In March 2016, the Inpatient Behavioral Health staff was informed that the unit would be going on full diversion due to a staffing crisis in the adult psychiatric practice. After consideration of other options, the administration decided to continue to provide services to patients with behavioral health needs in acute care departments despite the full diversion of the Inpatient Behavioral Health Department and no psychiatrist available for consultation.
A Behavioral Health Resource Team (BHRT) made up of behavioral health (BH) nurses, social workers (SW), chemical dependency counselors (CD) and recreational therapists (RT) was developed to meet those needs in the bed tower and EUCC. RNs from the BHRT continue to support the Family Medicine Residency program with a Behavioral Health Resource RN (BHRN established in 2015) and with an RN serving the four BH residential facilities (established in 2014).
The team came together in June 2016 and developed processes to define work flows and develop standard work using LEAN and self-directed work team principles. The team had their work developed within three weeks of coming together (two weeks ahead of time) and went live July 18, 2016. Work flows and standard work continue to be improved through weekly huddles and PDSA cycles.
The BHRT completes assessments and makes recommendations for: behavioral interventions, medication management, diversional activities, coping skills, chemical dependency care, patient care plans, discharge planning, and overall coordination of care and safety education. If the patient does not want to work with the team, they will still provide support/education to family and staff as needed.
Since the BHRT implementation in July 2016, violent restraint episodes have decreased from 112 to 3 per month (97.3 %) and nonviolent restraints have decreased from 224 to 19 per month (91.5%).
Listed below are some of the quotes by the staff in the acute care departments in response to the BHRT available as a resource to them:
"During rounding, they're always open to hear what possible patients we have"
"Always consistent with follow-up"
"Great experience of one of the RN's sitting with an agitated patient for hours to help calm them"
"Great resource to help understand the patient and have different perspectives especially if the patient is confused and unsafe"
"Nice to have early intervention on at risk patients"
Listed below is a sampling of positive outcomes from the BHRT:
RT visited with patient who was in restraints, but who calmed down with RT contact and diversional activity and was able to have restraints removed.
RN paged to go to combative patient's room, they had barricaded staff out of room. BHRT RN intervened and patient agreed to and allowed care on 7thfloor.
BHRN worked with two doctors to plan for medication change for patient with history of intolerance to many different antidepressants.
Patient in EUCC was hallucinating, was given a sound machine, and was able to fall asleep. Patient very grateful for sound machine and ability to relax/rest.
CD worked with a doctor, who agreed to give prescreen tear offs to those who are not seen by CD or SW.
I could go on and on about the invaluable care the Behavioral Health Resource Team provides. This team provides mental and spiritual care to the patient while the patient is here for a physical issue. The team takes care of the patient, family and is resource to staff. They have taken to heart Relationship Based Care in the care of others.

Members of the Behavioral Health Resource Team:
Oversight:
Heidi Rekow, BSN, RN (RN Leader)
Nan Anderson, RN, Director (retired)
Erica Runkle, RN, Director
Betty Jorgenson, MSN, RN, Administrator
Jeanine Scherbring, Director
Amber Sherman, L.C.S.W.
Amanda Kubista, MSW

BHRT RNS:
Kim McMahon, BSN, RN
Isaiah Dyke, AD, RN,
Craig Peterson, AD, RN
Toni Haun, AD, RN
Gary Wilhelmson, AD, RN
William Boisvert, AD, RN
Lauren Oldenburg, AD, RN
Danielle Olstad, AD, RN
Jamie D'Agostino, BSN, RN
Susan Cieslicki, MSN, RN
Ratha Elliott, AD, RN

BHRT RT:
Barb Sims, RT
Patty Horstmann, RT
Fawn King, RT
Sarah Yeiter, RT

BHRT CD Counselor:
Pam Reynolds, LCDC
Heather Roellig, MS

BHRT SW:
Pam Davis, BSW
Vicki Sanwick, BSW
Tatiana Wolf, MSW
Becky Rauch, MSW
Robert Hanson, MSW
Molly Marty, BSW
Emily Mortenson, MSW
Lisa Campbell, MSW
Molly Weis, MSW
Bridget Garrity, MSW
Catherine Lange, BSW
Kris Lynch, MSW
Carrie Rein, MSW