Tag: code black

Hospitals are Listening…Code Blacks

Brett0 comment

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Very pleased to announce that I had my ‘code black’ meeting with senior management at the RAH yesterday. To anyone new – a code black is when 4-6 security guards are called to restrain a patient.

I am really excited to report that out of everything that I have been involved with in the dementia space this was the most significant step forward and potentially the best opportunity for some serious change.

It was such a privilege to have a solid hour to share my EVERY thought I have had about the way people with dementia are cared for in our hospitals.

The good news is this information will be considered across the QEH and nRAH hospitals and some critical points may be weaved into training packages for nursing staff.

I actually spent literally 6-7 hours preparing for this meeting and collating all of your thoughts, ideas and feedback and presenting it to them in a single ‘easy to read’ document. This document contained your personal experiences, plus strategies and also a link to my presentation on acute care:

http://www.dementiadownunder.com/…/dementia-care-can-we-do…/

I learnt so much about hospital protocol, security team procedures and patient care in major hospitals. What has me so excited is that they were so willing to listen to our thoughts (DD Members)and were really appreciative to be able to get a rare snapshot and insight from the families of people with dementia who have received code blacks. I also passed on several personal stories that really hit home.

There has been some significant steps forward since Dad was in hospital and I can report that things are moving forward and changing.

Obviously not everything will be implemented but the families have been heard and our feedback will be given consideration where possible.

You can see below there were some serious topics discussed and I had the entire hour to myself and their full attention.

Some of the key areas that were discussed were:

• Communication flow between nursing staff and families (both ways)
• Value of involving family members, emotional impact and trauma to family members/carers when patient receives a code black, acknowledging family input and applying to the clinical process.
• Lack of knowledge for families when they enter the ED. Ways to improve this.
• ‘Dementia is different’- the patient often has no insight hence the focus of medical info gathering switches to the family. (is one of the few medical conditions that this occurs with)
• Enormous scale of people being admitted now and in future and how the hospitals need to adapt.
• Limiting the duress for families by allocating a team member to communicate progress and procedures. Selecting a key family member to obtain patient info, using the ‘Top 5’ approach to obtaining personal info on the patient, signage on the bed with key info eg family member names, pets etc…
• Use of the cognitive impairment identifier/symbol on bed to alert people that patient has cognitive impairment.
• attaching dementia related procedures to the identifier.
• Education of nursing staff in dementia / behaviours
• Handbooks for families
• Security Team protocol eg using a team leader (they wear a different colour shirt), verbally preparing families of potential code blacks, team huddles & handover prior to code black. Using less security members with dementia patients.
• Dementia training for guards, softer approaches to restraint, changing the uniforms of guards to be less confronting, limb restraint techniques and not throwing people to floor. staff protection and protocols.
• Nurse specials – having dementia knowledge
• Dementia champions allocated to wards,
• Muting of beeping machines in wards, use of a ‘noisebox’ under beds to change the overall sound environment
• single rooms versus wards advantages and disadvantages, gradual softer lighting that can be manually adapted to each patient,
• Adding a new emergency ‘code’ (eg code purple) specifically for cognitively impaired patients (this cannot happen, but the team huddles sort this problem)
• Ways to calm patient in ED before taking bloods thus limiting code blacks

Emergency Department – ‘Code Blacks’

Brett1 Comment

ED

 

I am in a very privileged position to meet with key people in the New Royal Adelaide Hospital (nRAH) in regard to discussing ‘code blacks’ and making practical changes to minimize the trauma to both patients and staff with escalating behaviours.

This is a golden opportunity to set a new standard in the ED of the hospital and have a different mindset in regard to people with dementia which can hopefully be adopted by hospitals around Australia.

I would like to represent the ‘DD Members’ that have an opinion or some feedback about the way things are currently done in the ED. I am really excited that the decision makers are listening and prepared to improve things – Please place your feedback, comments and ideas below so I can be fully prepared.

If you have experienced code blacks and the ED environment your participation in this discussion would be most appreciated.

Thank you

Phew!…. Another Code Black Avoided

Brett0 comment

I was walking into Ward R8 at the RAH when my mobile rang. It was the ward manager and she had bad news for me. I told her I was 5 metres  from where she was calling me from , so she hung up and came and spoke to me face to face. The very caring manager explained to me that Bob had been very agitated , refused all meds and grabbed the wrist of a nurse and hurt her. An intra muscular injection was called for and I gather a security team would be on stand-by. She was concerned about me seeing the trauma of the injection being administered, but I said I have seen it done enough to be fine. I asked the manager if I could have a try at giving the meds before they inject him, and she agreed.

I walked up to Dad carefully and gave him my normal happy greeting. He had the ‘evil stare’ he gets when agitated, and I reached for his hand to feel the tension. His hand was clammy and rigid and is a tell-tale sign of his mood and aggression level. We were surrounded by 4-5 nurses who were all trying to help the situation, but actually weren’t. Straight away I put myself in dad’s shoes…how is he feeling about the situation? To him it would look like another ‘code black’ was about to happen and he would be terrified.

I held his hand with a special grip that I learnt from an expert called Teepa Snow. It is used to comfort him, make him feel in control and give me protection against a possible hit. The grip worked well, I then directed Dad away from the crowd. Straight away I went onto his side of the situation and agreed with whatever he felt or said. Once I had distracted him and calmly spoke with him, I had his trust and he was compliant. As we did a lap of the hallway – I asked the nurses to prepare meds and water for me so I can give it to him smoothly. They handed me the cup and tablets on my next walk past, and I turned dad away from the nurses. I did my usual routine, placed the tablets in the palm of his hand, gestured with my hand to place them in his mouth and then gave him the water.

He complied instantly. The nurses were in shock as they had been trying for hours. The problem was they kept trying to give the meds to him by adding people, adding pressure and too much talk. He was confused, frustrated and also angry. I then decided to walk Dad up and down the hallways to get the medication to kick in quicker and also change the mood. More tablets were handed to me as I went past, and once again our medication routine worked a treat. After 20 minutes or so Dad’s hands loosened up, he started to smile and laugh and the incident was over. The manager ‘thanked me’ which was really nice of her.

Normally no-one would go near Dad after an agitated incident and a shower would be completely out of the question, as it is a potential hotspot. Something told me, that Dad may enjoy the water on his face if I can get him in the bathroom, and may keep him occupied. I usually start his routine by getting him to clean his teeth. If he doesn’t do it himself, I do it for him. He let me clean his teeth, so I knew we were a good chance of getting the showering done. The bathrooms in the RAH are horrendous. The shower is hand held (which means I can’t have both hands free), there are no shelves to put anything on and many people use the bathroom so they are not always clean. I asked a nurse to bring me 3 x towels and 2 x flannels asap.

You have to be extremely organised when showering, have everything on hand and be ahead of the game. I like to have a helper on the outside of the bathroom to pass me things as required.The nurse had walked off for some reason, and I was cross because I had forgotten the pull-up pants that were required.  I yelled out for someone to fetch them, which they eventually did. I was starting to sweat with the steam and the tension of the moment. It is critical that I am ready with his clothes the second he is dry. I throw them on him very fast as this is another guaranteed flash point for him. Even if he can’t get his arm in his shirt sleeve within 2 seconds, he may hit out. If you don’t get his pants and shirt on fast enough he may storm out of the bathroom naked and then you have a real problem.

Amazingly I showered Dad faster than normal and had him clean and dressed within 15 minutes. The nurses were staggered with the change in his behaviour and also the fact he was showered so quickly. The reason why I was able to turn things around is I understand dementia, I know Dad’s body language back to front and also he is familiar with me. It is hard for the nurse special as most are not dementia trained and are ‘going in cold’ with no idea of what Dad is capable of and what may set him off. By simply trying to assist to take his pants off he may firmly grab your wrist or hit you. I like to let him take his own pants off always (would you like your pants pulled down for you?). If he won’t take them off I may wet his pants with the shower head and they become heavy and he then naturally removes them. You need to think outside the square with dementia.

Dad’s dressing gown cord was missing and he started to tug at the front as he felt exposed and I could tell it was annoying him. I believe he would fiddle with it all day as it kept opening, which is an unnecessary stress. I then decided if we can’t find his cord , I will make one. I asked for some scissors and made  a belt from two pieces of material. I wrapped him up like a big present and he was then happy. His mood was now jovial and relaxed and everything was sorted. It was a great lesson for the nurses, to show them that dementia can be turned around without drastic measures if you know what to do. Thank goodness they rang me before calling the ‘code black’.

Code Black Restraint Teams – ‘Holding Hospitals Together’

Brett2 Comments

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“Code Black..Code Black” – This is the call to the security team that has been made over 20 times during Bob’s three stays at the Royal Adelaide Hospital (RAH). The restraint team consists of a team of 7 security guards that respond very quickly to any emergency within the hospital and are a vital part of the system. Both men and women are on the individual teams that work 12 hour shifts each day. One person is in the control room and the others team up to wherever the next restraint is required. Two guards are normally stationed in the Emergency Department (ED) as this is a ‘hotspot’ for trouble. This is due to alcohol and drug related violence often occurring on friday and saturday nights.

Another area the restrain teams are required regularly is in the three locked wards on Level 8 of the hospital . These wards include patients that may have dementia, schizophrenia or mental health problems.Patients can have unacceptable behaviours which may include aggression, hitting, kicking, biting, spitting, fighting, abuse, nudity and verbal outbursts. Gloves are worn by the guard as they attend each incident and some wear safety glasses and surgical masks when required. It is very re-assuring when you have a code black situation happening that at least 4 guards will be arriving within a couple of minutes.

The first time they were called when we were in the Emergency Department I will never forget the ‘whoosh’ and power of the group as they all grabbed an arm or a leg each and helped me restrain Bob. It seemed barbaric and cruel at the time but there simply is no other option when violence is involved with a patient. The team is trained to restrain and there does not appear to be any difference in how they handle each incident.  I assume this is because they often do not have time to reason with people or know what the patient is capable of. If they have a show of force quickly then the chance of escalation is reduced. The guards usually have no medical background and ultimately their role is to protect the person, the hospital staff and other patients.

I have worked with many members of the restraint teams as they have been called to help us many times. I will often talk to the first two guards and quickly explain that we are dealing with a dementia patient and a ‘softly, softly’ approach is to be attempted first if possible. The reason why dementia is different is that usually the person is older and more frail, but also the patient is scared or delusional and extremely traumatized by the sight of up to 6 guards in a small space trying to grab them. I am a big believer that ‘dementia training’ is a must for the restraint teams. As I have been involved so many times I have witnessed many occasions where we have avoided even touching the patient by not crowding the person with dementia, talking with them in soft,calm tones and re-directing them. The guards get to know the patient often and use his or her name and get a much better result because of this.

I have actually seen some of the guards adjust to this calmer method and it is really pleasing to see. Of course situations often escalate and force is required. If we can train the restraint teams to adapt to the conditions of the patient it will allow them alternative methods to try which will have the patient’s well being considered. I believe we need to provide dignity and respect wherever we can in our hospitals and the restraint teams is probably the most logical place to start.

I must say the more I get to know the guards and have them watch me deal with Bob, the more I understand how they work and the more tips they pick up on dementia from me. There are some terrific people on the restraint teams and we all try and have some lighter moments when we are standing together for up to an hour at a time. Thank you to all the guards in the hospital who keep everyone safe – you are doing a great job!

**Funny Story – In the middle of a tense situation whilst the restraint team were holding Bob, one of the male guards points at Mum and says to me “So who is is that lady over there? Is she your sister?” I responded with ” She’s my Mum and you have just made the Christmas List Buddy!” 🙂

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