• Effects of a Post-Discharge Telephone Follow-up Call on Psychiatric Readmission Rates

      Gorey, Michelle L.; Costa, Linda L. (2021-05)
      Problem & Purpose: Preventing early psychiatric readmissions presents a significant challenge to inpatient psychiatric units. Thirty-day readmission rates continue to rise using a significant amount of resources and increasing hospital costs. An inpatient psychiatric unit specializing in treating severe mental illness has a high readmission rate (20%). A quality improvement (QI) project was designed to reduce inpatient psychiatric readmission rates. The purpose of this QI project was to implement a nurse-led follow-up phone call within 72 hours post-discharge to identify issues related to patient understanding and ability to adhere to discharge plans. Identification of barriers encountered in the follow-up plan and early resolutions was posited to reduce thirty-day readmission rates. Methods: Psychiatric nurses in a 24-bed adult high acuity unit were educated to conduct post-discharge phone calls using a detailed script tailored to the organization. A corresponding documentation tool evaluating data collected on medication reconciliation, confirmed follow- up appointment, the patient’s medication regime, and the patient's understanding of discharge instructions was assessed and an intervention during the call was provided as needed. Night shift RNs audited the documentation tool. The phone call was to be completed on each patient discharging over a twelve-week period. Phone call and audit completions were tracked weekly and thirty-day readmission rates were tracked monthly. Results: Findings suggest the use of a post-discharge phone call was a successful intervention that can be adopted on psychiatric units. Phone call and audit completions reached the goal of 100%. This indicates nurses were able to accommodate the extra tasks without disrupting the milieu. Thirty-day readmission rates decreased 2% compared to the same time in the year prior. Conclusions: Post-discharge phone calls is a cost effective intervention that has shown to be a successful in reducing thirty-day readmission rates in this psychiatric settings. Future QI projects should consider this intervention in different psychiatric specialties.
    • Timed Reminders within the Electronic Health Record to Improve Pain Reassessment Documentation

      Noll, Rebecca L.; Bundy, Elaine Y. (2021-05)
      Problem & Purpose: Ineffective reassessment and documentation of a patient’s pain level can lead to physical and psychosocial impairments compromising the ability to participate in milieu activities among psychiatric inpatients. In a large community hospital’s inpatient psychiatric unit, pain reassessments were only completed 57% of the time. The purpose of this quality improvement project was to implement modifications to the pain assessment flowsheets in the electronic health record on an adult inpatient psychiatric unit to improve nurse adherence to reassessment and documentation of pain scores. Methods: Pain reassessment timed reminders were added into the electronic health record flowsheets and tracked over a 13-week period on an inpatient psychiatric unit in a large community hospital. An algorithm of the unit’s pain management policy was developed laying out step by step guidance for pain reassessment timelines and medication management. Twenty staff nurses from a unit with a 19-bed patient capacity participated in this quality improvement project. Nurses received education on how to add timed reminders into the electronic health record flowsheets prior to project implementation. Pre and post implementation surveys were administered to evaluate how often nurses reassess and document pain levels within the appropriate timeframe. Weekly run charts were used to analyze and track data on nursing staff compliance rates. Results: Data collected in the weekly audits reflected a 20% improvement in pain reassessment overall at the conclusion of the project timeline. A displayed pain assessment algorithm helped to boost reassessment documentation rates by 10% initially. The next week reassessment documentation decreased by 22% after posting names of individual nursing staff adherence rates. Documentation adherence rates increased within two weeks by 20% after posting a certificate of achievement displaying nursing staff achieving 100% weekly pain reassessment documentation. Conclusion: The use of timed reminders embedded into electronic health record flowsheets, a pain management algorithm, and recognition of staff with 100% documentation compliance contributed to improvement in pain reassessment documentation practices. Implications for practice included timely documentation of pain reassessments improving pain management among psychiatric inpatients.
    • Utilization of a Standardized Handoff Tool (PSYCH) to Reduce Errors of Omission

      Cannon, Kendall K.; Edwards, Lori A. (2021-05)
      Problem: The “handoff process” between nurses at shift change on an inpatient behavioral health unit of a large community teaching hospital in the Baltimore-Washington area was characterized by ineffective communication patterns that posed a risk to patient safety. Common problems with the handoff process include regular omissions of pertinent background information, inclusion of repetitive or non-essential health information, and patient overviews which are limited to the most recent nursing shift. Purpose: The purpose of this quality improvement project (QIP) was to implement a standardized handoff tool, PSYCH, on an inpatient behavioral health unit, and to evaluate the utility of this intervention in supporting the handoff process between nurses at change of shift. Methods: The QIP was implemented over eleven weeks. During this time, an evidence-based handoff tool was selected, an implementation team was mobilized, and change champions were mentored on the use of implementation tactics. A learning module was developed to educate nurses on how to use the handoff tool prior to implementation. The handoff was audited before and during implementation to obtain data for the identified outcome measure – nursing satisfaction – and the two identified process measures - utilization of the handoff tool and inclusion of specific patient information during handoff. Project outcomes were audited on a weekly basis and shared with the nursing staff to provide a marker for progress and to support behavioral changes. Results: Findings suggest that the majority of nurses were willing to use the PSYCH handoff tool to give report (90% average utilization rate during the implementation period), and specific patient information (e.g., code status, allergies, medical diagnosis, psychiatric diagnosis, and reason for admission) was reported with greater frequency when a standardized handoff tool is used. Staff members were also more likely to report higher satisfaction with the handoff process when a standardized communication tool was used compared to no standardized tool. Conclusions: Utilization of a standardized communication tool on an inpatient behavioral health unit has the potential to increase patient safety as nurses are more likely to report key aspects of the patients’ health condition.