APNA 30th Annual Conference Session 2045: October 20, 2016 Inappr - PDF document

APNA 30th Annual Conference Session 2045: October 20, 2016 Inappr opr iate Plac e me nt of De lir ium Patie nts on the Psyc hiatr ic Unit Ame ric an Psyc hiatric Nurse s Asso c iatio n 30 th Annua l Co nfe re nc e Prima ry I nve stig a to r: Mic he lle Ge iss RN-BC, BSN Co -I nve stig a to r: T a msyn We a ve r RN-BC, BSN Me mo ria l Me dic a l Ce nte r Spring fie ld, I llino is Oc to b e r 20, 2016 * T he spe a ke rs ha ve no c o nflic ts o f inte re st to disc lo se . Re se a rc h T e a m Me mbe rs: • Ashle y Ra ufe r RN-BC, BSN • Ca rrie Mc Co rmic k RN, BSN • L indse y Oyle r RN, BSN • Jill Cha mb e rla in RN, PhD • L o rna Sc o g g ins RN- BC, MSN • Sha nno n Da vis RN-BC, MSN • De b o ra h E dmo nso n RN-BC, BSN L e a rning Obje c tive s • I de ntify c ha lle ng e s o f ina ppropria te pla c e me nt o f pa tie nts o n psyc hia tric units. • I de ntify po ssib le pa tie nt risk fa c to rs tha t ma y c o ntrib ute to a pa tie nt ha ving a physiolog ic a l e me rg e nt e ve nt o n the psyc hia tric flo o r. Geiss 1

APNA 30th Annual Conference Session 2045: October 20, 2016 Ba c kg round • Dia g no stic o ve rsha do wing is a ma jo r c o nc e rn 1, 2, 3, 4, 5, 6, • Hig he r c o -mo rb idity ra te s 8, 1, 3, 9 • Unde rtre a te d: – stig ma o f me nta l illne ss 1, 3, 5 – la c k o f me dic a l a c c e ss 7 – c ha lle ng ing na ture o f the psyc hia tric po pula tio n 3, 5 – insuffic ie nt kno wle dg e o f physic ia ns 3, 10, 6 – insuffic ie nt infra struc ture o f e me rg e nc y de pa rtme nts to e nsure q ua lity a nd sa fe ty o f c a re in the psyc hia tric po pula tio n 5 Ba c kg round ‘ Diagnostic Ove r shadowing’ - inc lina tio n to • a sc rib e pa tie nt sympto ms o r b e ha vio rs to the ir unde rlying c o g nitive de fic its c a using unde r- dia g no se o f c o -mo rb id c o nditio ns 1 • L imite d inte rve ntio ns ide ntifie d • Misdia g no sis le a ds to : 10, 5, 11 – ina ppro pria te ho spita l unit tra nsfe rs – inc re a se d le ng th o f sta y – e me rg e nc y e ve nts – e ve n de a th • Co mmo n misdia g no sis - DE L IRIUM Purpose • Ove rc rowding of pa tie nts’ dia g nose d with psyc hia tric illne ss • Co- e xisting me dic a l c onditions is o fte n the c o ntrib uting fa c to r to de lirium . – Ina ppropria te pla c e me nt • No sta nda rdize d tool tha t disting uishe s b e twe e n de lirium a nd psyc hia tric illne ss. Geiss 2

APNA 30th Annual Conference Session 2045: October 20, 2016 Me thods • PHASE I – I nte rvie ws MDs & RNs (psyc h, E D, me d-surg ) – Ma jo rity a g re e / a wa re o f pro b le m – Ma jo rity wo uld like to se e inc re a se c o mmunic a tio n/ e duc a tio n with to pic • PHASE II – Cha rt Audit to ide ntify fa c to rs tha t c o ntrib ute to risk o f e me rg e nt me dic a l e ve nt • PHASE III – Cre a tio n o f to o l to a ssist in ide ntifying pa tie nts a t risk a nd a ppro pria te pla c e me nt Me thods • 2011-2015 – Re vie we d 80 psyc hia tric a dmissio ns • E me rg e nt Me dic a l E ve nt o r T ra nsfe r to Me d-Surg • T e a m o f RNs (E D, Psyc h, Me d-Surg ) – 57% o f the se pa tie nts we re de te rmine d to b e ina ppro pria te pla c e d due to de lirium Me thods • 40+ va ria b le s we re c o lle c te d – I de ntifie d thro ug h lite ra ture a nd c linic a l e xpe rtise – De mo g ra phic da ta – E me rg e nt E ve nt Da ta (Rapid Re spo nse T e am) – Co -mo rb iditie s – Me dic a tio ns – Vita ls (rig ht b e fo re e ve nt o c c urre d) – L a b s (rig ht b e fo re e ve nt o c c urre d) Geiss 3

APNA 30th Annual Conference Session 2045: October 20, 2016 Re sults • Pre se nc e o f Risk F a c to rs: – Ag e > 70 – Ab no rma l T e mp – Ab no rmal He a rt Ra te • T o o l Se nsitivity – 1 Risk F a c to r: Se nsitivity 91.6/ Spe c ific ity 51.4 – 2 Risk F a c to rs: Se nsitivity 68.7/ Spe c ific ity 85.8 F uture Pla n of Study • Asse ssme nt to o l in de ve lo pme nt tha t will he lp ide ntify patie nts at r isk fo r e me rg e nt e ve nts – Risk F a c to rs I de ntifie d in Re se a rc h Study – I nc o rpo ra ting De lirium Asse ssme nt (CAM) – Psyc hia tric E a rly Wa rning Sc o ring Syste m (E WSS) fo r e me rg e nt e ve nts – Psyc hia tric SBAR fo r c o mmunic a tio n ha nd-o ffs Re fe re nc e s 1. Jo ne s, S., Ho wa rd, L ., & T ho rnic o ft, G. (2008). ‘ Dia g no stic o ve rsha do wing ’ : wo rse physic a l he a lth c a re fo r pe o ple with me nta l illne ss. Ac ta Psyc hiatrSc and , 118, 169-171. do i: 10.1111/ j.1600- 0447.2008.01211.x 2. K o rn, C.S., Currie r, G.W., & He nde rso n, S.O. (2000). “Me dic a l c le a ra nc e ” o f psyc hia tric pa tie nts witho ut me dic a l c o mpla ints in the e me rg e nc y de pa rtme nt. T he Jo urnal o f E me rg e nc y Me dic ine , 18 (2), 173-176. 3. Nie uwe nhuize n, A., He nde rso n, C., K a ssa m, A., Gra ha m, T ., Murra y, J., Ho wa rd, L ., & T ho rnic ro ft, G. (2013). E me rg e nc y de pa rtme nt sta ff vie ws a nd e xpe rie nc e s o n Dia g no stic o ve rsha do wing re la te d to pe o ple with me nta l illne ss. E pide mio lo g y and Psyc hiatric Sc ie nc e s, 22, 255-262. 4. Re e ve s, R.R., Pe nda rvis, E .J., & K imb le , R. (2000). Unre c o g nize d me dic a l e me rg e nc ie s a dmitte d to psyc hia tric units. Ame ric an Jo urnal o f E me rg e nc y Me dic ine , 18 (4), 390-393. 5. She fe r, G., He nde rso n, C., Ho wa rd, L .M., Murra y, J., T ho rnic o ft, G. (2014). Dia g no stic o ve rsha do wing a nd o the r c ha lle ng e s invo lve d in the dia g no stic pro c e ss o f pa tie nts with me nta l illne ss who pre se nt in e me rg e nc y de pa rtme nts with physic a l sympto ms – a q ua lita tive study. PL OS ONE , 9 (11), e 111682. 6. Szpa ko wic x, M., & He rd, A. (2007). “Me dic a lly c le a re d”: Ho w we ll a re pa tie nts with psyc hia tric pre se nta tio ns e xa mine d b y e me rg e nc y physic ia ns? T he Jo urnal o f E me rg e nc y Me dic ine , 35 (4), 369-372. 7. T ho rnic ro ft, G., Ro se , D., & K a ssa m, A. (2007). Disc rimina tio n in he a lth c a re a g a inst pe o ple with me nta l illne ss. I nte rnatio nal Re vie w o f Psyc hiatry, 19 (2), 113-122. Do i: 10.1080/ 09540260701278937 8. F ro st, M. (2006). T he me dic a l c a re o f psyc hia tric inpa tie nts: sug g e stio ns fo r impro ve me nt. I nte rne t Jo urnal o f He althc are Administratio n, 4 (2). 9. T o fte g a a rd, K .L ., Gusta fsso n, L .N., Uwa kwe , R., Ande rse n, U.A., Be c ke r, T ., Bic ke l, G.G., … Bo rk, B. (2014). Whe re a re pa tie nts who ha ve c o - o c c uring me nta l a nd physic a l dise a se s lo c a te d? I nte rnatio nal Jo urnal o f So c ial Psyc hiatry, 1-9. do i: 10.1177/ 0020764014552866 10. Puska r, K ., He risko , C., & Urda , B. (2011). Me dic a l e me rg e nc ie s in psyc hia tric ho spita ls. I ssue s in Me ntal He alth Nursing , 32, 649-653. Do i: 10.3109/ 01612840.2011.587631 Geiss 4