Utilization of Nurse-Administered Screening, Brief Intervention, and Referral to Treatment in a Brief Psychiatric Inpatient Unit.

BACKGROUND: Screening, Brief Intervention, and Referral to Treatment (SBIRT) has been established as an effective screening tool for providing interventions for patients with risky substance use. OBJECTIVES: The objectives of this project were to train and coach staff nurses in the use of SBIRT, offer SBIRT to all admissions of a brief psychiatric inpatient unit, and decrease readmission rates. DESIGN: Using the Iowa Model for Implementing Evidence-Based Practices, SBIRT was implemented on the unit. Data were collected on the frequency of patients offered SBIRT and readmission rates. RESULTS: Fifty-nine percent of all admissions were offered SBIRT. The average readmission rates decreased by 18.3% for the first 2 months of implementation and by 67.5% for Days 16-31 postdischarge. CONCLUSIONS: SBIRT is an effective tool for nurses on psychiatric units to address substance use and to decrease readmission rates.

Evergreening of Psychiatric Medications: A Systemic Literature Review of Strategies, Case Examples, and the Implications of Cost.

Evergreening consists of multiple ways that pharmaceutical companies extend patent protection and prolong profitability of brand name drugs past patent expiration. In psychotropic medications, these strategies do not necessarily make more effective drugs, and often increase drug prices, which can result in lower access and utilization. There has not been a systematic literature review of evergreening strategies for psychiatric medications. Based on such a review, 11 strategies were identified and relevant examples were provided. Four case examples of commonly used psychiatric medications indicated evergreen prices 3 to 211 times the cost of the original medication, and the evergreen costs ranging from $132.00 to $10,125.24 higher than the original cost on an annual basis. The higher cost of evergreening medications can create inefficiencies and waste in healthcare resulting in lower-quality patient care. Healthcare providers, patient advocates, health insurance companies, and policy-makers should be aware of these practices to improve healthcare systems.

A Multidisciplinary Consultation-Liaison Team Approach to Reduce Enhanced Observer Usage.

BACKGROUND: There are few evidence-informed guidelines and findings to show that the use of sitters improves patient safety; overall, it is a costly intervention to address patients with disruptive behaviors. OBJECTIVE: The purpose of this article is to demonstrate that the creation of a multidisciplinary consultation-liaison (C-L) team, integrated with a psychiatric C-L team, together can decrease sitter use and improve outcomes using nonpharmacologic interventions. METHODS: This retrospective study describes the planning, implementation, and data collection using in creating an multidisciplinary C-L team to collaborate with the psychiatric C-L team and outcomes to support the approach. The multidisciplinary C-L team was composed of advanced practice registered nurses and creative art therapists. The teams worked closely with the medical units to develop and monitor criteria for sitter use. The key outcomes of the intervention improved patient safety and reduced overall cost. RESULTS: In the first year of implementation of a multidisciplinary C-L approach, sitter use decreased by 72%. Nonpharmacologic interventions improved patient outcomes by providing education to medical staff that enhanced the assessment and implementation of enhanced observer use across all the medical units. Subsequent data also reflect a sustained reduction in cost over the next 2-year period, saving the institution nearly $70K a month. CONCLUSION: An multidisciplinary C-L and psychiatric C-L team collaborated on the need for psychiatric medications, or nonpharmacologic interventions to address behaviors and decrease the need for an enhanced observer. The teams worked together to make policy revisions and algorithms and provide education, the result of which was significant financial savings and improved patient safety.

Improving Patient Care through Collaborative Consultation Integration: a Quality Improvement Initiative.

Evidence suggests that interdisciplinary care leads to improvements in patient care and efficiency. To determine whether integrating inpatient hospital behavioral health services would result in improved perceptions of patient care and efficiency, team members (N = 23) were surveyed 1 year after integration on measures of patient care, efficiency, and personal satisfaction. A majority of respondents believed integration improved patient care and efficiency. Overall satisfaction was high. The results suggest integration of behavioral health services improves individual perceptions of patient care, efficiency, and satisfaction.

Characteristics of Patients With Constant Observers.

BACKGROUND: The use of constant observers ("sitters") has been common practice in many medical centers to maintain patient safety. RESULTS: A retrospective chart review of patients who required sitters from October 1, 2007 to September 31, 2013 at a large, private hospital serving a multiethnic community showed that the top reasons for sitters include suicide risk, agitation, fall risk, interfering with medical devices, and confusion/disorientation. Sitters were used for a mean of 3.4 days ranging from 1 to 287 days, with a mean hospital length of stay of 18.9 days. Although 42.4% of all cases with sitters had a psychiatric consultation, psychiatry was consulted on only 8.5% of those with agitation, 6.3% of those who were disoriented, and 12.7% of those with decisional capacity concerns. Psychiatry was consulted on 87.4% of patients with a constant observer for suicide risks. Sitters were most often discontinued when behaviors improved or when patients were discharged. CONCLUSION: This information will be useful for understanding the optimal way to implement a program that will increase patient safety and decrease cost.