Dialogue Volume 14 Issue 4 2018 - Page 32

PRACTICE PARTNER Empower patients too, by encouraging them as they work to calm themselves. And if what you’re doing isn’t working, see if a colleague might have more success before you turn to other options. Studying data around incidents can also lead to solutions. At St. Joseph’s Healthcare in Hamilton, the Schizophrenia and Commu- nity Integration Service noted an increased risk of responsive behaviours at breakfast. They interviewed staff, looked at patterns and found many early warning signs in the 12 hours prior, during the night shift. So the team worked to de-escalate responsive behaviour before it turned into a violent in- cident. They also moved team safety huddles to before breakfast for the most at-risk units, and increased staff presence at breakfast. Incidents have since gone down. Doctors and When responsive behaviours other health-care are happening, always try to get at the root causes, says Dr. David professionals Conn, VP of Education and a should never be staff psychiatrist at Baycrest in surprised by or Toronto. He notes that a lot can be at play, like physical reasons unprepared for (e.g., the condition or pain), such situations changes in cognition, emotional reactions, the environment (is it noisy or crowded?), etc. For doctors, patient-centred care and level-headedness should prevail. “If we get upset, they’ll get more upset,” says Dr. Conn. Dr. Peter Prendergast, CPSO Medical Advisor and a psychiatrist, says restraints, both physical and chemical should be the last resort. They’re especially dangerous for the frail elderly. Skilled non-confrontational com- munication, he says, is the key to lowering the temperature. Baycrest is working on an app that will give staff instant information on patients (mostly those with dementia), such as their background, family, likes and dislikes, etc. It 32 DIALOGUE ISSUE 4, 2018 will encourage staff during tense moments to see patients as people, not as a situation to handle. And knowing more about them, says Dr. Conn, just might help people keep their own tone or attitude respectful. In implementing de-escalation techniques, think too of logistics, says Dr. Prendergast. He says that when a coronary event happens at a hospital, everyone knows what role to play. Yet when a patient or visitor has a vio- lent outburst in a hospital, there’s confusion as to who does what. It can create chaos and uncertainty. That shouldn’t happen, he says. Staff should have an understanding as to who will take the lead role in calming and relationship-building with the patient, who will clear the room of other patients, and who will ensure that chairs and other potential weapons in the room are not at hand. A training program organized by the facility and taken by employees will foster a team approach that ensures everyone is working from the same script. Responding on the fly makes things more dangerous for everyone, including the patient, other patients and staff. Dr. Prendergast says that it’s not necessarily the doctor who has to take the lead. In fact, if a doctor happens onto the scene and tries to take the lead, but hasn’t been trained in de-escalation, he or she could undo the work of whomever may have been having some success in calming the agitated patient. Some doctors are better than others at de-escalation. When de-escalation programs started, nurses (being the most vulnerable to assault) were the ones who pushed for change. Dr. Prendergast suggests that all doctors should take de-escalation training, because you never know which patient will become aggressive or violent. Doctors and other health-care professionals should never be surprised by or unprepared for such situations – and that means having strategies to defuse them. MD