Affiliations: [a] Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA | [b] Research in Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
Correspondence:
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Corresponding author: Adam K. Hill, Cincinnati Children's College Hill Campus, 5642 Hamilton Ave, Cincinnati, OH 45224, USA. Tel.: +1 513 636 1612; E-mail:adam.hill@cchmc.org
Abstract:
BACKGROUND: Quality improvement initiative focused on staff
injury reduction on a specialized inpatient psychiatric unit which offers
acute stabilization for children and adolescents with complex high-risk
behaviors. OBJECTIVE: To utilize quality improvement principles and
interventions to reduce staff injuries on a specialized inpatient
child/adolescent psychiatric unit. PARTICIPANTS: Direct care clinical staff within an inpatient
psychiatric unit for patients with co-occurring developmental disabilities
and psychiatric illness were the focus of the initiative. Direct care
clinical staff and clinical administrators were the active participants in
the quality improvement initiative, focusing upon the interactions between
staff and patients. METHODS: OSHA-recordable injuries were documented to guide
initiatives and measure outcomes on weekly run charts with raw data measures
of all staff injuries and the number of days elapsed between injuries. Rapid
Plan, Do, Study, Act (PDSA) cycles were utilized to test interventions and
guide decision making. RESULTS: Three months of a structured and systematic
intervention trial produced the first adopted interventions in August 2011.
The following six months reflected a 65% reduction of staff injuries
(from 2.2 injuries per week to 0.77 injuries per week). Between January and
August 2011, there were eight OSHA-recordable injuries with an average of
26.5 days between injuries. The average number of days between
OSHA-recordable injuries has increased from 26.5 days at baseline to 124
days. CONCLUSIONS: An initiative utilizing quality improvement
principles reduced staff injuries on an inpatient specialized psychiatric
unit. Reliability principles, system adaption, and engagement of the
frontline nursing clinicians have proven to be foundational and vital to
guide the initiative.
