February 24, 2015
IHI Expedition
Expedition: Making Mental Health Care Safer in the Hospital Setting
Session 6: Being Proactive and Avoiding Crises
James F. O’Dea, PhD,
MBA
Michael Claeys, MBA,
LPC
Kelly McCutcheon
Adams, LICSW
Today’s Host
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Dorian Burks, Project Coordinator, Institute for
Healthcare Improvement, is a current coordinator for
web-based Expeditions. He also contributes to the IHI
work in the Triple Aim and Improvement Capability
focus areas, as well as the Leading Quality
Improvement series. Dorian is a member of the
Diversity and Inclusion Council at IHI, where he and
fellow staff members develop strategies to enhance
IHI’s inclusive culture, both internally and externally.
Dorian graduated from Massachusetts Institute of
Technology in Cambridge, MA where he received his
Bachelor of Science degree in Biology and humanities
concentration in Anthropology.
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Expedition Director
Kelly McCutcheon Adams, LICSW has been a
Director at the Institute for Healthcare Improvement
since 2004. Her primary areas of work with IHI have
been in Critical Care and End of Life Care. She is an
experienced medical social worker with experience in
emergency department, ICU, nursing home, subacute rehabilitation, and hospice settings. Ms.
McCutcheon Adams served on the faculty of the U.S.
Department of Health and Human Services Organ
Donation and Transplantation Collaboratives and
serves on the faculty of the Gift of Life Institute in
Philadelphia. She has a B.A. in Political Science from
Wellesley College and an MSW from Boston College.
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Today’s Agenda
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Welcome
Action Period Assignment
Debrief
Being Proactive and Avoiding
Crises
Closing
Thank you!
Expedition Objectives
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At the conclusion of this Expedition, participants will be
able to:
Explain the importance of partnering with patients
and their families to improve safety for patients with
mental health conditions
Identify different areas to improve mental health
care safety
Describe examples of improvement efforts at other
organizations
Plan tests of change to begin or continue patient
safety improvement
Schedule of Calls
Session 1 – Partnering with Patients and Families
Date: Tuesday, December 2, 1:00 - 2:30 PM Eastern Time
Session 2 – Making the Physical Environment Safer
Date: Tuesday, December 16, 1:00 - 2:00 PM Eastern Time
Session 3 – Why Flow Matters
Date: Tuesday, January 13, 1:00 - 2:00 PM Eastern Time
Session 4 – Medication Safety
Date: Tuesday, January 27, 1:00 - 2:00 PM Eastern Time
Session 5 – Ensuring Staff Preparedness
Date: Tuesday, February 10, 1:00 - 2:00 PM Eastern Time
Session 6 – Being Proactive and Avoiding Crises
Date: Tuesday, February 24, 1:00 - 2:00 PM Eastern Time
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Action Period Assignment Debrief
Sharing examples of changing staff
hiring/orientation/training/preparedness to
improve mental health safety.
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Being Proactive
and Avoiding
Crises
James O’Dea and Michael Claeys
Faculty
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James F. O’Dea, PhD, MBA is a clinical psychologist and has been
employed at Backus Hospital since 1989. He is currently the
administrator for the hospital’s Level III trauma program as well as the
Regional Director of the Behavioral Health services for the Hartford
Healthcare East Region. Dr. O’Dea came to Backus Hospital in 1989 to
practice clinical psychology in the Department of Psychiatric Services.
He has been active in the development of the hospital’s bariatric surgery
program, heart failure program, stroke program, and its new peripheral
vascular program. Dr. O’Dea has also been actively involved in patient
safety and quality initiatives, heading up the Patient Safety and Quality
department for the last 15 months. In 2008, Dr. O’Dea assumed a
leadership position in the award-winning Backus Cancer program. He
continues in this leadership position and most recently was named the
Regional Director for Cancer Services for the Hartford Healthcare East
Region. He has worked closely with the Eastern Connecticut
Hematology and Oncology practice and multiple physician practices on
strategic and operational planning for the cancer service line. He has
recently been named to a leadership position in the Hartford Healthcare
Cancer Institute (HHCCI), which is currently developing the strategic and
operational affiliation with Memorial Sloan-Kettering (MSK), one of the
premier cancer programs in the world.
Faculty
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Michael Claeys is a Licensed Professional Counselor and
possesses a Master’s in Business Administration. He
developed one of Georgia’s first crisis centers along with
alternatives to state hospitalization at the Clayton Center
CSB in 1996. From 1999 to 2009 as Executive Director of
APS Healthcare, Mr. Claeys was responsible for a statewide
external quality review unit for mental health providers that
included extensive provider training, provider profiling, and
integration of consumer recovery activities. Since 2009 Mr.
Claeys has served as Executive Director of Grady Health
System’s Behavioral Health services. Grady Health System
is a large urban safety net hospital in Atlanta Georgia with
over 117,000 emergency room visits a year. Behavioral
Health Services at Grady consist of a full array of crisis,
inpatient, Assertive Community Treatment, and outpatient
services.
Safety and Security
Behavioral Health Services
Michael Claeys, MBA, LPC
Executive Director
Grady Health System
Hospital Overview
• Urban, safety net hospital with Level 1 Trauma
Unit
• People with behavioral health needs are
served throughout the hospital and
community
– Emergency room
– Med/Surg floors
– Psychiatric specific services
The “Rights” of Safety
• The Right mix of services
• The Right service at the Right time: Get the
person to the correct service level quickly
• The Right environmental safety features
• The Right safety protocols
Grady’s Mix of Services
• Emergent:
– EMS
– Emergency Room
– Psych Crisis Intervention Service
• Urgent:
– Psych Inpatient
– Psych Consult Services on Med/Surg floors
– Assertive Community Treatment
• Routine:
–
–
–
–
Outpatient Clinic
Case Management
Psychosocial Rehabilitation
Peer Support Services
Grady Emergency
Services
Positives:
EMS with one unit staffed by
paramedic and licensed
behavioral health
professional to prevent
unnecessary ER visits
• Dedicated rooms for
psych within ER
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•
•
Initial Property Search
and Securing
Belongings
Licensed BH
professionals and
limited coverage by
psychiatrists
Disposition decisions
within 7 hours
Risks:
• Risk of flight, leaving AMA
• Environmental and physical risks are present
• No body search
• Increase use of restraints as no continuous
monitoring
Coming August 2015 – Psych ED
• Physical plant design with specific features to
ensure safety and harm reduction
• 24 hour coverage by Psychiatry Attending
physicians and BH trained techs
• Supported by Licensed BH professionals
• Medical screening conducted by psychiatrists
Psych Services on Med/Surg Units
Positives:
• Consults based on medical
team referral, request
• Guidelines in place to suggest
when to “consult” psychiatry
• Psychiatric Consults completed
by psychiatrists, psych
residents, Physician Assistants
• Provide diagnostic
assessment, medication
management, behavioral
planning and referral to after
care services including
inpatient and/or outpatient
care, as appropriate
Risks:
• Environmental and physical
risks are present
• No property or body search
• Increased use of restraints for
uncooperative patients
• No continuous monitoring
Crisis Intervention (CIS) and Psych Inpatient
• Initial Property and Body
Search to find contraband (i.e.
weapons, drugs, lighters)
• Dedicated security staff 24/7
• Limited access through badge
swipe
CIS and Inpatient- Environmental
• Minimize risk of harm
• 100% completion of
Suicide Risk
Monitor at appropriate intervals
(i.e. 15 minute, line of sight, 1-1)
Maintain adequate staffing ratios
Safe Furniture Choices
Immovable chairs and
ottomans on CIS
TVs covered and mounted
high on wall
Hard plastic beds (No sharp
edges and bolted to floor)
CIS and Inpatient - Environmental
Anti-ligature technology
on doors
Soap dispensers and hand
sanitizers are fully protected,
tamper proof and anti-ligature
Monitor for damage
Reducing Environmental Risks
Doors with no hinges
Replace plastic liners
with paper
Retro Fit – Existing Environment
Fill space between wall and
handrails
Replace beds, current model
has no sharp edges, bolted to
floor
Monitoring for Safety
Real time monitoring as well
recorded review of incidents
and activity on unit
Behavioral Management
Stimulus Reduction Room
With Recliner (on CIS)
Construction Safety
Temporary walls with same
safety features such as anti-ligature
handles.
Monitor tools and materials.
Readmission Prevention Strategies
• Individualized discharge plans
• After discharge phone calls to assure
understanding of medications, follow up
appointments
• Step-down aftercare program provides same
day access post discharge from crisis/IP
services
• Case Management & Assertive Community Tx
Direct questions to:
mclaeys@gmh.edu
Department of Behavioral Health
Making Mental Health Care Safer
Being Proactive and Avoiding Crises
James F. O’Dea, Ph.D., MBA
Regional Director, Hartford Healthcare
Behavioral Health Network
Hartford Healthcare Behavioral Health
Network
Largest provider of behavioral healthcare in state of
Connecticut
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Institute of Living – IOL
Rushford Center
Natchaug Hospital
William W. Backus Hospital
The Hospital of Central Connecticut
MidState Hospital
Windham Hospital
The Platform
High Reliability Organizations
• The science of safety
• Learnings from other industries – aviation and
nuclear power
• Safety tools – work smarter, not harder
• Near misses, precursor events, safety events
• Open, transparent culture
People
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Partnership with staff and patients
Engaged, enthusiastic staff are keys to success
Affirmation and accountability
Every meeting starts with recognition of staff –
“wins”
Training and Education
• Management of Aggressive Behavior (MOAB)
• Therapeutic Crisis Team Intervention (TCTI)
Policies and procedures
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Level system
Assessment process
Re-assessment process
Safety rounds
Safety Huddle
• Review last 24 hours
• Plan for next 24 hours
• Shorter versions in change of shift meetings
Questions/Discussion
Raise your hand
Use the chat
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Checking-in
Going deeper on these topics?
Future topics?
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Thank you
Thank you for participating!
Thank you our many great faculty.
Thank you to our host, Dorian Burks.
We hope to see you on another Expedition soon.
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Expedition Communications
Listserv for session communications:
MentalHealthSafety@ls.ihi.org
To add colleagues, email us at info@ihi.org
Pose questions, share resources, discuss barriers or
successes
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