Real Reduction Experiences

1
Improving Safety and Reducing Violence
Implementing Trauma Informed Care

• Real Reduction Experiences
• What Worked?
• November 8, 2007

2
Real Reduction Experiences

Kevin Huckshorn, MSN, RN, ICADC Former CNO and
Assistant Hospital Administrator, ASH/SFSH 2/1997
to 2/2002
3
South Florida State HospitalFacility Profile

• Adult State Mental Health Facility
• First, fully privatized in the US (11/98)
• 325 beds Average Daily Census 275 (current)
• Average Length Of Stay
• 220 days since privatization started
• 3 years ALOS (all residents) including LOS of
  people who have been in residence for 8-30 years.
• Primary Diagnoses schizophrenia, major
  depression with psychosis, schizoaffective
  disorder

4
South Florida State HospitalFacility Profile

• 45 of residents have been involved with criminal
  justice system.
• 95 of residents are involuntarily committed, or
  court ordered.
• Charge from state was to change from long term
  care to intermediate care facility to end
  gridlock on admits to get accredited and to
  reduce SR, injuries, IM med use, AWOLS,
  recidivism etc.

5
South Florida State HospitalInitiative

• Seclusion/restraint reduction initiative started
  in November 1999.
• During ASHs first year of operation a total of
  264 seclusions and 197 restraints were
  administered.
• Since May 2002 there has been only 5 seclusions
  (gt hour) and 16 restraints. (updated 2-04)

6
South Florida State HospitalStrategies

• Decision made to eliminate S/R use by executive
  management group (EMG) after CEO attended a
  NASMHPD conference, heard about service user
  experiences and learned about PA initiative.
• No additional money, no consultants, no external
  training, less overall staff (by 200).

7
South Florida State HospitalEssential Components

• Full support and oversight by CEO/COO/CNO.
• Strong policy statement and revised S/R policies
  and procedures.
• Kick-off of initiative that included staff,
  residents and families, and the community mental
  health centers.

8
South Florida State HospitalStrategies

• Change in aggression control training model.
• Use of data, graphed and posted for unit
  comparisons every month/all units.
• Debriefing including root cause analysis and
  daily reports to EMG non-punitive environment.

9
South Florida State Hospital Essential
Components

• Change in staff roles (security, nursing, direct
  care staff).
• Supervisors responding to every incident on call
  EMG member involved for oversight 24/7.
• Use of persons served throughout project
• interview residents and staff post event
• make recommendations
• develop comfort rooms

10
Florida State Hospital Essential Components

• Project placed on every meeting agenda.
• Staff encouraged and acknowledged through
  individual certificate awards, quarterly unit
  awards, write up in monthly newsletter, and Good
  Stories annual report by G. Bluebird.
• Town Center programming implemented.

11
SECLUSION AND RESTRAINT RESULTS January 1999 -
March 2004
12
RESULTS
13
RESULTS
14
EMERGENCY INTRAMUSCULAR INJECTIONS MAY 2001-
MARCH 2004
15
Restraint and Seclusion Summary March 06
February 07

• Geo Care/SFSH had a total of 7 restraint and
  seclusion events between March 06 and February
  07.
• 2 persons served had 2 events, 3 persons served
  had 1 event.

16
(No Transcript)
17
(No Transcript)
18
(No Transcript)
19
(No Transcript)
20
Review of S/R Events

• Reviewed reasons for restraint - causes were all
  related to assault toward self or others and one
  case of extreme agitation and refusing meds.
• This information is referred to the Assault
  Reduction Task Force.
• No restraint or seclusion incidents resulted in
  injury to person served or staff. One person
  served did have abrasions on forehead from head
  banging not related to the restraint/seclusion
  event.

21
CHALLENGES

• Turnover of leadership staff
• Resistance resulting from infusion of staff from
  closure of criminal justice facilities in FL
• Issues regarding court ordered evaluations of
  people from jails and prisons
• Constant need to stay on top of this initiative

22
South Florida State HospitalKey Contact

• Diane Funston,
• Chief Executive Officer
• Atlantic Shores Healthcare, Inc./
• South Florida State Hospital
• 800 E. Cypress Drive
• Pembroke Pines, FL 33025
• [phone]
• dfunston_at_geocareinc.com