Transcript WRHA Mental Health Program Management Group

HSC – PSYCHEALTH
2012
Six Core Strategies
Presentation
Funded By
Research and Workplace Innovation
Program of the Workers Compensation
Board of Manitoba
Preventing Violence, Trauma
and the use of Seclusion and
Restraints in Mental Health
Setting
SIX CORE STRATEGIES
1) Leadership and Organizational Change
2) Using Data To Inform
3) Workforce Development and Training
4) Seclusion and Restraint Prevention Tools
5) Consumer Involvement in Inpatient Programs
6) Debriefing Activities
Leadership and Organizational
Change
Leadership and Organizational Changeincludes:
Creating a vision, living the
organizational values, using human
technology, using data to inform, and
valuing exemplary performance.
Seclusion/Restraint Prevention
Tools
Recognizing the applicability of crisis
prevention to service settings and the
importance of prevention strategies.
Making environmental changes that
incorporate sensory modulation and
sensory/ comfort rooms.
Identifying and Managing Seclusion
and Restraint Risk Factors
Staff become familiar with the concept of
risk assessments and the role they play
in helping to prevent injuries. This
includes the perceived lack of
individualized care, rigid use of the
medical model, and high routinized staff
tasks.
Workforce Development
Outlines the new and changing roles of
staff amidst the cultural change as well
as providing staff with fundamental
opportunities to education and training to
meet workforce objectives.
Debriefing Activities
Tools designed to rigorously analyze a
critical event, to examine what occurred
and to facilitate improved future
outcomes given the similar
circumstances.
Peer Roles in Inpatient Settings
Staff learns to appreciate the rationale
behind self-help and peer support and
their key role in seclusion and restraint
reduction efforts.
SO WHY DO WE WANT THIS?

Obligation to treat patients using the least restrictive
means possible
 Coercive or traumatizing settings do not foster hope,
healthy relationships, prosocial behaviours or trust
 Risk management issues related to both patients and
staff (Litigation, WCB claims, PTSD)
 Evidence based research drives change in clinical
practice (Can’t ignore the obvious)
 Consistent with the WRHA mission and philosophy
AND






To promote recovery/hope models rather than
custodial care
To promote better relationships with patients
and families
To practice to full professional scope
Recognition that there has to be a better way to
serve our patients
To define work as “Treatment Based” rather than
“Punitive” as seen by some of our patients
To diminish opportunities related to
retraumatization of patients
Summary Analysis
With the exception of a slip and fall incident this last year
($880.01), All WCB compensable injury claims have been
as a direct result of restraint and seclusion over the
previous four years ($71,707.18)
The cause and effect relationship reveals that, the fewer
times staff restrain and secluded, fewer staff related injuries
occur. Compensable time loss and the associated
rehabilitation is only a small measure of a multitude of
intrinsic factors that administrators must consider when
evaluating employee injuries. (Staff morale/satisfaction,
impact of absenteeism on team, traumatic stress to
staff/patients, etc.)
Do these strategies compromise
staff safety?
The short answer is: There is no
compromise in staff safety!!!!
The long answer (which is pretty short) is
that staff injury rates have decreased
dramatically. WCB compensable time loss
is at a historic low.
One claim for WCB cost unrelated to seclusion accounted for $10,600.00.
Compensable Claim Costs 2008-2012
$180,000
$160,000
$154,770
$140,000
$120,000
$100,000
Dollar Costs
$80,000
$60,000
$40,000
$13,620
$20,000
$0
WCB $ costs R/T
Seclusion
WCB $ costs Unrelated
One time loss incident unrelated to seclusion was for 73 days duration.
Compensable Time Loss in Days Related to
Seclusion Verses Unrelated
Fiscal Years 2008-2012
1200
1018
1000
800
600
Time Loss in Days
400
200
88
0
Time loss R/T Seclusion
Time loss Un R/T
Seclusion
Preventing Violence, Trauma, and the Use of
Seclusion and Restraint in Mental Health
Settings program was progressively introduced
April 1, 2011. Two compensable time loss
claims have occurred during the year, one on
April 15, 2011 (3 days) and one on July 10, 2011
(2 days). There has not been any compensable
time loss for the last 16 months on PY3-South.
Patients are not Aggressive if They
are SEDATED
True statement
- Monitoring the use of prn medications is as
important as monitoring WCB indicators
-To date, there has been a 20% decrease in the
use of intramuscular prn medications that we
traditionally use. Haldol, Ativan
-Accuphase (long-acting antipsychotic) use is
almost nonexistent
Total Injectable Med Use PY3-S
And
Seclusion and Duration Pre/Post PY3-S and St. B
Before Intervention
(04/2008-03/2011)
After Intervention
(04/2011-03/2012)
Increase
rate
p-value
LORAZEPAM 4 MG/ML INJ
11.5(6.1)
9.8(5.7)
-15.7%
0.39
LORAZEPAM 1-2 MG TAB
202.4(83.6)
215.7(91.3)
6.2%
0.66
HALOPERIDOL 5 MG/ML INJ
11.7(7.4)
9.1(7.4)
-22.3%
0.29
ZUCLOPENTHIXOL 50
MG/ML INJ
7.8(4.5)
6.2(5.4)
-21.0%
0.30
18.1(7.3)
8.8(5.4)
-51.6%
0.002
13409(7665)
2200(2424)
-83.6%
<.001
13.6(6.5)
19.8(10.3)
45.5%
0.05
4155(3143)
5707(3022)
37.4%
0.15
Variables
Medication Use (PY3S)
Seclusion Incidents (PY3S)
Total Number
Duration
Seclusion Incidents (St Boniface)
Total Number
Duration
Seclusion and Duration
2000
1800
1718
1624
1600
1400 1316
1200
# of Seclusion Events
1000
Duration in Hours
800
600
400
200 99
132
146
200
46
2675
Ap
ril
1/
08
to
Se
Ap
pt
ril
30
1/
09
/0
8
to
Se
Ap
pt
ril
30
1/
10
/0
9
to
Se
Ap
pt
ril
1/
30
11
/1
0
to
S
Ap
ep
ril
t3
1/
0/
12
11
to
Se
pt
30
/1
2
0
We now have irrefutable evidence that
literally every compensable staff injury has
been directly caused by staff having to
restrain and seclude a patient on PY3South.
Logically then, if staff are not restraining
and secluding patients than compensable
staff injury rates might very well be
reduced to zero; at least on PY3-South
The Six Core Strategies Work
This is evidenced informed practice that
can work on wards such as a high risk for
violence Mental Health ICU setting, but
can be successfully implemented in any
other type of Mental Health setting.
It is unquestionably cost effective on a
multitude of levels.
Thank you
Questions???