Bradley Hospital's department of behavioral education recently received the 2009 Lifespan Barnet Fain Quality Award. Established in 2002, this award recognizes outstanding efforts by teams or individuals to improve the quality of care provided by Lifespan's partner hospitals.
The team was selected for developing and implementing a hospital-wide initiative to address the most challenging undertaking for clinical staff at all psychiatric hospitals, including Bradley Hospital - responding to patients who are exhibiting disturbing and dangerous behaviors and may require physical intervention.
In 2008, the hospital formed the crisis prevention and intervention workgroup, recognizing that it was essential for Bradley staff at all levels to know how to prevent, minimize or de-escalate a child in behavioral crisis. The group was asked to examine the crisis management models then in use at Bradley, review other available models and make recommendations for improvement. The group had to be mindful that a crisis management program must be effective across various patient populations, treatment modalities and levels of care.
Following a thorough analysis, Bradley Hospital based its program on a single, nationally-recognized crisis management model. Because the model was originally developed for adults, the hospital's department of behavioral education customized a comprehensive training curriculum designed to meet Bradley's pediatric needs.
As part of the new crisis management program, the team established a safe patient handling program designed to reduce the potential for injury to both employees and patients by minimizing manual lifting, moving or escort of patients. If a patient care team determines that a physical intervention may be necessary, specially-trained safe patient handling specialists are called in to carefully assess the situation and, if warranted, direct and supervise the patient move. Other transfer aids or assistive devices, such as automated lifts, are also used when appropriate instead of manual lifting.
De-escalation interventions are another key component of the hospital's crisis management program. Given the varied special needs of Bradley's patient, resident and student populations, matching the interventions to the setting is critical to yielding a positive outcome.
Overall, more than 700 employees have been trained in Bradley's crisis management program in just over a year. Specifically, all staff with direct patient care responsibilities have been certified in the new curriculum, while staff with indirect or support care responsibilities were trained in incident prevention and personal safety techniques. A number of clinicians also became certified trainers.
The work that our team has done to address this very critical area in such a short amount of time is remarkable and has had a significant effect on the quality of care provided to our patients and their families, as well as the safety of our staff, said Daniel J. Wall, president and chief executive officer of Bradley Hospital. On behalf of the entire hospital, I congratulate them on this well-deserved award.
To ensure program compliance and reinforce skill competence among employees, Bradley formed coaching teams consisting of staff and clinical leaders from many of the hospital's major programs. Various crisis management training clinics were also held in central locations and on specific units to encourage staff comfort and confidence in their new skills. Meanwhile, all relevant policies, procedures and job descriptions were revised to support program implementation.
As a result, Bradley Hospital has experienced a number of significant improvements during crisis situations, including considerable reductions in injury to both patients and staff, and fewer crisis episodes are resulting in physical interventions.
Previously, only staff in select areas were trained in crisis management and two different models were used within the hospital, said Margaret Paccione-Dyszlewski, PhD, director of the department of behavioral education at Bradley Hospital. Consistency is important, particularly when dealing with a behavioral crisis situation. As we've seen, having all staff in all clinical disciplines trained in one model can greatly enhance the health, safety and well-being of both our patients and their caregivers.
The critical skills that staff need to hone in our settings are those that prevent a physical intervention. The best physical intervention is the one that we don't perform, Paccione-Dyszlewski added.
In addition to Paccione-Dyszlewski, the crisis management in child and adolescent psychiatric care project team included Walter Heisler, BS; Patricia Perry; Jodie Bey Vilardi, RN, M.Ed; Henry T. Sachs III, MD; and Susan Eagleson, RN, BSN.
The department of behavioral education at Bradley Hospital provides a variety of learning opportunities to help improve employee skills, knowledge, attitudes and behavior in order to enhance patient services through highly competent employees. In addition to a full-time training staff, clinician-scientists serve as educators throughout the hospital.
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