Real Reduction Experiences What Worked? Creating Violence Free and Coercion Free Service...

Real Reduction Real Reduction ExperiencesExperiencesWhat Worked?What Worked?

Creating Violence Free and Coercion Free Service Environments for the Reduction of

Seclusion and Restraint

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Real Reduction ExperiencesReal Reduction Experiences

Kevin Huckshorn, MSN, RN, ICADC

Former CNO and Assistant Hospital Administrator, ASH/SFSH

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South Florida State South Florida State HospitalHospital

Facility ProfileFacility Profile• Adult State Mental Health FacilityAdult State Mental Health Facility

• First, fully privatized in the country (11/98)First, fully privatized in the country (11/98)

• 325 beds; Average Daily Census 275325 beds; Average Daily Census 275

• Average Length Of Stay: Average Length Of Stay: – 220 days since privatization220 days since privatization– 3 years (all residents) 3 years (all residents)

• Primary Diagnoses: schizophrenia, major depression Primary Diagnoses: schizophrenia, major depression with psychosis, schizoaffective disorderwith psychosis, schizoaffective disorder

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Facility ProfileFacility Profile• 45% of residents have been involved with 45% of residents have been involved with

criminal justice system.criminal justice system.

• 95% of residents are involuntarily committed, 95% of residents are involuntarily committed, or court ordered.or court ordered.

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South Florida State HospitalSouth Florida State HospitalInitiativeInitiative

• Seclusion/restraint reduction initiative started Seclusion/restraint reduction initiative started in November 1999.in November 1999.

• During ASH’s first year of operation a total of During ASH’s first year of operation a total of 264 seclusions and 197 restraints were 264 seclusions and 197 restraints were administered.administered.

• Since May 2002 there has been only 1 Since May 2002 there has been only 1 seclusion (> hour) and 5 restraints.seclusion (> hour) and 5 restraints.

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StrategiesStrategies• Decision made by executive management Decision made by executive management

group (EMG) after CEO attended a group (EMG) after CEO attended a NASMHPD conference and learned about PA NASMHPD conference and learned about PA initiative.initiative.

• No additional money, no consultants, no No additional money, no consultants, no external training, no additional staff.external training, no additional staff.

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StrategiesStrategies• Change in aggression control training model. Change in aggression control training model.

• Converting CPI (Crisis Prevention Institute) Converting CPI (Crisis Prevention Institute) to NAPPI (Non-abusive Psychological & to NAPPI (Non-abusive Psychological & Physical Intervention) training and Physical Intervention) training and certification with primary emphasis on staff certification with primary emphasis on staff to persons served relations and assessment to persons served relations and assessment and response to behaviors. and response to behaviors.

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Essential ComponentsEssential Components • Full support and oversight by CEO/COO.Full support and oversight by CEO/COO.

• Strong policy statement and revised policies Strong policy statement and revised policies and procedures.and procedures.

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Essential ComponentsEssential Components• Use of data, graphed and posted for unit Use of data, graphed and posted for unit

comparisons.comparisons.

• Debriefing including root cause analysis Debriefing including root cause analysis (RCA) and daily reports to EMG; non-punitive (RCA) and daily reports to EMG; non-punitive environment.environment.

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South Florida State South Florida State Hospital Hospital

Essential ComponentsEssential Components • Change in staff roles (security, nursing, direct care Change in staff roles (security, nursing, direct care

staff).staff).

• Supervisors responding to every incident; on call Supervisors responding to every incident; on call EMG member involved for oversight 24/7.EMG member involved for oversight 24/7.

• Use of persons served throughout project:Use of persons served throughout project:– interview residents and staffinterview residents and staff– make recommendationsmake recommendations– comfort rooms.comfort rooms.

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South Florida State South Florida State Hospital Hospital

Essential ComponentsEssential Components• Project placed on every meeting agenda.Project placed on every meeting agenda.

• Staff encouraged and acknowledged.Staff encouraged and acknowledged.

• Town Center programming implemented.Town Center programming implemented.

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SECLUSION AND RESTRAINT RESULTS January 1999 - March 2004

TOTAL SECLUSIONS AND RESTRAINTS EVENTS (January 1999 - March 2004

0

5

10

15

20

25

30

35

40

45

99-

J AN

99-

FEB

99-

MAR

99-

APR

99-

MAY

99-

J UN

99-

J UL

99-

AUG

99-

SEP

99-

OCT

99-

NOV

99-

DEC

00-

J AN

00-

FEB

00-

MAR

00-

APR

00-

MAY

00-

J UN

00-

J UL

00-

AUG

00-

SEP

00-

OCT

00-

NOV

00-

DEC

01-

J an

01-Feb 01-

Mar

01-

Apr

01-

May

01-

J un

01- J ul 01-

Aug

01-

Sep

01-

Oct

01-

Nov

01-

Dec

02-

J an

02-

Feb

02-

Mar

02-

Apr

02-

May

02-

J un

02- J ul 02-

Aug

02-

Sep

02-

Oct

02-

Nov

02-

Dec

03 -

J an.

03 -

Feb.

03 -

Mar.

03 -

Apr.

03 -

May

03 -

J un.

03 -

J ul.

03 -

Aug.

03 -

Sep.

03 -

Oct.

03 -

Nov.

03 -

Dec.

J an-

04

4-Feb Mar-

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SECLUSION RESTRAINT

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RESULTSRESULTSRESTRAINT HOURS

(Aug. 2002 - Dec. 2003)

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0.70.67

0.75

0.69

0.59 0.590.56 0.54 0.53

0.620.66

0.60 0.610.65

0.580.62 0.61

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

Aug-02

Sep-02

Oct-02

Nov-02

Dec-02

Jan-03

Feb-03

Mar-03

Apr-03

May-03

Jun-03

Jul-03

Aug-03

Sep-03

Oct-03

Nov-03

Dec-03

ASH/SFSH NAT'L AVG

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RESULTSRESULTSSECLUSION HOURS (Aug. 2002- Dec. 2003)

0 0 0 0 0.01 0 0 0 0 0 0 0 0 0 0 0 0

0.98

0.84

0.66

0.43

0.51 0.52

0.37 0.37 0.36

0.45 0.42

0.34 0.31 0.31 0.330.37

0.46

0

0.2

0.4

0.6

0.8

1

1.2

Aug-02

Sep-02

Oct-02

Nov-02

Dec-02

Jan-03

Feb-03

Mar-03

Apr-03

May-03

Jun-03

Jul-03 Aug-03

Sep-03

Oct-03

Nov-03

Dec-03

ASH/SFSH NAT'L AVG

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EMERGENCY INTRAMUSCULAR INJECTIONS MAY 2001- MARCH 2004

INJECTION, SECLUSION AND RESTRAINT EVENTS MAY 2001-MARCH 2004

-5

15

35

55

75

95

115

135

01-May 01-J un 01-J ul 01-Aug 01-Sep 01-Oct 01-Nov 01-Dec 02-J an 02-Feb 02-Mar 02-Apr 02-May 02-J un 02-J ul 02-Aug 02-Sep 02-Oct 02-Nov 02-Dec 03-J an 03-Feb 03-Mar 03-Apr 03-May 03-J un 03-J ul Aug-03 Sep-03 Oct-03 Nov-03 Dec-03 J an-04 Feb-04 Mar -04

SECLUSION RESTRAINT INJECTION

EMERGENCY INJECTIONS FEBRUARY 2003-FEBRUARY 2004

8

27

60 0 1

6 4 3

17

42

60 0

4 61

1520 22

2 0 0 3

13

28

25 25

40 0 3 6 4 4

13 1610

0 1 2

114 4

2226

70 1

1320

1 4

12

22

50 1

93 0

612

27

62 0

15

73 2

14

43

11

3 6

1420

37

1317

84

0

114 1 1

613

61 4 6

11

2 43

24

5 2 06 8

511

3

22

5 2 4 3

19

7 6

0

10

20

30

40

50

60

70

80

February March April May June July August September October November December January February

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RESULTSRESULTSReported Number of Assault Victims per Quarter Since Janaury 1997

115

138

8298

85 78 8191

10484 81

114

76

119

161

8675

90 95 88

119

86

10991

104

138123 123

6273 76

5846

3318 23 26 18

36 28 2919 22 18

5164

53 54 51 52 52

77

41 4254

42 43

172

7 4 2 5 4 4 7 2 2 4 6 2 2 5 5 4 70

50

100

150

200

250

300

350

400

1st 2nd 3rd 4th 1st 2nd 3rd 4th 1st 2nd 3rd 4th 1st 2nd 3rd 4th 1st 2nd 3rd 4TH 1st 2nd 3rd 4th 1st 2nd 3rd 4th 1st

1997 Quarters 1998 Quarters 1999 Quarters 2000 Quarters 2001 Quarters 2002 Quarters 2003 Quarters 2004Quarters

P/S to P/S P/S to Staff Average Daily Census ORYX Injuries/Assaults

DCF OPERATED ASH OPERATED

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CHALLENGESCHALLENGES

Resources

Resistance

Training

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Key ContactKey Contact Debra Kirsch, MDDebra Kirsch, MD

Clinical Operations DirectorClinical Operations DirectorAtlantic Shores Healthcare, Inc./Atlantic Shores Healthcare, Inc./

South Florida State HospitalSouth Florida State Hospital800 E. Cypress Drive800 E. Cypress Drive

Pembroke Pines, FL 33025Pembroke Pines, FL 33025(954) 392-3000(954) 392-3000

[email protected]@sfsh.org

Real Reduction Experiences What Worked? Creating Violence Free and Coercion Free Service...

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