are sent to the Court Master weekly. In light of the current The hospital will continue to Nursing works with staffing demographics of admissions to monitor the staffing ratio as office daily to ensure that each Riverview, the adequacy of defined in the Consent Decree. unit, each shift has adequate staffing requires further In addition, the Integrated numbers of staff based upon independent review. It is Quality team will work with Consent Decree and taking highly recommended that Clinical Leadership to establish into account a minimum of 8 staffing ratios be determined measurements to test the additional acuity factors by acuity rather than by census reliability and validity of data including: increased level of on the units. used with acuity based models observation- medical issues – to ensure that, in addition to outside appointments – meeting the Consent Decree’s coercive events admissions – – minimum staffing ratios, discharges increased – staffing is sufficient to carry dangerousness level - out Consent Decree Nursing has offered flex shifts requirements. and is looking at unit based staffing. CONSENT DECREE Quality Improvement Actions Taken During the Measure Quarter Recommendation Riverview is cooperating with State Psychiatric Hospitals in Maine, Vermont and New Hampshire to test two acuity assessment tools: The Overt Aggression “Modified Scale” and the “Staff Observation Aggression Scale.” Meetings among staff at the hospitals are occurring to define measurement. A decision is being made to submit either single or multiple IRB applications for use of the instruments for research purposes. The use of "float" staff, 100% of new staff on acute All new must complete especially those recently hired units will have received and skills training as outlined by at Riverview, requires review in passed competency based skills the hospital prior to being order to reduce the likelihood training before being assigned. released from orientation. of risk due to unfamiliarity Some of these skills include with and knowledge of the MOAB training, CPR & power individuals with challenging point presentations with behaviors or the need for competency quizzes on the specialized interventions. This subjects of Incident Reports,
are sent to the Court Master weekly. In light of the current demographics of admissions to Riverview, the adequacy of staffing requires further independent review. It is highly recommended that staffing ratios be determined by acuity rather than by census on the units. The hospital will continue to monitor the staffing ratio as defined in the Consent Decree. In addition, the Integrated Quality team will work with Clinical Leadership to establish measurements to test the reliability and validity of data used with acuity based models to ensure that, in addition to meeting the Consent Decree’s minimum staffing ratios, staffing is sufficient to carry out Consent Decree requirements. Nursing works with staffing office daily to ensure that each unit, each shift has adequate numbers of staff based upon Consent Decree and taking into account a minimum of 8 additional acuity factors including: increased level of observation- medical issues – outside appointments – coercive events – admissions – discharges – increased dangerousness level - Nursing has offered flex shifts and is looking at unit based staffing. CONSENT DECREE Recommendation Quality Improvement Measure Actions Taken During the Quarter Riverview is cooperating with State Psychiatric Hospitals in Maine, Vermont and New Hampshire to test two acuity assessment tools: The “Modified Overt Aggression Scale” and the “Staff Observation Aggression Scale.” Meetings among staff at the hospitals are occurring to define measurement. A decision is being made to submit either single or multiple IRB applications for use of the instruments for research purposes. The use of "float" staff, especially those recently hired at Riverview, requires review in order to reduce the likelihood of risk due to unfamiliarity with and knowledge of the individuals with challenging behaviors or the need for specialized interventions. This 100% of new staff on acute units will have received and passed competency based skills training before being assigned. All new must complete skills training as outlined by the hospital prior to being released from orientation. Some of these skills include MOAB training, CPR & power point presentations with competency quizzes on the subjects of Incident Reports,
Section-13-Riverview-Report-FY16Q1.docx