QUALITY IMPROVEMENT INITIATIVES

Project Name: Brattleboro Memorial Hospital Patient Safety Initiative:
The Patient at Risk for violence/ Self-harm.

Time Frame: Q 4 2007 and ongoing

Aim Statement: Brattleboro Memorial Hospital endeavors to improve outcomes and ensure the quality of care for our patients. It is our goal to provide safe, quality, evidence-based care to our patients along the continuum of care. Performance Improvement is a process that assists in identifying opportunities for improvement, developing action plans, implementing these action plans and positively impacting patient care. An opportunity to positively impact patient and employee safety was identified with the increase in medical treatment of patients at increased risk for violence and or self-harm due to underlying mental illness.

Description: Brattleboro Memorial Hospital, in review of patient population served, identified an increase in number of patients coming to our Emergency Room for medical treatment who also presented with underlying mental illness and substance abuse disorders. BMH noted a need to not only treat the acute medical condition, but provide a safe environment for this complicated patient as well as our staff whose areas of expertise is the evaluation and management of acute medical conditions. BMH reviewed industry standards to identify best practices to implement at BMH.

Interventions:
The following are interventions put into place beginning Q 4 2007 to insure the safety of our patients as well as our staff at BMH:

• Clinical staff attended a violence management class on best practice techniques to identify and manage potential violent situations utilizing protective self-management strategies.
• The process for identifying patients at risk for violence or self-harm was reviewed and revised: staff was educated in the standardized process. Emphasis was on complete, comprehensive assessment and early intervention.
• A “Safe Room” was constructed in the emergency department to house patients at risk for self harm to provide a safe environment for close observation by the staff.
• A standard process was developed to notify appropriate staff when a violent situation occurred. Decision trees were developed outlining response strategies for different situations.
• In collaboration with the Safety Committee, a comprehensive plan was developed to address equipment needs, training of staff, communication and reporting.

Evaluation and Next Steps:

Brattleboro Memorial Hospital reviews all instances of staff responding to violent situation to identify ways to reduce these occurrences. BMH encourages staff to attend sessions where these occurrences are evaluated and recommendations from these sessions are implemented as appropriate. In the quarter since the completion of the violence management training BMH has noted a decrease in the need for interventions by security staff. In comparing interventions prior to the training and construction of the safe room, it has been noted that security staff need just position themselves outside the “Safe Room”, further intervention has not been needed 65% of the time. BMH will continue to evaluate and adjust processes as appropriate to insure the safety of our patients and staff.

Contact

Quality Management Department
Brattleboro Memorial Hospital
17 Belmont Avenue
Brattleboro, VT 05301
Mary L. Morgan
VP Quality Patient/Safety
mmorgan@bmhvt.org
802-257-8355 (phone)
802-257-8813 (fax)