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SITUATION
Located in South Brooklyn, the 387-bed, multisite, acute-care community medical center of Coney Island Hospital is home to a highly diverse mix of patients who require individualized care.
The driving forces behind the patient-centered training initiatives at Coney Island are Donna Leno-Gordon and Janet Ferguson, Director and Associate Director of Behavioral Health Nursing. In such fast-paced environments, the stress factor and potential for violence levels can be high, placing added importance on having staff that are trained to properly anticipate potentially volatile situations and take steps to de-escalate them.
"With the help of CPI, we radically changed the culture in the way that staff responds to and manages violent situations. And the clear result is better outcomes all around."
Donna Leno-Gordon
Coney Island Hospital
Brooklyn, NY
"Our goal was to change the mind-set of staff in the manner in which they responded to and managed violent situations," says Leno-Gordon.
Cross-training team members and instilling an understanding of the CPI model on all shifts has been Leno-Gordon’s and Ferguson’s focus. From house-keeping to clerical, to nurses and hospital police, all have been taught the CPI skills by twenty in-house Instructors.
In 2007–08, Coney Island embarked on an initiative to reduce the use of seclusion and restraints in the acute in-patient psychiatric unit. Early on, they conducted a staff survey that revealed a lack of training was a significant factor in increased levels of restraint and seclusion use on the unit.
Without adequate tools at their disposal, staff were opting to either abandon the escalating patient situation or call in police, as opposed to using their clinical skills. "There was a lot of fear, and it became apparent that staff needed training in how to work as a team," says Leno-Gordon.
Using the CPI training model, Coney Island Hospital commenced training all staff in team-oriented crisis prevention techniques. Over the course of the next year, approximately twenty staff members became CPI Instructors. Next, they created and trained a "Code Grey team," which would activate as soon as a potentially escalating situation was identified. The team would then draw upon their CPI training to bring the situation under control.
RESULTS
The data bears out the success of the initiative. In 2008, Coney Island Hospital averaged more than eight episodes per quarter in which restraints or seclusion had to be employed. Just a year later, they witnessed a remarkable reduction in such events, to where there were no restraints used during some quarters in 2009. Similarly, a significant increase was seen in the number of patients accepting oral medications as opposed to intramuscular (IM) injections for agitation. Another positive outcome has been a dramatic decrease in staff and patient injuries.
Leno-Gordon credits the standardized methodology and the trainers for much of the success of the program. "We found that when they take on responsibility for training, staff really integrate the skills and become true leaders in managing teams to effectively carry out the CPI regimen."
"Staff really enjoy the program and we’ve seen a palpable growth in individual confidence levels," Ferguson says. Staff feedback reflects a sense of being better prepared and an overall sense of well-being, knowing that other staff are available to assist them in emergency situations. "The sense of fear has been eliminated, and a shared language has transformed the old "custodial" culture and invigorated the units with a far more therapeutic spirit," Leno-Gordon and Ferguson agree.
The CPI training fosters junior staff growth and assumption of greater responsibility. "One of the most exciting things for me professionally and personally has been the emergence of younger staff stepping up to take on leadership roles," Ferguson indicates.
Yet another byproduct of the training has been a far more cohesive relationship between hospital security and other staff. Many of the hospital police officers have participated in the CPI training, resulting in a shared commitment to patient and staff safety. "The police are no longer viewed as the ‘enforcer.’ With CPI’s help, staff now collectively anticipate situations and take steps to forestall the need to use restraints."
ABOUT CPI
CPI was established in 1980 for human service professionals to address the need for crisis prevention and intervention training in safe, respectful, noninvasive methods. CPI remains on the forefront of critical issues and best practices in behavior management based on its founding philosophy of providing Care, Welfare, Safety, and SecuritySM for everyone involved in a crisis moment. More than six million people across the globe have been trained in CPI's Nonviolent Crisis Intervention® program.
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