February 24, 2015

IHI Expedition
Expedition: Making Mental Health Care Safer in the Hospital Setting
Session 6: Being Proactive and Avoiding Crises

James F. O’Dea, PhD,

MBA
Michael Claeys, MBA,
LPC
Kelly McCutcheon
Adams, LICSW
Today’s Host
2

Dorian Burks, Project Coordinator, Institute for

Healthcare Improvement, is a current coordinator for
web-based Expeditions. He also contributes to the IHI
work in the Triple Aim and Improvement Capability
focus areas, as well as the Leading Quality
Improvement series. Dorian is a member of the
Diversity and Inclusion Council at IHI, where he and
fellow staff members develop strategies to enhance
IHI’s inclusive culture, both internally and externally.
Dorian graduated from Massachusetts Institute of
Technology in Cambridge, MA where he received his
Bachelor of Science degree in Biology and humanities
concentration in Anthropology.
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Expedition Director
8

Kelly McCutcheon Adams, LICSW has been a

Director at the Institute for Healthcare Improvement
since 2004. Her primary areas of work with IHI have
been in Critical Care and End of Life Care. She is an
experienced medical social worker with experience in
emergency department, ICU, nursing home, sub-
acute rehabilitation, and hospice settings. Ms.
McCutcheon Adams served on the faculty of the U.S.
Department of Health and Human Services Organ
Donation and Transplantation Collaboratives and
serves on the faculty of the Gift of Life Institute in
Philadelphia. She has a B.A. in Political Science from
Wellesley College and an MSW from Boston College.
Today’s Agenda
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Welcome
Action Period Assignment
Debrief
Being Proactive and Avoiding
Crises
Closing
Thank you!
Expedition Objectives
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At the conclusion of this Expedition, participants will be able

to:
Explain the importance of partnering with patients and
their families to improve safety for patients with mental
health conditions
Identify different areas to improve mental health care
safety
Describe examples of improvement efforts at other
organizations
Plan tests of change to begin or continue patient safety
improvement
Schedule of Calls
11

Session 1 – Partnering with Patients and Families

Date: Tuesday, December 2, 1:00 - 2:30 PM Eastern Time

Session 2 – Making the Physical Environment Safer

Date: Tuesday, December 16, 1:00 - 2:00 PM Eastern Time

Session 3 – Why Flow Matters

Date: Tuesday, January 13, 1:00 - 2:00 PM Eastern Time

Session 4 – Medication Safety

Date: Tuesday, January 27, 1:00 - 2:00 PM Eastern Time

Session 5 – Ensuring Staff Preparedness

Date: Tuesday, February 10, 1:00 - 2:00 PM Eastern Time

Session 6 – Being Proactive and Avoiding Crises

Date: Tuesday, February 24, 1:00 - 2:00 PM Eastern Time
Action Period Assignment Debrief

Sharing examples of changing staff

hiring/orientation/training/preparedness to
improve mental health safety.
 13

Being Proactive
and Avoiding
Crises
James O’Dea and Michael Claeys
Faculty
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James F. O’Dea, PhD, MBA is a clinical psychologist and has been

employed at Backus Hospital since 1989. He is currently the administrator
for the hospital’s Level III trauma program as well as the Regional Director
of the Behavioral Health services for the Hartford Healthcare East Region.
Dr. O’Dea came to Backus Hospital in 1989 to practice clinical psychology
in the Department of Psychiatric Services. He has been active in the
development of the hospital’s bariatric surgery program, heart failure
program, stroke program, and its new peripheral vascular program. Dr.
O’Dea has also been actively involved in patient safety and quality
initiatives, heading up the Patient Safety and Quality department for the last
15 months. In 2008, Dr. O’Dea assumed a leadership position in the award-
winning Backus Cancer program.  He continues in this leadership position
and most recently was named the Regional Director for Cancer Services
for the Hartford Healthcare East Region.  He has worked closely with the
Eastern Connecticut Hematology and Oncology practice and multiple
physician practices on strategic and operational planning for the cancer
service line.  He has recently been named to a leadership position in the
Hartford Healthcare Cancer Institute (HHCCI), which is currently
developing the strategic and operational affiliation with Memorial Sloan-
Kettering (MSK), one of the premier cancer programs in the world.
Faculty
15

Michael Claeys is a Licensed Professional Counselor and

possesses a Master’s in Business Administration. He
developed one of Georgia’s first crisis centers along with
alternatives to state hospitalization at the Clayton Center
CSB in 1996. From 1999 to 2009 as Executive Director of
APS Healthcare, Mr. Claeys was responsible for a statewide
external quality review unit for mental health providers that
included extensive provider training, provider profiling, and
integration of consumer recovery activities. Since 2009 Mr.
Claeys has served as Executive Director of Grady Health
System’s Behavioral Health services. Grady Health System is
a large urban safety net hospital in Atlanta Georgia with over
117,000 emergency room visits a year. Behavioral Health
Services at Grady consist of a full array of crisis, inpatient,
Assertive Community Treatment, and outpatient services.
Safety and Security
Behavioral Health Services

Michael Claeys, MBA, LPC

Executive Director
Grady Health System
 Hospital Overview
• Urban, safety net hospital with Level 1 Trauma
Unit
• People with behavioral health needs are
served throughout the hospital and
community
– Emergency room
– Med/Surg floors
– Psychiatric specific services
 The “Rights” of Safety

• The Right mix of services

• The Right service at the Right time: Get the
person to the correct service level quickly
• The Right environmental safety features
• The Right safety protocols
 Grady’s Mix of Services
• Emergent:
– EMS
– Emergency Room
– Psych Crisis Intervention Service
• Urgent:
– Psych Inpatient
– Psych Consult Services on Med/Surg floors
– Assertive Community Treatment
• Routine:
– Outpatient Clinic
– Case Management
– Psychosocial Rehabilitation
– Peer Support Services
Grady Emergency
Services
Positives:
EMS with one unit staffed by
paramedic and licensed
behavioral health
professional to prevent
unnecessary ER visits
• Dedicated rooms for
psych within ER
• Initial Property Search
and Securing Belongings
• Licensed BH
professionals and Risks:
limited coverage by • Risk of flight, leaving AMA
psychiatrists • Environmental and physical risks are present
• Disposition decisions • No body search
within 7 hours • Increase use of restraints as no continuous
monitoring
 Coming August 2015 – Psych ED

• Physical plant design with specific features to

ensure safety and harm reduction
• 24 hour coverage by Psychiatry Attending
physicians and BH trained techs
• Supported by Licensed BH professionals
• Medical screening conducted by psychiatrists
Psych Services on Med/Surg Units
Positives: Risks:
• Consults based on medical team
referral, request • Environmental and
• Guidelines in place to suggest when physical risks are present
to “consult” psychiatry
• No property or body
• Psychiatric Consults completed by
psychiatrists, psych residents, search
Physician Assistants • Increased use of
• Provide diagnostic assessment,
medication management,
restraints for
behavioral planning and referral to uncooperative patients
after care services including
inpatient and/or outpatient care, as
• No continuous
appropriate monitoring
Crisis Intervention (CIS) and Psych Inpatient
• Initial Property and Body Search
to find contraband (i.e. weapons,
drugs, lighters)
• Dedicated security staff 24/7
• Limited access through badge
swipe
 CIS and Inpatient- Environmental
• Minimize risk of harm
• 100% completion of
Suicide Risk

Monitor at appropriate intervals

(i.e. 15 minute, line of sight, 1-1)
Maintain adequate staffing ratios
Safe Furniture Choices
Immovable chairs and
ottomans on CIS
TVs covered and mounted
high on wall

Hard plastic beds (No sharp

edges and bolted to floor)
CIS and Inpatient - Environmental
Anti-ligature technology
on doors

Soap dispensers and hand

sanitizers are fully protected,
tamper proof and anti-ligature

Monitor for damage

Reducing Environmental Risks
Doors with no hinges

Replace plastic liners

with paper
Retro Fit – Existing Environment
Fill space between wall and
handrails
Replace beds, current model
has no sharp edges, bolted to
floor
 Monitoring for Safety

Real time monitoring as well

recorded review of incidents
and activity on unit
 Behavioral Management
Stimulus Reduction Room
With Recliner (on CIS)
 Construction Safety

Temporary walls with same

safety features such as anti-ligature
handles.
Monitor tools and materials.
Readmission Prevention Strategies
• Individualized discharge plans
• After discharge phone calls to assure
understanding of medications, follow up
appointments
• Step-down aftercare program provides same
day access post discharge from crisis/IP
services
• Case Management & Assertive Community Tx
 Direct questions to:
mclaeys@gmh.edu
Department of Behavioral Health
 Making Mental Health Care Safer
Being Proactive and Avoiding Crises
James F. O’Dea, Ph.D., MBA
Regional Director, Hartford Healthcare
Behavioral Health Network
 Hartford Healthcare Behavioral Health
Network
Largest provider of behavioral healthcare in state of
Connecticut
• Institute of Living – IOL
• Rushford Center
• Natchaug Hospital
• William W. Backus Hospital
• The Hospital of Central Connecticut
• MidState Hospital
• Windham Hospital
 The Platform
High Reliability Organizations
• The science of safety
• Learnings from other industries – aviation and
nuclear power
• Safety tools – work smarter, not harder
• Near misses, precursor events, safety events
• Open, transparent culture
 People
• Partnership with staff and patients
• Engaged, enthusiastic staff are keys to success
• Affirmation and accountability
• Every meeting starts with recognition of staff –
“wins”
 Training and Education
• Management of Aggressive Behavior (MOAB)

• Therapeutic Crisis Team Intervention (TCTI)

 Policies and procedures
• Level system
• Assessment process
• Re-assessment process
• Safety rounds
 Safety Huddle
• Review last 24 hours
• Plan for next 24 hours
• Shorter versions in change of shift meetings
Questions/Discussion
41

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Checking-in
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Going deeper on these topics?

Future topics?
Thank you
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Thank you for participating!

Thank you our many great faculty.
Thank you to our host, Dorian Burks.

We hope to see you on another Expedition soon.

Expedition Communications
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