Tag: ED

Hospitals are Listening…Code Blacks

Brett0 comment

Gary-Ramge_Essay_Photo-1

 

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

Hanging on the Telephone

Brett0 comment

This dementia journey has produced some magical moments for me over the last 5 years. I want to share a small but powerful moment that happened at a recent dementia workshop I was presenting at last week.

One of the staff from Alzheimer’s Australia/DBMAS was in the audience listening to me speak about a story involving my night in the Emergency Department (ED)of the hospital with Dad being restrained by the security guards many years ago.

I told the audience I was in a really distressed state and was traumatized at what had just happened and had no idea what I was going to do next (I knew zero about dementia back then). I explained how I went into a corner of the room in the ED and called the help line. The voice on the end of that line was very comforting and it was one of the most amazing calls I have ever made.

This person came up to me after the presentation and said “Brett, After hearing you tell that story about your Dad in the ED, I had to let you know that I was the first person on the other end of the line that night when you called. I will never forget that call as long as I live….you sounded so distressed and emotional.”

Wow!…I am without words….