De-Escalation Training Prepares Hospitalists to Calm Agitated Patients

The Hospitalist. 2015 March;2015(03):

March 3, 2015 | The Hospitalist

The standard states that “staff are trained in the use of nonphysical intervention skills,” says Cynthia Leslie, APRN, BC, MSN, associate director of the Standards Interpretation Group at The Joint Commission, which is based in Oakbrook Terrace, Ill. “These skills may assist the patient in calming down and prevent the use of restraints and/or seclusion.”

In addition, staff must be trained before they participate in a restraint or seclusion episode and must have periodic training thereafter.

Anyone who wants de-escalation training can contact a company like CPI directly or establish in-house training teams (CPI offers an Instructor Certification Program). “This allows a cost-effective way [approximately $10 per person] to cascade training to others within the hospital who are part of care teams,” Schubert says.

In Sum

Providing for the care and welfare of patients while maintaining a safe and secure environment for everyone is a balancing act that requires the involvement of a multidisciplinary hospital team, Schubert says.

“Coordination, communication, and continuity among all members of a hospital team are crucial to minimize conflict, avoid chaos, and reduce risks,” she explains. “By being armed with information and skills, hospitalists are less likely to isolate themselves from other team members or react in a nonproductive way when crisis situations emerge.

“Training will help staff to take steps to ensure that their behavior and attitudes don’t become part of the problem and increase risks for others involved. Care team perceptions of physician involvement in solution-focused interventions are important for hospitalists to fully understand so risks can be avoided.”

Karen Appold is a freelance medical writer in Pennsylvania.

Quick Tips: De-escalating a troubled patient

Knowing how to handle a potentially volatile situation can prevent it from escalating out of control. Judith Schubert, president of the Crisis Prevention Institute (CPI), a Milwaukee, Wisc.-based company that offers de-escalation training, offers this advice to hospitalists:

Be aware of your own nonverbal, paraverbal, and verbal communication to avoid contributing topatient stressors.
Respect a patient’s personal space, which is considered an extension of self.
Communicate professionally and respectfully: Avoid using medical jargon, which can cause confusion and escalate someone who is already anxious.
Work cohesively with other team members to convey calm control of situations.
Be aware of environmental factors that can add to anxiety, such as sensory stimulation/overload, and consider ways to limit impact.
Provide information—even when it may seem obvious—as it can minimize stress of the unknown. In stressful situations, it can be easy to forget to tell patients what you are doing and why you’re doing it.

—KA

10 domains of de-escalation³

Respect personal space
Do not be provocative
Establish verbal contact
Be concise
Identify wants and feelings
Listen closely to what the patient is saying
Agree or agree to disagree
Lay down the law and set clear limits
Offer choices and optimism
Debrief the patient and staff

Source: Printed with permission by the Western Journal of Emergency Medicine.

De-Escalation Training Prepares Hospitalists to Calm Agitated Patients

In Sum

Quick Tips: De-escalating a troubled patient

10 domains of de-escalation3

References

10 domains of de-escalation³