Background: The Homestead Hospital Healthcare Violence Prevention Committee and the BHSF Pro-fessional Development Council have both been reviewing the data for the hospital’s Code Greens: Six-ty five percent (65%) of the Code Greens reviewed from January of 2018 to June of 2018 were appropriate calls for Code Greens (ie: Patient/Visitor Disruptive; Verbal Abuse/Threatening behavior; physically violent). The remaining 35% of Codes would have been better addressed using another method of de-escalation. MS5 had the highest number of Code Green in situations when a patient became cognitively impaired.
Purpose: The goal of the “Code Strong” Initiative was to create an atmosphere where patients who are at risk for falls and/or episodes of confusion (cognitive or dementia related) can be either redirected without the use of a Code Green deployment or assisted off the floor if they fall.
Implementation: On October 15th, the hospital initiated a pilot program on the 5 floor (MS5). When a patient on the MS5 exhibits one or more of the following behaviors: challenging behavior, wandering behavior, catastrophic reactions and/or, disinhibition and individual staff are unable to re-direct the patient, a request for an overhead page of “Code Strong” will be initiated by the patient’s primary nurse. The page will include the location of the patient. “Code Strong” is an encrypted overhead page signaling to available, pre-identified staff that healthcare providers require: Immediate assistance with a cognitively challenged, possibly elderly patient who is reluctant to comply with simple safety commands and/or The need for immediate assistance to help lift a patient up who has fallen. When the team arrives, the patient’s primary nurse is the lead communicator as to why the team is being summoned (patient fall versus patient requiring re-direction).
Evaluation: The pilot was completed on January 15 2019, MS5 had twenty one (21) “Code Green” called on their unit during the three month period. Of those “Code Green”, fourteen (14) out of twenty one (21), totaling sixty seven (67%) met “Code Strong” criteria. Thirty three percent (33%) of the “Code Green” paged on MS5 could be truly classified as meeting “Code Green” criteria. This indicated that the number of “Code Green” being called on MS5 were overinflating our hospital wide “Code Green” numbers and erroneously giving the perception that more “Code Green” are occurring than actually are. Our sister facilities had nothing similar to this code. The BHSF Security Council and PCLC approved and endorsed the “Code Strong” Initiative for full system wide implantation in 2019 under the name of “Nurse Assist” instead of “Code Strong".
Implications for Practice: Hospitals have many codes that can be confusing, as the connection between the code and situations they represent can be blurred. This appears to be the case with the amount of Code Greens Homestead Hospital is experiencing. By implementing the “Code Strong” initiative, the benefits of being able to provide a high level of safe care to our patients while ensuring that their specific needs are being met, thus providing nothing less than favorable outcomes.
14th Annual BHSF Research Conference
Gaitan, Martha and Sordo, Ellen, "The Strength of Safety: “Code Strong”, the Birth of “Nurse Assist”" (2019). All Publications. 3305.
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