TL5-10 Psychiatric Services in ED

Date: January 27, 2011

Time: 5:00 – 6:30pm

TeleconferenceBridge: 866.382.0408 code 7765507

Attendees: Charlene Coffin, Kate McCord RN, Dr. Oram Smith, Pam Assid RN, Melissa Williamson RN, Rosanna Parmelee RN/PETT, Brian Sarpy, Facilities, Bob Trefethen, Security, Pete Walsh MD, Sandy Moreno, Adm Support, Sr. Sanford, Don Walker RN, Todd Farina RN, McCrea Andersen, Adm Support

Leader:Facilitator: Don WalkerScribe: McCrea AndersenTimekeeper:

  1. Job scope/expectations Mental Health Workers in the ED
  2. Who will supervise, train, evaluate
  3. ED
  4. PETT
  5. Budget allocation – can Productivity Standard that was allocated to 3 East be dispersed among the floors/departments that are now working with M-1 hold pts? Kate McCord says, not at this time. We need to collect data to show the needs for those funds.
  6. RN training on acute pts, monitoring reassessing and documenting regularly- Is it possible to get any psych techs on the 5th floor?
  7. Training related possible medical issues

Agenda Items from PETT

  1. EMTALA and Behavioral Health pts
  2. EMTALA are believed to be needed when transferring a patient to Aspen Pointe because the pt will be leaving the Centura system…is there is no EMTALA, then who will take responsibility for the pt.
  3. Charlene will talk to legal and get clarification about the use and need for EMTALA…but until then fill one out for transfers
  4. It may be that because Aspen Pointe is not a licensed facility, an EMTALA may not be needed
  5. EMTALA are not needed to Detox patients since they are a discharged patient
  6. Gown/Personal Belongings issues
  7. All M-1 hold pts MUST be in gowns, it is POLICY. If the physician does not feel a gown is necessary, the order must be put in writing
  8. With the psych techs on the floor, a higher number of psych pts have been put in gowns
  9. If a pt is not on an M-1 hold, he/she can not be forced to wear a gown. You may call Security to do a wand pat-down (no touching of the person is permitted, unless necessary for safety precautions)
  10. Personal belongings will put into a locker and WILL NOT be transferred to the 5th floor with the pt.
  11. All meds will be sent to the Pharmacy
  12. A member of the Security Staff must ALWAYS go with the transport for any M-1 hold
  1. Breathalyzer(s) at PH;
  2. Todd will check to see if the breathalyzers that we have are able to be recalibrated. Some can be recalibrated on site, others need to be sent to manufacturer/distributor for recalibration
  3. Availability is more important than accuracy. If a pt is blowing under the legal limit and is still acting “drunk” then an assessment is still necessary.

Staff & Patient Safety

  1. Safety of staff and patients is the top priority
  2. Undressing and searching patients – it is POLICY, unless there is a written order from a physician, it MUST be done
  3. Consistent – If we are not consistent it is confusing to the pts and the staff. Consistency is critical
  4. Dispo of belongings & Storage on inpatient units – all belongings will be stored in the ED in lockers (including weapons)
  5. Medications & elicit Drugs – Meds will all be turned into the Pharmacy

Security Issues:

  1. There is concern that it is uncalled for to search & log a pts belongings in front of him/her. However, since we are not police officers,it is best if we search the items in front of the pt with his/her consent in order to find ID, Health Ins information and family contact info.
  2. Who informs security when a transfer needs to occur? Nurses, Physicians or Unit Secretary

Physician Related Items:

  • It’s great having the psych techs in the ED, but are not as medically skilled as other techs in the ED. If they are going to be there, we need to find the best way to maximize their time (not just waiting for a psych pt.)
  • We need to stick to the 12-14 hr maximum for an M-1 hold to be in the ED. Even that is long, but where else can they go until they are stable.
  • After the 12-14hr period, then send pt to 5th floor
  • If a pt is violent or unsafe, they should remain in the ED, 5th floor is not as well equipped to handle such pts
  • The prior 2710 info wasn’t clear, so we will be reapplying and the license is due July 1st.
  • We can not let this issue change our community mission. This is a hospital wide problem, not just ED.
  • Is there somewhere in the hospital that we can dedicate 6-8 beds/rooms for M-1 hold pts?
  • Cedar Springs has a low turnover, and our ED doesn’t have an excess capacity
  • If a pt needs to be transferred to Cedar Springs and an MDRO shows up can we still transfer? Yes, the ED Physician will use his/her best judgement
  • How are we going to deal with the liability of releasing an M-1 hold? How will we help out hospitalists and physicians feel more comfortable making that decision?
  • The “M-1 Hold” option in Meditech means NOTHING…there MUST be paperwork. Please be sure it is signed paperwork.
  • The physician (or RN) needs to fill out the form as best as possible. PETT can assist with what else is needed.

Patient Representative Concerns:

  • Once a pt is entered into the system a certain way, he/she becomes a secret pt
  • Since we are not a psych hospital we do not have to have privacy pts (unless requested by the pt.)
  • The Policy needs to be reviewed – right now the pt can sign a consent for to lift “silent status”, but why not ask them to sign a form if they WANT TO BE on “silient status”
  • “Silent status” makes it VERY difficult for the family to follow up (there have been complaints)

Review of Action Items:

  1. Charlene to follow up with legal about EMTALA forms
  2. Start tracking Data to show that funds are needed to support M-1 patients (Todd will start working on this)
  3. Length of time in ED
  4. Diagnosis
  5. Inpatient sitter hours needed
  6. How many are transferred to 5th Floor
  7. When is pt Medically Cleared (how is medically cleared defined?)
  8. Can we get more psych techs in ED to help?
  9. Possibly install some plexiglas in some rooms on the 5th Floor
  10. We are working on a contract with an outside source to supply sitters. Is it possible to request sitters with psych experience?
  11. Start the M-1 hold at the beginning of the process – most likely will be done by the primary RN