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Guarding the Frontline: Acute Care Behavioral Rounds
Share PrintAlarming rates of violence threaten nurses & healthcare heroes. Our project fights back. We use a real-time communication system, clear signage, and a designated team approach to identify at-risk patients & empower staff with resources. Implementation of this innovative approach skyrocketed nurses' satisfaction by nearly 50% in one year. Join us in guarding the frontline staff & creating a safer environment for everyone.
Origin:
October 2023, Clement J. Zablocki Veterans' Administration Medical Center (Milwaukee, Wisconsin)
Adoptions:
3 in-progress
Awards and Recognition:
Endorsement by National Directors of Workplace Violence Prevention, Nomination for the Joint Commission Eisenberg Award for Safety
Recent Updates
Overview
Problem
Healthcare workers face a growing threat of violence, with reactive approaches leading to high staff turnover, burnout, and moral distress. A gap in how to approach and care for patients with behavioral challenges was identified. A literature review showed no published data or proactive methods to manage behavioral challenges in acute care settings. Addres
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Healthcare workers face a growing threat of violence, with reactive approaches leading to high staff turnover, burnout, and moral distress. A gap in how to approach and care for patients with behavioral challenges was identified. A literature review showed no published data or proactive methods to manage behavioral challenges in acute care settings. Addressing challenging behaviors and identifying proactive interventions were thought to positively influence outcomes. A quality improvement initiative was developed with goals to enhance communication of potential threats, develop individualized behavioral action plans, and standardize documentation of the interventions.
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Situation
Background
Assessment
Goals
Solution
A Behavioral Rounding Team was established, consisting of a Clinical Nurse Specialist and two Registered Nurses. A secure Microsoft Teams with an Excel spreadsheet was created for communication with staff and to notify the team of a consult. Any patient exhibiting a challenging behavior can be added to the spreadsheet at any time. There is no exclusion crit
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A Behavioral Rounding Team was established, consisting of a Clinical Nurse Specialist and two Registered Nurses. A secure Microsoft Teams with an Excel spreadsheet was created for communication with staff and to notify the team of a consult. Any patient exhibiting a challenging behavior can be added to the spreadsheet at any time. There is no exclusion criteria. The team utilizes this information to chart review and round on the consulted patients before meeting with beside staff and includes patients and family as needed. Each patient receives an individualized behavioral action plan including the patient’s preferences and preferred interventions for care approaches. An example is staff sharing information that bright lights or loud sudden sounds disturb the patient.
After the team determines appropriate interventions to trial, the behavioral action plan is placed on a deidentified, interactive signage which hangs outside the patient’s room and in the electronic medical record. The sign facing the hallway says, “Please review our patient’s preferences on the reverse side before entering”. The backside has a detailed list of helpful interventions, unhelpful interventions, patient triggers, warning signs of escalation, as well as personalized interventions tailored specifically to that patient.
The team documents the behavioral action plan in the electronic medical record and provides the medical team with recommendations. The signage facilitates communication with other healthcare professionals, such as dietary, lab techs, and housekeeping who do not utilize the electronic medical record. All Staff are expected to read the signage before engaging with the patient. When the patient travels through the hospital, a copy of the action plan accompanies the patient.
All patients with behavioral action plans are reviewed weekly or more frequently if needed. The team meets with staff to determine the action plan’s effectiveness. If the plan needs revision, the team meets with Licensed Providers and bedside staff to update the behavioral action plan. The plan remains fluid and staff are encouraged to add to the action plan as they learn about specific patient engagement options. An example would be a patient mentioning their grandchild’s name to utilize in conversation and minimize stress.
The team additionally facilitates consults to interdisciplinary teams, facilitates interdisciplinary care team meetings, and creates and distributes additional signage and resources specific to that patient's needs back to the bedside. See more
After the team determines appropriate interventions to trial, the behavioral action plan is placed on a deidentified, interactive signage which hangs outside the patient’s room and in the electronic medical record. The sign facing the hallway says, “Please review our patient’s preferences on the reverse side before entering”. The backside has a detailed list of helpful interventions, unhelpful interventions, patient triggers, warning signs of escalation, as well as personalized interventions tailored specifically to that patient.
The team documents the behavioral action plan in the electronic medical record and provides the medical team with recommendations. The signage facilitates communication with other healthcare professionals, such as dietary, lab techs, and housekeeping who do not utilize the electronic medical record. All Staff are expected to read the signage before engaging with the patient. When the patient travels through the hospital, a copy of the action plan accompanies the patient.
All patients with behavioral action plans are reviewed weekly or more frequently if needed. The team meets with staff to determine the action plan’s effectiveness. If the plan needs revision, the team meets with Licensed Providers and bedside staff to update the behavioral action plan. The plan remains fluid and staff are encouraged to add to the action plan as they learn about specific patient engagement options. An example would be a patient mentioning their grandchild’s name to utilize in conversation and minimize stress.
The team additionally facilitates consults to interdisciplinary teams, facilitates interdisciplinary care team meetings, and creates and distributes additional signage and resources specific to that patient's needs back to the bedside. See more
Images
ACBR TEAMS Channel Spreadsheet
ACBR Behavioral Action Plan Interactive Signage
CPRS ACBR Team Note
Zablocki Acute Care Behavioral Rounds Team
ACBR Framework
Results
Staff satisfaction was surveyed over one year showing positive outcomes in access to resources, more efficient response times, and increased support from colleagues and leadership. Results at one year showed an increase in satisfaction of resource availability for handling challenging behaviors by 33%, addressing workplace violence concerns in a timely manne
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Staff satisfaction was surveyed over one year showing positive outcomes in access to resources, more efficient response times, and increased support from colleagues and leadership. Results at one year showed an increase in satisfaction of resource availability for handling challenging behaviors by 33%, addressing workplace violence concerns in a timely manner by 32%, and available support for handling challenging behaviors by 49%. These findings suggest a positive shift in the work environment. This process significantly improved staff satisfaction and provided a proactive approach to workplace violence mitigation for acute care settings. While further research is warranted, this project demonstrates the value of proactive interventions in creating a safer and more supportive work environment.
While the patients were not surveyed, several patients reminded staff to read their behavioral action plans prior to entering their rooms, demonstrating patients' engagement with the process. Several patients stated that they liked the approaches that staff used when interacting with them.
We were able to correlate this project to several serendipitous outcomes. Because of the implementation of the spreadsheet, we can now quantify the number of patients with challenging behaviors in acute care. Additionally, we correlated this initiative to a decrease in annual falls in acute care and an increase in workplace violence reporting. We have several examples of patients who were unable to be placed in long-term care due to challenging behaviors, that were later placed appropriately after a consult and intervention from our behavioral rounds team. See more
While the patients were not surveyed, several patients reminded staff to read their behavioral action plans prior to entering their rooms, demonstrating patients' engagement with the process. Several patients stated that they liked the approaches that staff used when interacting with them.
We were able to correlate this project to several serendipitous outcomes. Because of the implementation of the spreadsheet, we can now quantify the number of patients with challenging behaviors in acute care. Additionally, we correlated this initiative to a decrease in annual falls in acute care and an increase in workplace violence reporting. We have several examples of patients who were unable to be placed in long-term care due to challenging behaviors, that were later placed appropriately after a consult and intervention from our behavioral rounds team. See more
Images
Staff Satisfaction Results
Additional Outcomes and Correlations
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Implementation
Timeline
-
1 month
Creation of an Acute Care Behavioral Rounds Team -
1 day
Creation of a Shared Teams Channel
Departments
- Psychiatry
- Geriatrics
- Hospital medicine
- Nursing services
- Psychology
Core Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
|
PROCESSES |
|
TOOLS |
|
Files
- Implementation Toolkit Guide Implementation Toolkit
- Behavioral Rounds Paper Action Plan Signage- To be printed on Gold Cardstock Behavioral Rounds Paper Action Plan Signage
- CPRS Note Template CPRS Note Template
- Spreadsheet Template Spreadsheet Template
- ACBRT Workflow Framework Workflow Framework
Optional Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
|
Files
- CPRS Forms Request CPRS Forms Request
- Team Flyer Team Flyer
Risks and mitigations
| Risk | Mitigation |
|---|---|
| Union Restrictions | Proper procedural communication |
| Competing priorities of team members | Designated FTE for these roles |
About
Original team
Shannon Jensen
Project Lead
Dr. Kayla Atlija
CNS
Kyle Peterson
Data Analyst
Angelina Kinter
Acting Acute Care Inpatient Nursing Division Manager
Comment
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