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Best Practices: Safety Guidelines for Injury-Free Management of Psychiatric Inpatients in Precrisis and Crisis Situations

The authors are affiliated with Twin Valley Behavioral Healthcare (TVBH), an inpatient facility of the Ohio Department of Mental Health (ODMH), 2200 W. Broad St., Columbus, OH 43223 (e-mail: shortb{at}mh.state.oh.us). Mr. Short is chief executive officer, Dr. Raia is psychology director, Ms. Bumgardner is clinical nurse specialist and director of staff training and education, Mr. Chambers is safety and health inspector, and Ms. Lofton is quality assurance and performance improvement director, all at TVBH. Dr. Sherman is medical director of ODMH. William M. Glazer, M.D. is editor of this column.

Twin Valley Behavioral Healthcare developed safety guidelines for injury-free inpatient management, which were implemented in 2004. The guidelines focus on best practices in the areas of verbal and physical interactions between patients and staff, administration of emergency medication, communication of critical information during precrisis and crisis periods, measurement of safety outcomes, and application of safety rules via policies and use of the agency logo, "Working Smart=Working Safe." Between 2004 and 2008 staff injuries decreased 90%—from 91 to nine injuries. Restraints and seclusions fell by 36%, patient complaints by 37%, and the need for codes for staff to assist in a psychiatric emergency by 25%.

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