Lancaster Physician Fall 2020 - 11

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Christy Kreider, Nurse Manager, Behavioral Health Services; David Domanski, Behavioral Health Technician; Anna Workman, Behavioral Health Technician;
Robert Wolpert, Security Officer

Any staff member in the hospital may call
the BERT if they are having a difficult time
calming a patient and would like support. So
far this year, hospital staff has called the team
for help about 30 times at Ephrata and more
than 400 times across the system.
BERT includes team members who have
distinct roles and work to support each other.
At Ephrata, the BERT members who respond
to calls include:
* A member of the hospital's behavioral
health staff, who talks to the patient and
addresses concerns using therapeutic crisis
intervention techniques.
* An intensive/progressive care unit nurse,
who works with the bedside nurse to identify
any possible medical causes or treatments
for the crisis behavior.
* The hospital nursing supervisor, who looks
at the staffing needed for the patient, to
ensure that the patient has the right kind
and amount of help needed.
* A member of the security department, who
can provide additional support if needed.
Workplace violence against nurses has significantly increased in the past decade across the
country. A study in the Journal of Emergency
Nursing reports that 76 percent of registered
nurses report experiencing workplace violence,
with about 30 percent of them reporting physical
abuse. WellSpan began the program because it
wanted everyone, including its staff, to feel safe
in its hospitals.
WellSpan's BERT program is new, and leaders
are still collecting data, but early indications
are that the program is decreasing both the

frequency of and the costs associated with
workplace injuries as well as reducing the use
of medical restraints for patients.
Across the system, about 75 percent of
BERT calls were successfully de-escalated since
the beginning of the year. Also, staff members
have expressed more confidence in dealing with
potentially disruptive or threatening behaviors.
The program has helped staff members to
understand more about the triggers for crisis
situations: alarms, noises, lights, crowds, a lack
of choices, waiting, being touched, feeling
misunderstood, and having communication
issues. They are tracking the most likely time
of day and day of the week for BERT calls so
they can understand any additional potential
triggers for patients. They already have learned
to take proactive measures if they have upset
or confused patients: removing unnecessary
items to reduce the possibility that patients
may throw things; keeping rooms quiet and
free of commotion as much as possible; and
maintaining a calm, listening presence.
"When the BERT is activated, one person
talks at a time to the patient, reorients them,
sees what their needs are, what is triggering the
problem, and how we can help them," Kreider
says. "They might say, 'I can see you are upset.
Can you tell me what is making you feel this
way? Is there something I can do for you?' "
After a BERT call, the hospital's behavioral
health staff will check on the patient the following day to see how they are feeling and if they
need any additional help.
David Domanski and Anna Workman, two
behavioral health technicians at WellSpan Ephrata Community Hospital, are BERT members.

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"We don't know what situations we are necessarily getting into," Domanski says, "but we
have a whole team. Only one person needs to
have a good idea for the solution. It's good to
have more people to brainstorm and see what
we can try to de-escalate the situation."
Workman said that patients may not be
in the hospital for a mental health need, but
they may still need mental health support if
they grow confused or angry from being on
medication, being ill, being away from home,
or just feeling scared.
"We are eager to work with other nursing
floors to provide support and care to patients
who have mental health symptoms," Workman
said. "We saw this as an opportunity to break
the mental health stigma while working with
other units."
Robert Wolpert is a security officer at WellSpan Ephrata Community Hospital and a part
of BERT. Before BERT, security officers were
the ones called to respond to crisis situations.
Now Wolpert supports and works with others.
"It's a team-based thing," Wolpert said. "First
and foremost, we try communication. Most
of the time patients are pretty frustrated and
just really want to be heard. The team shows
compassion for what they are saying and how
they are feeling. They are listening to listen, and
not really to respond."
Wolpert has found that BERT training is a
useful skill in life.
"Conflict can happen anytime and anywhere,"
he said. "You can use the training with others to
validate their feelings and talk to them in a way
they can feel heard. This helps you understand
how to really go about that."



Lancaster Physician Fall 2020

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