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Improve Work Flow
2/28/2003 7:38:24 PM
User Comments on Improve Work Flow
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Total Posts: 1
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Re: Improve Work Flow
4/29/2008 6:40:11 PM
Hi everyone!
Looking for ideas on how to deal with violent patients coming into the ED. What processes, collaborations with internal and external partners have other hospitals developed. Does anyone have a communique that they use to disseminate information to other facilities in the case of AMA. Help!
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Total Posts: 12
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Re: Improve Work Flow
6/19/2008 5:14:47 PM
Wendy,
Here is a procedure sent from Shari Welch, MD-
Violent, Self Destructive or Suicidal Behavior Procedure for IMC ED
Purpose: To ensure appropriate care of the patient presenting to the IMC Hospital Emergency Department who may be at risk for violent, self destructive or suicidal behavior.
I. Do a triage screening of all patients presenting with psychiatric or behavioral health complaints, including those who have attempted suicide. Use the following questions:
a. Do you have current thoughts of hurting yourself or anyone else?
b. Are you intending to hurt yourself or anyone else now?
c. Do I have any concerns for your safety of the safety of others?
II. If the answer to any of the screening questions is “yes” then immediately put the patient in observation status.
a. A staff member is assigned to stay with the patient.
b. Put the patient in a room.
c. Have the patient put on a gown and secure their belongings
d. Notify the charge nurse that the patient is under constant observation.
III. Further assessment of the patient
a. The Doctor or Crisis worker needs to do a more thorough assessment of the patient to determine the risk of violent or suicidal behaviors.
b. Determine the level of risk and then provide the appropriate care to the patient.
IV. Low Risk Patients
a. These patients may be monitored by family or friends while care is being provided.
V. Moderate Risk Patients
a. These patients should have constant observation by hospital staff.
b. Follow the Patient Safety Attendant Instruction/Check list
c. Document the status and response of the patient in the nursing record as any other patient.
VI. High Risk Patients
a. Initiate the Aggressive/Assaultive/Seclusion/Restraint Flowsheet.
b. The Doctor needs to assess and write the Seclusion/Restraint order every 4 hours.
c. Whether the patient is in a seclusion room or physically restrained, the patient must have continuous observation by a hospital employee. They should make use of the Patient Safety Attendant Observation Instruction and Check list. Any of the following may be used as a Patient Safety Attendant.
i. Security.
ii. EDTechs.
iii. Nurses
iv. Nursing Assistants
v. Patient care techs, etc.
vi. ED charge nurses should coordinate with the supervisor, security, and ED staff to assign PSA’s.
d. Anytime the Patient Safety Attendant is changed a new Patient Safety Attendant Observation Instruction and Check list should be used.
e. The department nurses are responsible for assessing the patient and documenting on the Aggressive/Assaultive/Seclusion/Restraint Flowsheet every 15 minutes.
VII. The order for Seclusion or restraint may be initiated or revoked at any time by the doctor.
VIII. To ensure patient safety, the ED physician has the option of requesting additional consultation from the on-call psychiatrist at any time.
And a checklist:
Patient Safety Attendant PSA
Patient Observation Instructions and Checklist
Patient name: __________________________________________________________
As the Patient Safety Attendant (PSA), you will be required to continuously observe a patient at risk for harming themselves or others. Your specific responsibilities will include:
• Report to the charge nurse and patient care nurse when you arrival on the unit.
• Continuously observe the patient. If the patient is under the Aggressive/Assaultive Protocol notify the RN every 15 minutes of the need for an RN assessment.
• Notify the care nurse or staff as needed.
• Give information when handing off the responsibility to another PSA who is taking over for you.
• Report off to the patient care nurse before leaving if continuous observation is no longer necessary.
If you have any questions about your duties or responsibilities at any time please ask the patient care nurse or unit charge nurse. You must turn in these instructions with the information you have recorded to the patient care nurse when you have been relieved from observing the patient.
PSA, Please print your name: __________________________________________________________
Observation START Date & Time: _____________________
Observation End Date & Time: _____________________
Patient care nurse name: _____________________________________________________________
Charge nurse name: _____________________________________________________________
When taking report from the patient care nurse and beginning patient observation please make sure the following is complete and clear.
Yes No
Do I understand why this patient requires observation?
(If the answer to above is NO, then clarify this with the patient care nurse.
Have harmful items been removed from the room and is the patient in a gown?
(If the answer to above is NO, ask the care nurse remove the harmful items and put the patient in a gown.)
Is patient under formal seclusion or aggressive/assaultive restraint procedure?
(If the answer to above is YES then a nurse is required to assess the patient every 15 minutes and document it on an Aggressive?Assaultive/ Seclusion/ Restraint Flowsheet. You will need to help track the time from the last assessment. A doctors assessment and order is needed every 4 hours)
Is there anything that should be avoided to reduce the risk of upsetting the patient?
(If the answer is YES, please clarify this with the patient care nurse.)
Do I understand what I should do if the patient asks to go to the bathroom, ask for a smoke, wants food or water, or asks for their belongings?
(If the answer to above is NO then clarify with the patient care nurse.)
Do I understand when and how to contact the staff if immediate help is needed?
(If the answer to above is NO then please clarify with the patient care nurse.)
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