This document discusses the importance of standardizing communication processes during transitions of care in behavioral health to improve patient safety. It provides tips for effective handoff communication between providers and departments, such as using a standardized format like I PASS the BATON to exchange relevant patient information verbally. The document also addresses how to improve discharge planning and transitions between levels of care through coordinated treatment planning, engaging social supports, and orienting patients to upcoming care. Overlapping and blending levels of care can help facilitate continuity of care.
There are several main dimensions most frequently used to measure hospitals performance via clinical efficiency ( Clinical quality , evidence -based practices , health improvement and outcomes for individual and patients)
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This presentation has the measures to be taken for the safety of patients. It covers the 6 goals
Goal 1: Identify patients correctly
Goal 2: Improve effective communication
Goal 3: Improve the safety of high-alert medications
Goal 4: Ensure safe surgery
Goal 5: Reduce the risk of health care-associated infections
Goal 6: Reduce the risk of patient harm resulting from falls
Nursing tool used in a medsurg environment to detect early changes in patient conditions monitoring temperature, respirations level of consciousness and oxygen level
This presentation has the measures to be taken for the safety of patients. It covers the 6 goals
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Goal 2: Improve effective communication
Goal 3: Improve the safety of high-alert medications
Goal 4: Ensure safe surgery
Goal 5: Reduce the risk of health care-associated infections
Goal 6: Reduce the risk of patient harm resulting from falls
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Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
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Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
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FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
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Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
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ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
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According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
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Growing Prevalence of Lifestyle Diseases
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Hand Off Communication
1. HAND OFF
COMMUNICATION
Improving patient safety in the Behavioral Health care field
by standardizing communication processes in transitions of
care and when there are risks.
2. A HANDOFF INVOLVES
THETRANSFER OF
PATIENT INFORMATION
AND ESTABLISHING
RESPONSIBILITY
BETWEEN
PROVIDERS AND
DEPARTMENTS
Approaches to
Improvement:
Improve Communication
Improve Discharge
planning &Transitions
between Levels of Care.
Improve Admissions
More efficiency with
Assessments,Treatment
Plans, and overall
patient care
3. Questions to
Consider
Where is the communication failure
happening?
When are we discovering that
information is not being
communicated/transferred?
Is the failure internal or external?
Where is the opportunity for
improvement?
How will we measure the impact of
changes to our communication?
How we will ensure continued
compliance of timely, accurate,
complete, and fully understood hand
off information?
4. Tips for Hand Off Communication
■ Provide handoff in the same order every time;
■ Use verbal, face-to-face communication;
■ Allow two-way exchange;
■ Limit distractions;
■ Allow others to overhear the information;
■ Complete patient assessment prior to handoff;
■ Include the "5 Ps“:
– Patient name, Problem list, Plan of care, Purpose of plan, & Precautions.
5. Tips for Hand Off Communication
■ Use clear language
■ Incorporate effective communication techniques
■ Standardize
■ Create a smooth hand-off between settings
■ Use technology to your advantage
6. Use
Mnemoics:
I PASS the
BATON
Introduction: Introduce -
yourself,Your position,
your patient
Patient: Name,
Identifiers,Age, Sex,
Location
Assessment: Presenting
complaints, vitals, and
symptoms/diagnoses
Situation:Current
status/circumstances,
recent changes, level of
certainty
Safety: Concerns, Labs,
Allergies, Alerts (Falls,
Isolation, Suicide risk)
Background: Previous
episodes, medications,
family hx.
Actions:What actions
were taken or are
required
Timing: Level of
Urgency, prioritization
of actions.
Ownership:Who is
responsible (nurse,
therapist, etc.) including
patient responsibilities.
Next:What needs to
happen next?
Anticipated changes?
Contingency plan?
7. What are the
Barriers
to
Communication
?
Are we communicating
effectively? If not, what
is the most effective
way to share
information?
Is the message clear?
Do I have to search for
the information – or is it
in a place where it is
easily recognizable?
Are we exchanging the
right information?
What type of
information is pertinent
and what is not
important?
8. How do we
improve
Communication
Handoffs?
Coach patients on:
• Medication self-management
• Use of patient-centered language in their chart
• Importance of follow up with physicians and
clinicians
• Knowledge of red flags (signs that the patient’s
condition is worsening and what to do)
Use ‘TEACH BACK’ to assess the
patient’s understanding of discharge
instructions and self care.
Include other providers, family, and
community caregivers as full partners
in assessments and predicting
community needs.
9. Proper Discharge Planning
■ TreatmentTeam participates in discharge planning; Nursing, Case
Managers &Therapists.
■ Discharge planning begins the day the patient arrives.
■ TreatmentTeam meets regularly to discuss progress in the patient’s
discharge planning. Specifically identify readmission risk and factors
those into discharge plan.
■ Provide customized, real time critical info to the next care provider.
– Specifying the process in detail –the content, sequence, timing and
responsible person for each step
– Establishing connections between each step
– Designing a pathway that is simple
– Continuously assessing the outcome and striving to improve
10. Where to
Start?
■ Assess high risk areas
■ Analyze processes associated with
those areas
■ Look for potential areas for failure
■ Seek improvements to reduce failure
likelihood
11. Overview of Handoff Communication
■Make connections with the next level of care or post-treatment supports:
Emphasize the "we" in each person's journey to long-term recovery. Let them know that there are individuals and organizations that can help them to
sustain their recovery, and wherever possible, establish personal connections for internal and external referrals. Establish clear two-way expectations and
communication between levels of care.
■ The guided tour:
Encourage and empower patients to meet with individuals and organizations providing ongoing recovery supports before they leave the facility through
participation in the next level of care or recovery support groups prior to discharge.
■Streamline Paperwork:
Streamline the paperwork process between the referral source and outpatient program to eliminate duplication of effort.
■Overlap Levels of Care:
Overlap outpatient treatment with inpatient treatment from the referring level of care so that patients have the opportunity to experience outpatient
care before being discharged from the referring level of care.
■Blend Levels of Care:
Blend other levels of care with outpatient treatment so that patients can develop therapeutic relationships and familiarity with outpatient patients,
therapists, and locations before moving to outpatient care.
■OrientClients toTreatment:
Provide orientation for both inpatient and outpatient treatment before admission and prior to discharge from a referring level of care. Providing a
patient with Orientation empowers them to know what to expect from the treatment process and their providers.
12. Summary ■ Offer aTour Guide
■ Overlap Levels of Care
■ Blend Levels of Care
■ Include Family/Support Circle in Discharge andAdmission Planning
■ Use Motivational Interviewing
■ UseVideo Conferencing
■ Map Out ContinuingTreatment
■ Orient Clients toTreatment
■ OfferTelephone Support
■ Follow up before and after the patient’s appointment’s post-discharge.