HSC – PSYCHEALTHHSC – PSYCHEALTH2012 2012

Six Core StrategiesSix Core Strategies

PresentationPresentation

Funded ByFunded By

Research and Workplace Innovation Research and Workplace Innovation Program of the Workers Compensation Program of the Workers Compensation Board of ManitobaBoard of Manitoba

Preventing Violence, Trauma Preventing Violence, Trauma and the use of Seclusion and and the use of Seclusion and Restraints in Mental Health Restraints in Mental Health

SettingSetting

SIX CORE STRATEGIESSIX CORE STRATEGIES

1) 1) Leadership and Organizational ChangeLeadership and Organizational Change

2) 2) Using Data To InformUsing Data To Inform

3) 3) Workforce Development and TrainingWorkforce Development and Training

4) 4) Seclusion and Restraint Prevention Tools Seclusion and Restraint Prevention Tools

5) 5) Consumer Involvement in Inpatient ProgramsConsumer Involvement in Inpatient Programs

6)6) Debriefing Activities Debriefing Activities

Leadership and Organizational Leadership and Organizational ChangeChange

Leadership and Organizational Change- Leadership and Organizational Change- includes: includes:

Creating a vision, living the Creating a vision, living the organizational values, using human organizational values, using human technology, using data to inform, and technology, using data to inform, and valuing exemplary performance.valuing exemplary performance.

Seclusion/Restraint Prevention Seclusion/Restraint Prevention Tools Tools

Recognizing the applicability of crisis Recognizing the applicability of crisis prevention to service settings and the prevention to service settings and the importance of prevention strategies. importance of prevention strategies.

Making environmental changes that Making environmental changes that incorporate sensory modulation and incorporate sensory modulation and sensory/ comfort rooms.sensory/ comfort rooms.

Identifying and Managing Seclusion Identifying and Managing Seclusion and Restraint Risk Factors and Restraint Risk Factors

Staff become familiar with the concept of Staff become familiar with the concept of risk assessments and the role they play risk assessments and the role they play in helping to prevent injuries. This in helping to prevent injuries. This includes the perceived lack of includes the perceived lack of individualized care, rigid use of the individualized care, rigid use of the medical model, and high routinized staff medical model, and high routinized staff tasks.tasks.

Workforce Development Workforce Development

Outlines the new and changing roles of Outlines the new and changing roles of staff amidst the cultural change as well staff amidst the cultural change as well as providing staff with fundamental as providing staff with fundamental opportunities to education and training to opportunities to education and training to meet workforce objectives.meet workforce objectives.

Debriefing Activities Debriefing Activities

Tools designed to rigorously analyze a Tools designed to rigorously analyze a critical event, to examine what occurred critical event, to examine what occurred and to facilitate improved future and to facilitate improved future outcomes given the similar outcomes given the similar circumstances.circumstances.

Peer Roles in Inpatient Settings Peer Roles in Inpatient Settings

Staff learns to appreciate the rationale Staff learns to appreciate the rationale behind self-help and peer support and behind self-help and peer support and their key role in seclusion and restraint their key role in seclusion and restraint reduction efforts.reduction efforts.

SO WHY DO SO WHY DO WEWE WANT THIS? WANT THIS?

Obligation to treat patients using the least restrictive Obligation to treat patients using the least restrictive means possiblemeans possible

Coercive or traumatizing settings do not foster hope, Coercive or traumatizing settings do not foster hope, healthy relationships, prosocial behaviours or trusthealthy relationships, prosocial behaviours or trust

Risk management issues related to both patients and Risk management issues related to both patients and staff (Litigation, WCB claims, PTSD)staff (Litigation, WCB claims, PTSD)

Evidence based research drives change in clinical Evidence based research drives change in clinical practice (Can’t ignore the obvious)practice (Can’t ignore the obvious)

Consistent with the WRHA mission and philosophyConsistent with the WRHA mission and philosophy

ANDAND To promote recovery/hope models rather than To promote recovery/hope models rather than

custodial carecustodial care To promote better relationships with patients and To promote better relationships with patients and

familiesfamilies To practice to full professional scopeTo practice to full professional scope Recognition that there has to be a better way to Recognition that there has to be a better way to

serve our patientsserve our patients To define work as “Treatment Based” rather than To define work as “Treatment Based” rather than

“Punitive” as seen by some of our patients“Punitive” as seen by some of our patients To diminish opportunities related to To diminish opportunities related to

retraumatization of patientsretraumatization of patients

Summary AnalysisSummary Analysis

With the exception of a slip and fall incident this last year With the exception of a slip and fall incident this last year ($880.01), ($880.01), All WCB compensable injury claims have been All WCB compensable injury claims have been as a direct result of restraint and seclusion as a direct result of restraint and seclusion over the over the previous four years ($71,707.18)previous four years ($71,707.18)

The cause and effect relationship reveals that, the fewer The cause and effect relationship reveals that, the fewer times staff restrain and secluded, fewer staff related injuries times staff restrain and secluded, fewer staff related injuries occur. Compensable time loss and the associated occur. Compensable time loss and the associated rehabilitation is only a small measure of a multitude of rehabilitation is only a small measure of a multitude of intrinsic factors that administrators must consider when intrinsic factors that administrators must consider when evaluating employee injuries. (Staff morale/satisfaction, evaluating employee injuries. (Staff morale/satisfaction, impact of absenteeism on team, traumatic stress to impact of absenteeism on team, traumatic stress to staff/patients, etc.)staff/patients, etc.)

Do these strategies compromise Do these strategies compromise staff safety?staff safety?

The short answer is: There is no The short answer is: There is no compromise in staff safety!!!!compromise in staff safety!!!!

The long answer (which is pretty short) is The long answer (which is pretty short) is that staff injury rates have decreased that staff injury rates have decreased dramatically. WCB compensable time loss dramatically. WCB compensable time loss is at a historic low.is at a historic low.

One claim for WCB cost unrelated to seclusion accounted for $10,600.00.

Compensable Claim Costs 2008-2012

$154,770

$13,620

$0

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

$140,000

$160,000

$180,000

WCB $ costs R/TSeclusion

WCB $ costs Unrelated

Dollar Costs

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

1018

88

0

200

400

600

800

1000

1200

Time loss R/T Seclusion Time loss Un R/T

Seclusion

Time Loss in Days

Preventing Violence, Trauma, and the Use of Preventing Violence, Trauma, and the Use of Seclusion and Restraint in Mental Health Seclusion and Restraint in Mental Health Settings program was progressively introduced Settings program was progressively introduced April 1, 2011. Two compensable time loss April 1, 2011. Two compensable time loss claims have occurred during the year, one on claims have occurred during the year, one on April 15, 2011 (3 days) and one on July 10, 2011 April 15, 2011 (3 days) and one on July 10, 2011 (2 days). There has not been any compensable (2 days). There has not been any compensable time loss for the last 16 months on PY3-South.time loss for the last 16 months on PY3-South.

Patients are not Aggressive if They Patients are not Aggressive if They are SEDATEDare SEDATED

True statementTrue statement - Monitoring the use of prn medications is as - Monitoring the use of prn medications is as

important as monitoring WCB indicatorsimportant as monitoring WCB indicators

-To date, there has been a 20% decrease in the -To date, there has been a 20% decrease in the use of intramuscular prn medications that we use of intramuscular prn medications that we traditionally use. Haldol, Ativantraditionally use. Haldol, Ativan

-Accuphase (long-acting antipsychotic) use is -Accuphase (long-acting antipsychotic) use is almost nonexistentalmost nonexistent

Total Injectable Med Use PY3-S And

Seclusion and Duration Pre/Post PY3-S and St. B

Variables Before Intervention (04/2008-03/2011)

After Intervention (04/2011-03/2012)

Increase rate

p-value

Medication Use (PY3S)

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

Seclusion Incidents (PY3S)

Total Number 18.1(7.3) 8.8(5.4) -51.6% 0.002

Duration 13409(7665) 2200(2424) -83.6% <.001

Seclusion Incidents (St Boniface)

Total Number 13.6(6.5) 19.8(10.3) 45.5% 0.05

Duration 4155(3143) 5707(3022) 37.4% 0.15

Seclusion and Duration

99 132 14646 26

1316

17181624

20075

0

200

400

600

800

1000

1200

1400

1600

1800

2000

# of Seclusion Events

Duration in Hours

We now have irrefutable evidence that We now have irrefutable evidence that literally every compensable staff injury has literally every compensable staff injury has been directly caused by staff having to been directly caused by staff having to restrain and seclude a patient on PY3-restrain and seclude a patient on PY3-South.South.

Logically then, if staff are not restraining Logically then, if staff are not restraining and secluding patients than compensable and secluding patients than compensable staff injury rates might very well be staff injury rates might very well be reduced to reduced to zerozero; at least on PY3-South

The Six Core Strategies WorkThe Six Core Strategies Work

This is evidenced informed practice that This is evidenced informed practice that can work on wards such as a high risk for can work on wards such as a high risk for violence Mental Health ICU setting, but violence Mental Health ICU setting, but can be successfully implemented in any can be successfully implemented in any other type of Mental Health setting.other type of Mental Health setting.

It is unquestionably cost effective on a It is unquestionably cost effective on a multitude of levels.multitude of levels.

Thank youThank you

Questions???Questions???