Children's Hospitals Today - Winter 2023 - 8

ROUNDS / FROM EXPERIENCE
How to reduce staff injuries
A 90-day sprint led to decreased staff harm, patient self-harm and
use of restraints among behavioral health patients.
BY ABBY MOOG and INGRID LARSON
T
he national crisis in children's
mental and behavioral health has
caused a rise in admissions at Children's
Mercy Kansas City in those patient populations,
leading to increased escalations
and more frequent and severe staff injuries.
In response, the hospital created
an improvement team and launched a
90-day sprint to address the growing
problems. The initiative achieved substantial
reductions in staff injuries, patient
self-harm, and the use of restraints with
behavioral health patients.
The initiative was based on the Rapid
Results framework, a method for getting
results in under 100 days. Children's
Mercy set three goals:
 Reduce the total use of
pharmacological and physical
restraints by 25%.
 Reduce the risk for self-harm in
patients with suicidal or homicidal
ideation by 20%.
 Reduce reported physical staff
injuries related to behavioral
health patients by 30%.
The goals were executed by three workgroups
within the behavioral health rapid
improvement team (BHRIT) focused on
specific areas: patient cohorting and unit
staffing, staff education and training,
and staff support. The workgroups were
led by a doctor/nurse dyad leadership
structure and supported by an administrative
sponsor. BHRIT overall was
also supported by an executive sponsor,
a coach and a communications and marketing
specialist. The team represented a
variety of disciplines and levels of staff,
including nursing, social work, regulatory,
child life, psychology, psychiatry,
local leaders and frontline staff.
Patient cohorting
and unit staffing
The patient cohorting and unit staffing
workgroup focused on environmental
modifications to improve the care of
patients and decrease patient escalations.
They sought to group behavioral
health patients on one unit to require
less staff, but regulations prohibited it.
Instead, the team implemented facility
BY THE NUMBERS
A 90-day sprint at Children's Mercy Kansas City caused a reduction in staff
and patient harm and restraints for inpatients.
33% 78% 14% 11%
reduction in
frequency of staff
injuries
reduction in
violent physical
restraints
reduction in
pharmacological
restraints
reduction in
risk for patient
self-harm
8
CHILDREN'S HOSPITALS TODAY Winter 2023
room modifications, adapted a patient
room risk-mitigation checklist, and
built confirmations into Tracers with
AMP, a Joint Commission resource,
for ease of collection. These changes
resulted in safer rooms by removing
items and equipment that could pose
a risk for patient self-harm, such as
sharp objects, choking hazards and
ligature points. Additionally, the workgroup
initiated remote monitoring of
patients with eating disorders. This
allowed more one-on-one observers to
stay with the more aggressive patients
while still preventing self-harm in the
patients with eating disorders.
Education and training
The education and training workgroup
focused on preparing staff to meet the
needs of patients and provide interventions
to reduce patient escalations.
The group implemented three pilots:
increase Mandt training, provide foundational
behavioral health education to
all clinical staff, and produce soothing
stations for patients.
Children's Hospitals Today - Winter 2023

Table of Contents for the Digital Edition of Children's Hospitals Today - Winter 2023
