has dealt specifically with such issues should be hired.

The main reason that an outside training team should be hired is in the interest of risk management. An in-house team may have the expertise, but they are not singularly focused on the training. The behavioral health staff also has their department to deal with besides the training, so it would behoove the hospital to hire an expert outside team. The outside team would have the ability to see problems that might not occur to the in-house team because the outsourced team has more exposure to cases that have occurred at other hospitals. This expertise could be very valuable when training the staff in the scenario. The outside training staff will also have a plan for the training that is based on the experience that they have had at other hospitals.

Plan Measurement

Measurement of the plan is probably the most critical element of the scenario because there has to be some way to determine if the plan was as successful as hoped. The staff who is being trained at the time will be given a pretest assessment to evaluate their knowledge prior to receiving the training. This information will help managers determine what needs to be done in the future to make sure all staff has adequate training prior to being allowed patient contact. After the training, the staff will be given a post-training assessment to see what their knowledge of different aspects of treating patients with a behavioral health diagnosis has become. Both of the assessments will need to involve specific scenarios such as the one that occurred.

Since the training will also contain a legal element, the staff will also have to be quizzed based on their knowledge of the legal ramifications of the scenario. Since the patient was able to run out of the ward when he was obviously in psychiatric and medical distress (as evidenced by the fact that he was back the next day), what legal responsibility does the hospital, and members of the staff, have. This is a critical piece of both the training and the assessment.

Evaluation of Implementation Outcome

Once the training has been implemented, there are several means of determining if it was effective. First, the staff who received the training can be polled based on their comfort level dealing with scenarios such as that which occurred. After an incident occurred, the incident report needs to be evaluated for the response of the different staff members. This data can be collected to see if more training is needed for specific members of the staff. Also, the data will tell whether the training was effective overall. If the entire staff did not respond as desired after the training was completed, then there needs to be either a new solution or better training.

5 Step Unit Protocol

The following five steps should be followed to make sure that situations such as that contained in the scenario are mitigated.

1. Prescreen patients based on psychiatric criteria as well as medical criteria. The patient should be asked if they have a psychiatric diagnosis, when was the last time they saw a psychiatrist, and others to determine certain risk factors of a behavioral episode.

2. The number of the behavioral response team should be prominently displayed.

3. Every staff member must have gone through the behavioral/psychiatric training prior to patient contact. If this is not possible due to staff constraints then there should be at least one staff member per shift who is trained in responding to behavioral emergencies.

4. Patients who have a previous psychiatric or behavioral diagnosis should be frequently rescreened to make sure that they are not escalating for some reason unknown to the staff.

5. When a patient is determined to be a possible risk, they should be given a room that is as close to the nurse's station as possible.

References

American Hospital Association. (2007a). Case examples. Behavioral Health Challenges in the General Hospital.

American Hospital Association. (2007b). Recommendations. Behavioral Health Challenges in the General Hospital.

Cooke, M. (2010). The safe management of behavioral health patients in non- behavioral health settings. Alabama Safe Management.

DMHRM. (1997). Management of aggressive behavior. Women and Children's Hospital, Adelaide.

Elson, W. (2006). Restraints and seclusion. Sarasota Memorial Hospital Policy.

Loucks, J., Rutledge, D.N., Hatch, B., & Morrison, V. (2010). Rapid response team for behavioral emergencies. Journal of the American Psychiatric Nurses Association, 16(2), 93-100.

Tesar, G.E., & Stern, T.A.… [END OF PREVIEW]

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