Baptist Hospital East's Behavioral Health Department of Psychiatry

Crisis Management Unit

CMU Unit-Based Shared-Governance Committee

Presentation to the Operations Committee

Accomplishments, Current Work,

and

Upcoming Projects April 2011

CMU UBSG Committee

Chair: Janet Brock, RN Co-chair: Phoebe Girgis, RN Staff Nurse II Jackie Hancock, RN Ish Hill, MBA, RN Meghan Howell, MEd, Intake Coordinator Linda Roosevelt, MA, RN Chelley Rouda, MA, US Jodi Tompkins, RN

CMU: Unit Briefing

Baptist Hospital East Inpatient Psychiatric Care

CMU Serves Patients With:

Dementia: Alzheimers

Vascular

ETOH/ Korsakov's Lewy Body Other Dementias

Special needs due to: Memory loss, confusion, wondering, delirium, aggression, loss of self-care and other functioning, frequent dysphasia, additional physical complications, placement needs, end of life care, and/or family issues.

Suicidal intentions Homicidal intentions Depressive Disorders Anxiety Disorders Bipolar Disorder Psychosis

Substance abuse Personality Disorders Other DSM-IV diagnoses

Patients with these illnesses have special needs due to:

Adjusting to new medications and their side effects, emotional fragility, lability, thoughts of harming self or others, elopement, 72 hour holds, detoxification process, confusion, impulsiveness, aggression, hallucinations, delusions, extreme life stressors, overwhelmed coping skills, grief and loss, family issues, legal issues and/or feelings of hopelessness, helplessness, and worthless.

CMU Milieu Safety Examples: Specially-trained staff.

Locked unit. Confidentiality codes.

All patients are designated as Privacy Patients.

15 minute rounds on all patients.

Break-away curtains. Double swing doors with safety knobs.

Daily group therapeutic and psychoeducational programming

Individual precaution level addressed by psychiatrist daily.

Visitation restrictions. Property restrictions.

Physical management, restraints, seclusion room available.

CMU UBSG Committee Mission

To promote the current BHE Nursing Goals within the Crisis Management Unit:

Nursing infrastructure Quality and patient safety Customer relations Financial performance

Nursing Infrastructure: Accomplishments/ Current Work

I. CMU has representatives on each of the major nursing committees:

Education: Pheobe Girgis, RN

Magnet: Sue Mines, RN

Practice: Natalie Smith, RN

Quality: Ish Hill, MBA, RN

Research: (pending)

II. CMU Unit-Based Shared-Governance Committee: Meets monthly. Representatives from each shift. Facilitates communication through use of

HBSG and UBSG Binders, emails, postings, and open invitation to attend monthly meetings.

III. Supporting administration's efforts to continue to build a vibrant nursing culture that is collaborative, respectful, approachable, professional, and patient-centered.

Current Work: I. Enhanced patient safety and

confidentiality through development of a more stringent visitation policy.

II. Developed a more structured process for entering vital signs into HED. III. Revised EA process

IV. Placed suggestion boxes in the CMU report room and Access Center office.

V. Developed a Nurses' Back-Up Log for coverage of staff call-ins. VI. Placed dry erase board in nursing station to facilitate improved communication of upcoming discharges and booked beds.

VII. Improving safety with restricting belts from the unit. Zip ties as substitute.

VII. Continuing improvement in processes for shift-based tasks. Revised assignment and task sheet updates are under construction.

VIII. Enhancing process for assessing safety of patients' electrical devices.

Customer Relations Accomplishments:

I. Developed discharge instructions that specify exactly when and

where to meet for our outpatient programs. II. Developed our own patient satisfaction

survey to include perception of how patient felt prior to admission compared to time of discharge.

III. Initiated weekly informational classes for family members of patients.

IV. Focused in on effective patient and family communication through additional staff education and training. V. Decided to provide gum and hard

candy for patients experiencing dry mouth, a common medication side-effect.

Financial Performance Accomplishments:

I. Enhanced processes for return or storage of patient property not allowed on unit. Patient claims are down as a direct result

II. Reduced excessive inventory of supplies on unit. III. Revised our scheduling of validation and competency days. Directly decreased overtime and improved our productivity. Improved educational and training delivery for adult learners.

IV. Focusing on denture custody and documentation when patient is admitted/ transferred to/from unit. Eyeglasses. V. Exploring new requirements for amount of advance notice needed in requesting vacation time.

CMU UBSG Process

Inclusive.

Open invitation to any staff member to join. Open invitation to all to submit ideas, questions

and concerns.

CMU UBSG Process

Evaluation Question: Does the area of concern relate to one of the nursing goals? SWOT Analysis of situation: strengths, weaknesses, opportunities, threats? Decide next steps?

Make decision.

Share information with unit staff and assist with

implementation.

Evaluate changes made. Use evaluations to generate continuing improvements.

Upcoming Projects and Challenges: Customer Relations

I. Exploring other avenues to improve and evaluate patient outcomes. Exploring improvements in programming.

II. Continuing to assist patients (and families) in treatment compliance, despite the continuing societal stigma of mental illness, especially as it impacts follow-up compliance.

Upcoming Projects & Challenges: Financial Performance

Changes in reimbursement from Medicare for hospital-acquired falls, pneumonia, and infection treatment. CMU's geriatric population is a high risk one.

Finding more creative ways of meeting unit needs for patient educational materials.

Thank you for your interest

in our work here on Baptist Hospital East

Crisis Management Unit

Feel Better!