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ABSMC MRI Hours and Ordering Process

Posted on Jul 7, 2017 in Uncategorized | 0 comments

Donner Network West Recognition

Posted on Jul 7, 2017 in Uncategorized | 0 comments

Donner Network West has recognized ABSMC for its invaluable contribution in the field of eye and tissue recovery for the second year in a row. 2016 Silver Award recognizes hospitals for meeting and exceeding key metrics vital to successful eye and tissue recovery programs.

Pictured l to r: Nakia Madrigal, Donor Network West; Jeff Chen, M.D.; Kristina Kury, M.D.; Lylian Muttakywawa, Assistant Nurse Manager, ICU and Angela Rosati, Donor Network West.

Identifying and Managing Aggressive Behavior

Posted on Sep 6, 2016 in Uncategorized | 0 comments

Skills for managing aggressive behavior are essential to all staff providing human services. When confronted with potential violence, a person lacking training and skills in managing aggressive behavior tends to revert to ineffective instinctive responses, which are based on fear and self-preservation.

In order for us to develop the tools necessary to effectively manage aggressive behavior, it is important to understand the stages or levels of crisis development. The purpose of identifying the four levels of crisis development is to attempt to meet the distinct levels with the appropriate response to de-escalate and defuse.

  • Anxiety Level. Simply, anxiety is a noticeable change in a person’s behavior manifested by a higher level of energy expenditure. You may notice that there is something “different” about the person or that the person seems to be pacing without reason. This level is where most potentially volatile situations are defused. Staff members may effectively de-escalate by employing the Supportive Response at this level. The Supportive Response simply is to engage in active listening and be empathetic. Being dismissive or judgmental of the person’s source of anxiety contributes to an escalation into the next level.
  • Defensive Level. If staff did not recognize or was unable to intervene successfully at the Anxiety Level, an individual may enter this next level of crisis development, the Defensive Level. At this level, the individual will give verbal and nonverbal clues indicating a loss of rationality and self-control. The defensive person may challenge you and your authority. As the defensive person’s self-control deteriorates, you may find yourself a victim of verbal abuse and button pushing. Your race, weight, sex, and other sensitive areas are most often targeted by the defensive person to test your limits and professionalism.
    At this critical level of the crisis, a Directive approach by staff to establish behavioral limits may be effective. The key to successful intervention at this level is to set clear and simple limits in a non-negative manner. Deliver your directive in a way for the defensive person to understand that consequences are based on their decisions. Issuing “ultimatums” are usually ineffective. Consider the following two ways of delivering the same directive:
  • Clear and non-negative: “You may remain in the waiting room if you stay calm and not disturb other individuals who are also here to seek help. With your cooperation and understanding, I will be able to assist everyone.”
  • Ultimatum: “You need to be quiet or I will call security to have you removed.”

Dealing effectively with a defensive person to set behavioral limits requires a calm, professional approach and your loss of self-control could escalate the crisis to a dangerous level.

  • Acting-Out Level. If staff was unsuccessful in setting reasonable behavioral limits to de-escalate a crisis while in the Defensive level, the individual may lose total control. The Acting-Out person may resort to physical aggression and attempt to cause physical harm to staff, bystanders, or himself. At this level, physical intervention may be necessary as a last resort. It is imperative to follow policy and procedures during this level of crisis management.
  • Tension Reduction Level. Regardless of the prior level(s) of crisis development reached, the Tension Reduction Level is the final stage. Unfortunately, this level is most often forgotten or ignored even though it may be the most important stage of a successful resolution. At this stage, the individual starts to come down from the peak energy expenditure plateau. This stage is often recognized by either a reduction in physical energy (if restrained) or a change in behavior. The key point to remember is that the individual is beginning to regain control and rationality. You may facilitate this process by establishing therapeutic verbal communication. This is realized by encouraging deep breathing and being informative on the sequence of events to follow. A compassionate approach is most effective at this final level of managing a crisis.

This article is not intended to oversimplify the approach or techniques to managing aggressive or violent behavior. It is merely an introduction to bring awareness to how a crisis develops and the most basic guidelines for establishing an appropriate response to intervene and de-escalate.  The guidelines suggested here are recommended by the Crisis Prevention Institute (CPI).

The ABSMC Security Department facilitates an onsite eight-hour CPI Nonviolent Crisis Intervention training program which emphasizes recognition and early intervention for prevention of managing disruptive behavior. If you are interested in participating in the training program, please contact your department manager.

Finally, despite our best efforts at prevention, volatile situations do occur. Staff should familiarize themselves with the Fast Facts Emergency Response Instructions located in every department and work station.  The booklet allows you to customize department specific responses to emergencies including abusive/assaultive behaviors.

In addition to the Code response procedures listed in the Fast Facts, you may contact the Security Operations Center (SOC) directly at any hour to report non-emergency related security concerns.

  • Alta Bates/Herrick: 747-7847; Summit: Ext 7847
  • Berkeley Police non-emergency: 510-981-5911
  • Oakland Police non-emergency: 510-777-3333
  •  Emergency Line: Alta Bates/Herrick: Ext 611; Summit: Ext 5555

By John Ramirez
Administrative Director Support Services & Facilities

           

 

 

 

Admitting Guidelines for Telemetry

Posted on Aug 1, 2016 in Uncategorized | 0 comments

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Inpatient Status

Posted on May 5, 2016 in Uncategorized | 0 comments

  • Appropriate for:
    • A patient whose medical condition, safety or health would be significantly threatened if care is provided in a less intensive setting, ­and
    • Who requires 2 or more midnights of medically necessary services in the hospital
  • Orders in Sutter EHR (EPIC)
    • Admit to Inpatient
    • Admit Direct
    • Admit to Inpatient from Observation
  • OUTPATIENT STATUS
    • Includes Emergency & Laboratory/Radiology services, MD Office visits, and Same Day Surgeries, Observation, Ambulatory Surgery, Outpatient in a Bed
  • Observation is appropriate for:
    • Short term evaluation and/or treatment
    • Further work up is needed before a decision can be made to admit or discharge
    • Decision to admit or discharge made within 48 hours, usually < 24 hours
      • Examples: Abdominal Pain, Chest Pain, Gastroenteritis
    • Unexpected complication following an outpatient procedure
      • Examples: Delayed recovery from anesthesia, protracted vomiting
  • Observation is not appropriate for:
    • Medically stable patients requiring diagnostic or outpatient procedures
    • Procedures routinely performed as an outpatient
      • Laparoscopic cholecystectomy, Kyphoplasty, Pacemaker battery replacement
    • Patients awaiting placement: SNF, Board & Care, Conservatorship, etc.
  • Orders in Sutter EHR (EPIC)
    • Initiate Outpatient Observation
    • Change Patient Class from Inp to Obs
  • Outpatient in a Bed (OIB) or Ambulatory Surgery is appropriate for:
    • Patients within the “recovery” state following an outpatient procedure or surgery
      • Appendectomy, Thyroidectomy, TURP
      • Non-emergent, elective Cardiac Catheterization
  • Patients who need an overnight stay after an Outpatient procedure (late case)
  • Patients who do not meet medical necessary criteria for Inpatient or Observation and have non-clinical or social issues presenting barriers to discharge
    • Examples: Failure to thrive, patients dropped off in the ED for placement
  • Orders in Sutter EHR (EPIC)
    • Outpatient in a Bed
    • Ambulatory Surgery

By Manj Gunawardane, M.D., Summit Hospitalist Director; Physician Advisor, Utilization Management
 

Welcome, Vicky Limbrick

Posted on May 5, 2016 in Uncategorized | 0 comments

We are excited to report that Vicky Limbrick has been selected to the BA Acute IP Clinical EHR Applications Manager position.

Vicky, who replaces Paul Fong, has more than 17 years of experience in health care and information technology, with 6 ½ years at Sutter, and most recently 3 ½  years as an applications tem supervisor.  She is EpicCare Ambulatory, Orders and ClinDoc Certified and possess a bachelor’s degree in information systems.

Her experience includes supervision of optimization and implementation projects as well as support. She also has Epic End User experience as a medical assistance and worked on the PAMF Epic rollout from 1999-2003.

Please join me on congratulating Vicky on her new role.  Her start date was March 28.

By Sameh Nasser
Acute director, Sutter Health Bay Area, Information Services