Early BeRRTs: Safety Through Behavioral Rapid Response

Purpose:
Acute inpatient psychiatric nursing staff reported personal safety concerns due to patients' disruptive behaviors. The goal of the Behavioral Rapid Response Team (BeRRT) innovation was to promote safety among patients and staff through rapid, early and less restrictive interventions.

Significance:
Nursing staff are the most frequent victims of the increasing violence in psychiatric hospitals. Strategies are needed to assure staff safety and provide opportunities for early patient intervention when disruptive negative behaviors are identified.

Strategy and Implementation:
In 2004, the Institute for Healthcare Improvement (IHI) encouraged the use of Rapid Response Teams (RRTs) to improve patient outcomes. Embracing the objectives of the acute care Rapid Response Team, the Unit Based Practice Council of the inpatient psychiatric unit developed and implemented the multidisciplinary Behavioral Health Rapid Response Team, or “BeRRT”. The BeRRT team includes four defined roles with assigned competencies and responsibilities: milieu manager, station manager, safety manager and negotiator. Any staff member who identifies a patient with increasing anxiety or disruptive escalating behaviors can silently announce or overhead page “Bert to the Staff Station” to activate the team. A team huddle with SBAR communication activates BeRRT in an organized response.

Evaluation:
Ten months after BeRRT was implemented, nurse satisfaction with safety has improved as well as patient satisfaction. The reported assaults and injuries to staff have decreased. Seclusion and restraint interventions have declined as rapid and early intervention requires less restrictive treatment.

Implications for Practice:
A BeRRT program provides psychiatric nurses with a rapid and early intervention to de-escalate disruptive behaviors among potentially violent psychiatric patients. The team approach fosters development of expertise in psychiatric nursing and improves patient outcomes.