A Code Gray With a Silver Lining

It might sound like just another day in the life of a hospital—a patient is in crisis, and staff are paged to respond. A Code Gray had been called on our unit, which meant that a patient was displaying combative behavior. But in her own words, the patient felt unsafe and unable to cope after witnessing a peer threaten to harm both the staff and themselves.

Fortunately, our staff’s detailed planning, teamwork, and thorough preparation made for a less difficult intervention, and an all-around safer experience for everyone involved. The responding staff came up with a plan to verbally support the patient in crisis because they wanted her to not only be safe, but feel safe. They moved with subtle urgency to close the distance between themselves and the patient, while auxiliary team members quietly cleared the surrounding area and removed any furniture that might be a potential hazard to her safety or an obstruction to approaching staff.

Throughout the event, staff maintained an open line of communication with the patient, making specific efforts to mention the many peers and staff members who cared about her. As staff continued to use their verbal de-escalation training, they asked how they could help, offering solutions that the patient might find comforting. The patient ultimately agreed to a conversation, and subsequently asked for a weighted blanket that she could lie down with in her room.

At this point, the staff and patient agreed to help keep one another safe, by talking about any feelings or thoughts that might jeopardize the patient’s or staff’s safety.

Although it had initially appeared that there was a likelihood for this crisis to become physical, it never did. No hands-on intervention was ever required during the entire event thanks to the staff’s Nonviolent Crisis Intervention^® training, which in addition to verbal de-escalation tactics, incorporated a clearly defined team dynamic and effective communication among team members. The staff entered the situation with a specific plan of intervention and a contingency plan should it be needed.

Our staff’s ability to manage the Code Gray and maintain order throughout the unit was noteworthy. It demonstrated a positive outcome from our implementation and regular review of Nonviolent Crisis Intervention^® training here at our state hospital, which limits injuries and discourages crisis escalation. I was proud to provide oversight to a situation where our Psych Unit, Security, and Code Responders worked as one team to successfully de-escalate a patient in crisis and keep her (and themselves) safe. It was just another day in the life of our hospital—a patient was in crisis, and our staff responded with care.

With over 30 years of experience at the Arizona State Hospital in Phoenix, D.C. Foster is a Behavioral Health Intervention Specialist and Master Level CPI Instructor. D.C. works with individuals identified as Serious Mental Illness (SMI), Forensic, and Sexually Violent Persons (SVP). Since 2012, he has been using CPI training to create a more person-centered, trauma-informed, recovery-oriented therapeutic environment for patients. D.C. is also a leading member in the CPI Instructor Community, where he exchanges training strategies and professional development techniques with his fellow Instructors.