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In working with our psychiatric hospital clients, we have noted a standard in the Hospital manual which sometimes gets overlooked. That standard is PC.02.01.19 in the Provision of Care chapter: “The hospital recognizes and responds to changes in a patient’s condition.”

The rationale behind this standard is that a significant number of critical inpatient events are preceded by warning signs prior to the event. A majority of patients who have cardiopulmonary or respiratory arrest demonstrate clinical deterioration in advance. Early response to changes in a patient’s condition by specially trained staff may reduce these types of events and avoid patient mortality. For psychiatric hospitals, the ability to respond to these events is especially critical since this is typically not their area of expertise. Thus, prompt identification and appropriate treatment or timely transfer to a medical facility is critical.

The elements of performance for this safety standard have four distinct requirements:

  1. The hospital must have a process in place for recognizing and responding as soon as a patient’s condition appears to be worsening.
  2. The hospital must have written criteria describing early warning signs of a change or deterioration in a patient’s condition and when to seek further assistance.
  3. The hospital must inform the patient and family how to seek assistance when they have concerns about a patient’s condition.
  4. Based on the hospital’s early warning criteria, staff seek additional assistance when they have concerns about a patient’s condition.

There is also a related requirement in the Human Resources chapter: HR.01.05.03 EP 13. It requires that the hospital provide staff education/training that addresses how to identify early warning signs of a change in a patient’s condition and how to respond, including how and when to contact responsible clinicians.

In the past year, we have seen psychiatric hospitals cited for the following issues:

  • Not having a procedure in place for responding to deteriorating patient conditions
  • Not having written criteria for staff to use to evaluate the change in condition
  • Not providing training to nursing staff on this topic

So, we encourage you to have your clinical leadership and your Training & Education Department closely review this standard to ensure that the following are in place:

  • There is a written procedure for responding to changes in a patient’s condition.
  • The procedure contains criteria for staff to use to evaluate the patient’s condition and gives them clear steps to follow about how to respond and whom to notify.
  • There is a process in place for informing the patient and family about how to seek assistance when they have concerns about a patient’s condition. (This can be done at time of admission and as needed at other times throughout the patient’s hospital stay.)
  • Staff have been trained on the procedure and this training has been documented.