The simulator can take a variety of forms. One example is the use of complete full-body manikins. These manikins may also have interactive features such as pulse, breathing sounds, and/or audio voice. These anatomical simulators may also allow for intubation practice with an airway or torso access for placing chest tubes. Highlighting the patient safety benefits of the experience, Oster and Braaten (2021) emphasize that this is “more than just play-acting or role- playing, an effectively designed and conducted simulation experience allows participants to suspend disbelief, immersing themselves in realistic sights, sounds, smells, feelings, emotions, stressors and human dynamics—all of which are consistent with the situation being simulated and the goals of the simulation” (p. 335). Client Safety in Behavioral Health Settings Although behavioral health and medical settings share many vulnerable care delivery processes, behavioral healthcare presents unique challenges. One challenge is that the symptoms associated with many mental conditions render clients vulnerable because of diminished ability to communicate effectively with providers. Also challenging are several at-risk groups: certain age groups (such as older adults suffering from dementia and children with ADHD), patients falling within certain diagnostic categories (such as severe mental disorders with psychotic features and co- occurring mental illness and substance abuse), and patients having certain procedures (such as electroconvulsive therapy). Moreover, behavioral health settings have different features than acute care hospitals (D’Lima et al., 2017; Thibaut et al., 2019), namely: ● A greater emphasis on outpatient or community-based care, including telehealth care ● The expansion of behavioral healthcare via the Affordable Care Act, especially within primary and pediatric care settings ● The increased risk of self-harm and suicide ● Greater emphasis from managed care insurers to provide patient care via partial hospitalization and intensive outpatient programming Two important regulatory initiatives target safety issues specific to behavioral health settings: The Joint Commission’s 2014 National Patient Safety Goals for Behavioral Health and individual state licensing board requirements for continuing education on medical error. Correct identification of clients is one of the Joint Commission’s 2014 Behavioral Health Care National Patient Safety Goals (The Joint Commission, 2014). Based on the rationale that misidentification can occur at any stage of diagnosis and treatment, this goal is intended for behavioral health settings where high-risk medications such as methadone are administered, and its aim is to reliably identify the correct individual for whom a particular service or treatment is intended. At least two identifiers are required. Acceptable identifiers include the patient’s name; assigned identification number; telephone number; or another type of person-specific identifier, such as birth date. In behavioral health settings with populations that are less in flux, such as group homes or individual therapy, visual recognition is an acceptable identifier. Psychiatric Hospitalization: Improving Assessment of Suicide Risk Hospitalized psychiatric patients who commit suicide are the most frequently reported sentinel event in behavioral health settings (reference). Paradoxically, suicidal risk can be misunderstood by behavioral health workers, who may lack in-depth training on successfully handling these types of patient risks. Some frontline staff report feelings of anxiety related to patients who are actively suicidal, and they also
Simulation practice and research has experienced a significant evolution in recent years, and evidence is clear that it is an effective tool, when properly designed with the optimal criteria. Simulation is another tool that is supported by current research and that enhances the quality and safety of patient care. Researchers point out that consulting with content experts and simulation professionals is critical for the success of this type of programming. Moreover, healthcare professionals can expect that simulations can be improved, according to Watts and colleagues (2021), by reviewing the relevant literature and research from the field, joining professional simulation healthcare organizations, participating in mentorship opportunities, and attending workshops and national conferences for advanced training. experience anxious concerns for their own safety. Naturally there is stress in being a healthcare worker responsible for the safety of patients with this type of issue (Morrissey & Higgins, 2018). Identifying individuals at risk for suicide is one of The Joint Commission’s 2014 Behavioral Health Care National Patient Safety Goals. Its purpose is to identify individuals who are at risk for suicide both during the time they are receiving treatment from a healthcare organization and following discharge. The 2014 goal requires conducting a risk assessment that identifies specific characteristics of the individual served (risk factors) and environmental conditions, such as the quality of social support and access to lethal weapons, that increase or decrease that risk (The Joint Commission, 2014). Interestingly, Large and colleagues (2018) sought to understand the clinical viability of certain assessment measures used on inpatient psychiatric units. Their meta- analysis uncovered several caveats for clinical practice. The first cautionary point issued by the research group was to realize that the classification of patients by high risk of suicide and low risk of suicide can be clinically deceptive. Researchers found that almost half of inpatient suicides occurred within groups that were clinically considered low risk, cautioning that clinicians must realize that certain assessment classifications will provide a false sense of security in preventing patient suicide. Moreover, their research uncovered that a significant number of high-risk patients will not go on to commit suicide. This caveat from the research team emphasized the importance of tempering the use of intrusive coercive interventions within this patient group. Overall, the study emphasized the limited reliability of standard assessments and rote interventions to effectively predict or prevent patient suicide. Rather, Large and colleagues (2018) a thorough and sympathetic assessment of the patient’s individual circumstances and current treatment needs should always form the basis of an inpatient treatment plan” (p. 1126). Patient Safety: Behavioral Practice in Primary or Outpatient Care Of course, a percentage of people commit suicide and are not receiving any type of ongoing care from a behavioral, medical, or inpatient psychiatric provider—simply put, they are in the community. Additionally, suicide rates are difficult to accurately gauge because of the impossibility of knowing the true intent of the victim. Despite this difficulty, reported suicide rates are at a 70-year high in the U.S. (Martínez-Alés et al., 2022). Interestingly, Ayer and colleagues (2022) have uncovered data that indicates that 80% of suicide victims have had contact with primary care, defined as family medicine, internal medicine, or women’s health, within one year of their suicide, and that 44% of suicide victims have had contact with primary care within one month of their suicide.
Page 61
Book Code: PCUS1525
EliteLearning.com/Counselor
Powered by FlippingBook