Feeling safe in ED
Changing the way things are done in hospitals can be challenging but when change is supported by quality research, the transition can be a successful one. This has certainly been the case for South Western Sydney Local Health District’s ‘Feeling Safe in ED’ project which has caught the attention of other local health districts for standardising the management of mental health patients in Emergency Departments across the LHD.
The project was established to examine how to reduce aggression in emergency departments whilst ensuring quality patient care.
Unfortunately, violence and aggression directed towards healthcare professionals in emergency departments is a common problem. Incidences range from verbal abuse to physical violence. Understanding the importance of tackling this issue, both for the safety of staff and patients, led to the development of a Behavioural Assessment and Observation Form.
Safety Culture Coordinators SWSLHD, Teniele McPherson and Clair McEntee, along with the LHD Emergency Department Clinical Nurse Consultants, Kathryn Spears, Jenny Morris and Ron Wilson, were tasked to specifically work on the development of the form which is now used, not only in ED, but across all wards (except mental health wards) in SWS hospitals.
Faced with the problem of how to objectively capture data about patient behaviour, Clair and Teniele held focus groups, clinical audits and surveyed nursing staff to ensure that they gained valuable insight from nurses’ perspectives. The result is the current version of the Behavioural Assessment and Observation form which has been described as a form “that successfully objectifies a subjective assessment.”
The form includes a Behavioural supervision matrix in which patient behaviours are ranked from -3 (unconscious) to +3 (violent) with 0 being neutral.
“Every hour, nurses do a visual observation of the patient and make a clinical decision based on their observation and by referring to the interventions on the form. In doing this, nurses can identify signs early and use the recommended interventions to bring the patient down to neutral,” said Clair.
The extensive research into the form’s development has not ended with its implementation.
“We’re still collating all the data but so far the results are positive,” said Clair.
The biggest shift has been in nurses’ attitudes to mental health patients in ED. In their analysis of the language used by nurses when describing their experience of managing mental health patients, there was a 50% reduction in the use of negative words. Initially, words like “frustrated,” “challenging” and “unsafe” dominated the conversations. With the implementation of the new form, nurses report feeling more “competent” “more organised” and most importantly, the best feedback of all: “we feel safer.”
These results prove that conducting quality research can improve clinical outcomes on a day-to-day basis.