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 Change includes: 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 $140,000 $120,000 $100,000 $80,000 $60,000 $40,000 $20,000 $0 $154,770 $13,620 WCB $ costs R/T Seclusion 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

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

Variables

Medication Use (PY3S)

LORAZEPAM 4 MG/ML INJ LORAZEPAM 1-2 MG TAB HALOPERIDOL 5 MG/ML INJ ZUCLOPENTHIXOL 50 MG/ML INJ

Seclusion Incidents (PY3S)

Total Number Duration

Seclusion Incidents (St Boniface)

Total Number Duration Before Intervention (04/2008-03/2011)

11.5(6.1) 202.4(83.6) 11.7(7.4) 7.8(4.5) 18.1(7.3) 13409(7665) 13.6(6.5) 4155(3143)

After Intervention (04/2011-03/2012)

9.8(5.7) 215.7(91.3) 9.1(7.4) 6.2(5.4) 8.8(5.4) 2200(2424) 19.8(10.3) 5707(3022)

Increase rate

-15.7% 6.2% -22.3% -21.0% -51.6% -83.6% 45.5% 37.4%

p-value

0.39 0.66 0.29 0.30 0.002 <.001 0.05 0.15

Seclusion and Duration

2000 1800 1600 1400 1200 1316 1718 1624 1000 800 600 400 200 99 132 146 200 46 0 A pr il 1/ 08 to S A ep pr t il 30 1/ /0 09 8 to S A ep pr t il 30 1/ /0 10 9 to S A ep pr t il 30 1/ /1 11 0 to S A ep pr t il 30 1/ /1 12 1 to S ep t 30 /1 2 # of Seclusion Events Duration in Hours

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 PY3 South.

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???