(withdrawn) Tools & Tactics to Create a Sustained Culture of Safety within an Inpatient Geriatric Behavioral Health Unit

Purpose:
Patient falls, elopement, behavior escalations and staff injuries were common in the geriatric behavioral health (GBH) unit at OU Medical Center Edmond. A belief prevailed that these outcomes were unpreventable and acceptable. A paradigm shift was required to create a sustained culture of safety.

Significance:
Dementia, physiological changes of aging and other geriatric and behavioral health syndromes increase the risk of elderly patient harm events and their severity. Staff who work with GBH patients are also at risk for injury from harm events. The fear of these events can lead to staff turnover.

Strategy and Implementation:
In late 2010, a strategic plan was developed and implemented for this 17 bed inpatient GBH unit to develop a sustained culture of safety. The overall plan consisted of the implementation of TeamSTEPPS™ and Studer Group tactics. TeamSTEPPS™ principles provided the structure to impact unsafe situations. Shift huddles, briefing, event debriefing and handover were tools which gave organization to the approach. Unit report cards were used to create a current picture and vision of success. A series of educational offerings, such as TeamSTEPPS™ training, falls prevention, environmental safety, care of the GBH patient, and de-escalation competencies, specific to licensed and non-licensed staff were mandatory. The Studer Group tactics were also utilized to offer an additional method to lead change and sustain the new culture. Leadership rounding, internal customer rounding, senior leader rounding, hourly rounding, bus-stop conversations and reward/recognition proved valuable tools.

Evaluation:
Fall Rate (patient falls per 1000 patient days): 11/10 28.73; 3/12 5.64. Staff Struck by Patient: 1/11-6/11 5 events; 7/11-4/12 0 events. Behavioral escalations: 1/11-9/11 6 events; 10/11-4/12 0 events. Voluntary Staff Turnover: 2010 - 32.70% turnover; 2012 - 0% annualized turnover thru April.

Implications for Practice:
TeamSTEPPS™ tools and The Studer Group tactics can be implemented in any inpatient practice setting to create a sustained culture of both patient and staff safety with similar results. Additionally, this approach can be expected to impact employee engagement and retention.