Matthew Ireland

Lauren Hartley

George Blundell

Staff Training - The Effects on their Sense of Safety & Wellbeing & Impacts on Daily Practice as a

Caregiver

Matthew Ireland

Lauren Hartley

George Blundell

St John of God Richmond Hospital

• Hospitaller Order of St John of God purchased Belmont House in 1951

• 88 Bed Private Psychiatric Hospital in North West Sydney

• 40 acre site

• Classified as a semi-rural hospital

• Tennis courts, ‘mini golf course’, Aboriginal memorial site, 500m driveway, chapel, monastery, pool, other service buildings

• Falls within Hawkesbury LGA

• 25 minutes to Ambulance & Police

Matthew Ireland

Lauren Hartley

George Blundell

Matthew Ireland

Lauren Hartley

George Blundell

Matthew Ireland

Lauren Hartley

George Blundell

Matthew Ireland

Lauren Hartley

George Blundell

What we do

• Inpatient & day patient programs

• Outpatient medical consultations

• Outpatient allied health consultations

• Treatment programs;

– Anxiety & Depression

– Psychogeriatric & enduring mental health issues

– Alcohol & Other Drug (AoD)

– Post Traumatic Stress Disorder (PTSD)

• All programs are voluntary

• Any patient needing treatment under the Mental Health Act (2007) must be transferred.

Matthew Ireland

Lauren Hartley

George Blundell

Identifying the need for change

• New leadership

• Greater occupancy

• Changes in nursing skill mix

• The intensity of aggressive incidents has increased

• Very near misses

• Existing training was not meeting the new demands

• Our patients have changed….

Matthew Ireland

Lauren Hartley

George Blundell

Complex demographics

– PTSD

• New theatres of war

• Longer periods on the front lines

– AoD

• Changes in the patterns of substance use

• Changes in the substances being used

– Increasing number of enquiries via forensic programs

– Greater complexity to social situations

Matthew Ireland

Lauren Hartley

George Blundell

Effects on the clinical team

• Perception of patients problems

– Inappropriate for the treatment setting

– Too complex

• Clinical staff withdrawal from treatment areas

– Lack of confidence

• Staff conflict

– Inconsistent treatment expectations

• Insufficient care planning

– Focussed on routine tasks, not on behaviour

• Reactive interventions

• Increased requests for a security presence.

Matthew Ireland

Lauren Hartley

George Blundell

Case Study

• 28 year old male

• Ex-Army

• 1 Tour of Afghanistan

• PTSD diagnosis

• Complex polysubstance use

• Unstable living situation

• Poor social relationships & supports

• Difficult to engage in treatment

Matthew Ireland

Lauren Hartley

George Blundell

Case Study

• Patient on unapproved leave/absconded from hospital on a Sunday

• Returned intoxicated to the hospital during early hours Monday morning

• Administrative decision made to discharge following morning

• Patient told at approx. 9am of decision

• Discharge delayed awaiting return call from VMO

• Communication breakdown with client ?considered discharged?

• By 3pm the patient has become extremely agitated, verbally aggressive and physically threatening

• No return phone call from VMO due to working in area with poor mobile reception. No alternate contact details.

Matthew Ireland

Lauren Hartley

George Blundell

Case Study

• Verbally abusive

• Physically threatening

• Extremely high level of distress

• Emergency response called

• Patient self harming – bashing head against a brick wall

• Other patients trying to de-escalate the situation

• Patient charged at emergency responders

• Restrained by two other patients on the floor

Matthew Ireland

Lauren Hartley

George Blundell

Behavioural incidents Sept 2014- Sept 2017

17

10

14

10

18

13

9

17

7 811

21

1316

19

28

17

33

19

24

1114

9 8

12

Sep

-14

Oct

-14

No

v-1

4

De

c-1

4

Jan

-15

Feb

-15

Mar

-15

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Richmond Hospital, Behavioural Trends for the displayed period.

Behavioural Trends

Matthew Ireland

Lauren Hartley

George Blundell

Addressing the problem

• New leadership

• Security audits

• Clinical supervision

• Strengths and recovery oriented practice

• New de-escalation training program

Matthew Ireland

Lauren Hartley

George Blundell

Addressing the problem

• New Leadership

– Management & clinical leadership

– Existing managers embracing change

– More inclusive

– Driving positive culture change

– Investing in training and people

Matthew Ireland

Lauren Hartley

George Blundell

Addressing the problem

• Security review

– Audit of our physical environment

• Challenges getting this done

• Remote location

• Expansive grounds

• Difficulties controlling access

– Audit of our response systems

• No security onsite

• Long response times for police & ambulance

– Building relationships with the local police, public treatment services.

• Police security audit

• Community liaison

Matthew Ireland

Lauren Hartley

George Blundell

Addressing the problem

• Clinical supervision for clinical staff and managers

– ‘Clinical supervision is a process within which the clinician brings his or her practice under scrutiny in order to more fully appreciate the meaning of their experience, to develop their abilities, to maintain standards of practice and to provide a more therapeutic service to the client” (Mike Consedine, 1995)

– Sessions offered everyone month to clinical staff and managers

– Shown to reduce staff burnout

Matthew Ireland

Lauren Hartley

George Blundell

Strengths and recovery

Matthew Ireland

Lauren Hartley

George Blundell

Strengths and recovery

• Workshops for managers, senior clinicians, junior clinicians

• Shifting the treatment focus to the strengths of the individual

• Recovery oriented practice

• Top to bottom changes

• Changing the language we use with and about people in our care

• Changing the way we approach challenging behaviours in our policies and procedures

• Finding new and innovative ways to empower our patients

Matthew Ireland

Lauren Hartley

George Blundell

New de-escalation training program

• Whole day added to mandatory training

• In house ‘train the trainer’

• 2 session a month from Jan 16 to May 16

• All staff receive the same training ie. clinical, hotel services etc.

Matthew Ireland

Lauren Hartley

George Blundell

New training program

• Program addresses;

– Identifying patient warning signs

– Identifying stages of crisis development

– Identifying our role in an incident• How not to become a risk factor

• How to respond to different stages of crisis

– Break away techniques

– Post incident interventions• System review

• Care plan review

• Staff development needs

• Multi-departmental

Matthew Ireland

Lauren Hartley

George Blundell

Question One: I feel more confident working with people displaying aggressive behaviours (N=25)

0% 0%4%

56%

40%

Strongly Disagree Disagree Neutral Agree Strongly Agree

Matthew Ireland

Lauren Hartley

George Blundell

Question Two: I found the training provided me with skills that I can use in my day to day practice (N=25)

0% 0% 0%

48%52%

Strongly Disagree Disagree Neutral Agree Strongly Agree

Matthew Ireland

Lauren Hartley

George Blundell

Question Three: I feel more confident in my team members and their ability to support me when dealing with aggressive behaviours (N=25)

0% 0%4%

52%

44%

Strongly Disagree Disagree Neutral Agree Strongly Agree

Matthew Ireland

Lauren Hartley

George Blundell

Question Four: I would recommend this training to others to increase their confidence in managing aggressive behaviours (N=25)

0% 0% 0%

44%

56%

Strongly Disagree Disagree Neutral Agree Strongly Agree

Matthew Ireland

Lauren Hartley

George Blundell

What benefits do you feel you have gained through attending this course?

“Confidence and skills” “More confidence”

“Increased my confidence to handle it if there is an incident.”

“SJOG Richmond is the first hospital I've worked at that has offered this training. Increased awareness, better understanding of how to de-escalate and guard against aggression”

“More realistic ways to deal with aggressive behaviours”

“Confidence in working with patients. The scope in which I can practice/deal with aggressive behaviour”

Matthew Ireland

Lauren Hartley

George Blundell

Where are we now?

• Critical mass of staff have attended the training

• Response has been overwhelmingly positive

17

10

14

10

18

13

9

17

7 811

21

1316

19

28

17

33

19

24

1114

9 8

12

Sep

-14

Oct

-14

No

v-1

4

De

c-1

4

Jan

-15

Feb

-15

Mar

-15

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Richmond Hospital, Behavioural Trends for the displayed period.

Behavioural Trends

Train the trainer

Staff training commences

Critical mass

Matthew Ireland

Lauren Hartley

George Blundell

Where to next?

• Random training drills

• Post incident follow up with staff

• Root cause analysis

• Consumer driven care planning

• Strengths and recovery oriented care processes

– Documentation redesign

– Greater transparency

– Greater participation

• Working partnerships with Hawkesbury District Health Service

– Resource sharing

Matthew Ireland

Lauren Hartley

George Blundell

Questions?