Rationale / Objectives
In Coney Island Hospital (CIH), the stress factor and potential for violence levels were high, placing added importance on having staff that are trained to properly anticipate potentially volatile situations and take steps to de-escalate them. CIH’s goal was to change staffs’ mindset regarding how they responded to and managed violent situations. 1
Project/Program Description & Major Achievements
CIH implemented The Crisis Prevention Institute (CPI) training model. CPI is an international training organization that specializes in the safe management of disruptive and assaultive behavior. Using the CPI training model, CIH trained all staff in team-oriented crisis prevention techniques. One year after program start-up, approximately twenty staff members became CPI Instructors. They created and trained a "Code Grey team," which would activate as soon as a potentially escalating situation was identified. The team would then draw upon their CPI training to bring the situation under control. CIH witnessed a dramatic decrease in staff and patient injuries due to violence. A sense of fear between staff has been eliminated, and staff confidence levels have increased. 1
The MAPA program (Management of Actual or Potential Aggression) and the Dementia Capable Care Behaviours program reduced the use of restraints and seclusion from an average of eight episodes per quarter in 2008 to some quarters in which no restraints were used during some quarters in 2009. Similarly, a significant increase was seen in the number of patients accepting oral medications as opposed to intramuscular (IM) injections for agitation.
CIH found that when staff took on responsibility for training, they integrated the skills and became true leaders in managing teams to effectively carry out the CPI regimen. The CPI training fostered junior staff growth and assumption of greater responsibility. 1
CPI was established in 1980 for human service professionals to address the need for crisis prevention and intervention training using safe, respectful, noninvasive methods. CPI is committed to best practices and safe behavior management methods that focus on prevention. Through a variety of specialized offerings and innovative resources, their programs educate and empower, and create safe and respectful work environments.
The Crisis Prevention Institute has 3 main programs:
Management of Actual or Potential Aggression (MAPA): equips staff with safe and effective physical interventions to manage the more challenging and aggressive behaviors.
Clinical Holding (CH-3): helps staff in: Making best-interest decisions, safely delivering essential care and treatment, improving patient outcomes, satisfying legal and ethical responsibilities, ensuring clinical excellence and effectiveness and minimizing reputational risk.
Dementia Capable Care Behaviours program: delivers comprehensive training to boost staff confidence and equip them with skills to deal with dementia patients. 1 2
In 2008, CIH averaged more than eight episodes per quarter in which restraints or seclusion had to be employed on dementia patients. Just a year later, they witnessed a remarkable reduction in such events, to where there were no restraints used during some quarters in 2009. Similarly, a significant increase was seen in the number of patients accepting oral medications as opposed to intramuscular (IM) injections for agitation. The sense of fear has been eliminated, and a shared language has transformed the old "custodial" culture and invigorated the units with a far more therapeutic spirit and more cohesive relationship between hospital security and other hospital staff. 1
|Restraints used on dementia patients||More than 8 episodes per quarter||Baseline prior to intervention program, 2008|
|Restraints used on dementia patients||Improved (no restraints in some quarters)||After introduction of intervention program, 2009|
|Number of patients accepting oral medications||Increased||As compared with intramuscular administration, 2009|