The formula to improve safety: Data driven strategies for enhanced patient care
How do you learn from incidents where there may be a potentially volatile situation to create a safer environment for staff and a better experience for patients?
Pam Johnston, Nurse Manager at St. Joseph’s Healthcare Hamilton, and her team in Psychiatric Emergency Services, have found a way.
Pam and the Psychiatric Emergency Services team are examining information from Code White calls to determine methods of providing better and safer care. A “Code White” is one of St. Joseph’s emergency codes and is a safe and non-violent crisis intervention strategy. It is activated when someone requires immediate response to assist with a situation in which there is violence or threat of violence to self or others, and additional resources are required to manage the situation safely. Activating a Code White results in a team of trained and certified hospital staff going to the location of the call with the intent of de-escalating the situation to try to keep everyone safe and offer support for the clinical team. The code white team uses verbal de-escalation techniques and exhausts all least intrusive, least restrictive alternatives. St. Joe’s is monitoring Code White calls, standardizing Code White debriefing sessions and encouraging monitoring of trends in Code White data to look for opportunities to improve care and safety.
Pam shares Code White activation data with her team in psychiatric emergency services, and works with the team to come up with changes to continually improve safety and to ensure high quality patient care.
One major change is the creation of a new position to partner a mental health nurse with the physician working in the initial assessment area of the emergency department. This partnership has decreased the placement of patients at low risk of aggression into a locked setting in psychiatric emergency services, where they may become more agitated.
Additionally, the psychiatric emergency services team has focused on identifying risk much quicker and uses a number of tools to become familiar with the patient’s history, as well as complete an immediate mental status examination.
“Data is the start of how we make positive changes here,” says Pam. “You need data to understand what your program needs, what your patients and staff need, where the gaps might be and what you are doing well. Data is invaluable to psychiatric emergency services. It drives us toward every initiative we’ve implemented.”
The Psychiatric Emergency Services (PES) team knows that calling a Code White is an important safety measure and that it’s never wrong to call a code. They also provide a learning experience and opportunity for further safety measures and tactics that have led to significant improvements for the team. Among other efforts, Pam credits the following changes as the drivers for the positive improvements on her team:
- Quickly building therapeutic rapport and creating trust with patients – Whether it’s taking the time to listen, or offering patients a cup of tea, the PES team is actively working to understand the patient’s needs and plan for best patient care.
- Active use of a comfort cart – Using the comfort cart, the PES team has a number of tools at the ready that have helped to effectively reduce anxiety.
- Code white debriefing – Every PES team member participates in Code White debriefs to learn in real time if there is anything that could have been done better and to discuss options for intervening earlier.
- Continuity of care by a PES physician – A new shift schedule was implemented for staff psychiatrists to improve continuity of care with patients.