Creating a Flexible Outpatient Mental Health Transitions Program.

Limited resources to support persons with mental illness create a crisis in our health care system. There is a shortage of inpatient beds, and emergency departments are overwhelmed by the number of persons experiencing a mental illness crisis. This article describes the design of a program to address the gaps in treatment.

Using a Potentially Aggressive/Violent Patient Huddle to Improve Health Care Safety.

Background: Unexpected situations of workplace violence are occurring in the United States at increasing rates in health care environments, warranting increased attention to processes supporting safety for health care workers. At a large, academic hospital, two patient safety incidents had occurred in a two-year period in which a patient had become violent at the time of admission from the emergency department (ED) to the medical unit.

Methods: A multidisciplinary quality improvement (QI) team was formed to address the risk of violent patient events.

Managing challenging patient behaviors.

This column discusses how to manage challenging patient behaviors.

Centralizing a registered nurse preceptor program at the institutional level.

New nurses are traditionally oriented into their professional role by a registered nurse preceptor. This article describes the process of renovating and centralizing RN preceptor programs within the Department of Nursing in a multispecialty medical center in the Midwest. Outcomes of centralizing the preceptor program included involvement of nursing leaders, identification of methods of RN preceptor recognition, implementation of methods of improving institution-wide RN preceptor professional development, identification of opportunities for specialized RN preceptor classes and forums, creation of a tool to measure workload productivity, and finally, the formulation of a database to track performance and completion of orientation programs.

Using a symptom-triggered approach to manage patients in acute alcohol withdrawal.

Nurses working in the medical-surgical setting routinely care for patients experiencing acute alcohol withdrawal. Symptom-triggered therapy using the revised Clinical Institute Withdrawal Assessment (CIWA-Ar) (Sullivan, Sykora, Schneiderman, Naranjo, & Sellers, 1989) is currently recommended. Scoring patient symptoms using the CIWA-Ar and educating staff nurses are keys to providing consistent management of a patient in acute alcohol withdrawal.