1. Illinois Division of Mental Health Quality & Safety Improvement Initiative Charter Team Topic: Health Crisis Hospital: Madden MHC QCSI III Charter Teams Report Out Meeting June 24, 2013 – Springfield, IL DRAFT: For Review and Discussion1

2. Charter Team Members Team Leader: Joyce Miller, MD, Medical Director Charter Team Members: – Robert Petkofski, DON – Facilitator – Edith Newman, HA – ex-officio, non-voting member – Laura Godinez, QM – Recorder – Myounghee Koo, MD – Medical Specialist – Martha Alexander, RN – CNM – Marty Hines, Consumer Specialist – Elsy Joseph, RN – Diana Nesbitt, LPN – Wanda McNeal, MHC DRAFT: For Review and Discussion2

3. Topic: Risk Assessment: Health Crisis Overview of Deliverables Draft Administrative Directive Appendices  Form for Medical Clearance  Parameters for specific conditions Training Outline Patient Education Materials Outline for monitoring and evaluating process DRAFT: For Review and Discussion3

4. QCSI Charter Team Work Process Held weekly meetings and assigned tasks between meetings. Collected/reviewed policies, procedures and forms from other facilities. Developed a questionnaire for patient input. Reviewed aggregate data from all facilities on medical issues. Consulted with team sponsor. Reviewed evidence based article provided by sponsor. Searched internet for resources. DRAFT: For Review and Discussion4

5. Difficulties/Barriers Extremely limited time frame to complete extensive amount of work. Additional/competing demands for time. Resources to purchase equipment or materials (blood pressure machines, staff training materials, patient education materials) DRAFT: For Review and Discussion5

6. Deliverables/Work Products Administrative Directive for Assessing and Managing Health Crisis. Includes:  medical clearance process.  initial assessment of medical conditions.  process for identifying and reporting Health Crisis or change in condition.  mandate for initial training and annual competencies.  mandate for monitoring and evaluation of processes. DRAFT: For Review and Discussion6

7. Deliverables/Work Products Appendices for Administrative Directive  Standardized list of conditions to exclude for medical clearance.  Medical Clearance Form  History and Physical Forms  List of co-existing medical diagnosis DRAFT: For Review and Discussion7

8. Deliverables/Work Products Training Plan Initial training/orientation for new employees Annual refresher training for all direct care staff Key points: common co-existing medical diagnosis in psychiatric patients signs and symptoms of health crisis and recognizing changes in condition Process for reporting health crisis and responding to the crisis Training and competencies for staff taking vital signs – pulse, temps, respirations, blood pressure – both manual and automatic DRAFT: For Review and Discussion8

9. Deliverables/Work Products Monitoring & Evaluation Measures/Activities  Screening  Track # of patients sent back to ER within 24 and 72 hours.  Assessment  H&P auditing: Peer Review, OPPE - presence/quality/handoff  Patient Education  Pre and Post test for understanding of conditions DRAFT: For Review and Discussion9

10. Deliverables/Work Products  Change in condition  Log treatment of medical conditions on unit  Name and time patient told staff of problem or Staff noticed change  Time Staff notified RN  Time RN notified MD  Time MD arrived  Disposition/time sent out.  Discharge Planning  Follow up care and recommendations for medical condition DRAFT: For Review and Discussion10

11. Outstanding Questions/Issues Did not address patients coming from jails Did not address those hospitals that have fewer alternative services besides the SOF. Are there other co-existing diagnosis we should consider – particularly in the longer term setting. Investigate/standardize patient education materials further DRAFT: For Review and Discussion11

12. Lessons Learned/Recommendations Though automatic BP machines are easier to use, they are less reliable. Regular training on use of manual BP machines is advised. Physicians could benefit from more frequent in-services on change in conditions DRAFT: For Review and Discussion12