4/17/14 MSH Meeting Minutes

John Knobbe, Shannon Pech, Molly Kennedy, Tim Headlee, Connie Anderson, Scott Grefe, Mike Homer, Ryan Cates, Eric Hesse, Amanda Mathiowetz, Carol Olsen, Tom Christensen, Greg Frey, Scott Reed, Tom Kolstad, Colleen Ryan, Michelle Chalin, Rita Olsen, Meghan Goodrich, Jennifer Frew, Jaclyn Jaycox

1. Safety and Overtime Statistics
a. February and March reports received due to not having a meeting in March. A contribution to more overtime is that there has been a higher acuity. Will look at improving 1 to 1’s and who is currently on them.
b. Almost all of the dead bids have been filled starting next week or the week after. There are two positions left, both .5. 5 Security Counselors and 1 HSS will be starting next week. 1 Counselor will be starting the cycle after that. Interviews will be conducted next week.
2. Utilization of Unit 100
a. There have been conversations on how to best utilize the beds. CRP is consistently 6 over their population. On April 17th CRP is 10-11 over. Some CRP patients have been placed on 100, 200, and 300 in their own area. It is not in the patient’s best interest to be spread out and the patients should not be mixed. Per the Ombudsmen this practice is ok and is not going against any regulations.
b. When looking at how to manage patient needs better management has determined to take Unit 100 and make 10 of the 14 beds CRP. This would consist of 2 women from CRP and 4 women off of Unit 900 that are ready to engage in treatment. This will provide the next level of care for women.
c. There has been a lot of talk about how chaotic Unit 900 is and how patients are not engaging in treatment because of that environment. Management has been talking to Paul Ploog and Emily Rentas about this. Unit 100 staff will remain the same and assist in monitoring CRP patients and the treatment to the women patients.
d. Management will be taking a look at current patients on YAAP and which could benefit from different treatment. They could possibly be placed on Unit 300. There are around 6-8 YAAP patients who will take one area of Unit 200. Management is figuring out what needs need to be provided.
e. Staff would like a clear line with the two different policies. There is a lot of concern with the populations being blended. There are a lot of unknowns and management has received a lot of feedback, they welcome more. Would like to bring together a small group of staff to look at the proposal.
f. The patients moving would be programmed to their living unit and would not be transferred back to North. Those who have completed CRP treatment would be placed on Unit 100. Please know that this is a number that flexes. Activities that these patients will be able to do are yet to be decided.
g. Would like to separate crisis from admissions. There is a lot of concern over blending women and men patients. If they are completely separated, this will take a lot of beds offline. Management is pricing out 3 different options. One includes a potential of splitting Unit 700 in half so genders would not be mixed. Another option being priced out is a separate building on campus.
3. Scheduling Office Update
a. Beginning June 4th the schedule will be expanding to Tom Christensen’s area (Campus Security and Master Control).
b. How many vacation slots are currently offered in Control Center? At one point in time when there was 3 but now it is down to 1 spot.
c. There is a large problem with getting people into Master Control and getting them to stay due to high seniority, no vacation, non-desirable days off, excessive inversing, etc. Different ideas were proposed like being able to mutual to doubles or 10 hour shifts. A small group will be meeting to come up with how to better this work area.
1. Break rooms for MSH Nursing/LPN’s
a. A break room in the street is currently being remodeled. Staff has decided what they would like in the break room. Cabinets and counters are in, carpet and furniture is ordered, and walls will be repainted.
b. There will be a break room where the night shift’s mailboxes are. Nurses will no longer be having report there. The mailboxes will go back to the mail room. That room will be gutted and remodeled as well.
c. Patients have walked through one break room to get to their courtyard. Physical Plant will be looking at options, possibly repositioning the door to get to the courtyard area, to eliminate patients entering the break room.
d. A break room in Bartlett will also be looked at. One idea is to use part of the dining room on 1st floor, to build a room within a room. Mentioned that staff in Bartlett rarely has time to take a break and it was asked if management will be pushing for 30 minute breaks? They are not. Management would like to provide break rooms to staff because it is helpful to have an area away from the work area to take a break.
e. There will be computers in all break rooms. A computer has been added to the staff lounge by Unit 600.
f. Looking at getting additional lockers at the Nursing Home.
2. Vocational 1 safety and security (ICS) procedure patient & staff ratios
a. During an ICS should staff leave the doors they are posted at? There is a need for clarification. There is a concern among staff on how they should respond to an emergency situation. There was a table top drill that went well about a year ago and to help there will be another drill in the next couple of weeks.
b. Mentioned that a phone may be helpful downstairs by the door.
c. If a patient were to take off are there door issues that need follow up? There is a meeting scheduled April 17th to look at all of this. One idea is to put an alarm system in place so staff is aware when a door is opened. The doors must remain open to be up to code. Management will be talking about this.
d. Reminder that all staff should be wearing radios.
3. Safety and Security equipment (shields, chairs, spit rags, and transport device). MSH units 900, 100, including North & South camera/monitor requests including training concerns.
a. Trainers have expressed concerns over the new techniques being taught. There are concerns over the Medical Transport Device and its functionality because it has never been utilized. It has been reported that staff have hurt their backs while practicing with the equipment. A cloth was added to alive this and it has worked. Management encourages staff to practice with the device.
b. It was mentioned to Carol Olsen by a new employee that the trainer was very negative towards the equipment. This will continue a negative perspective.
c. In training staff are not moving a hostile patient. The equipment is not intended to move a struggling patient. At this point, staff should put the patient down and continue when he/she is no longer struggling.
d. There is an extra chair available for when one is broken. It is located in the crash cart room. Please contact Tom Christensen when any equipment is down. Brian fills in when TC is on vacation or staff can go through their TTS.
e. Management is asking for a group to come together to discuss what techniques can be offered to staff beyond TSS. This would be adding, not taking away. Some staff has been told in their classes that if a move is not taught in class, it cannot be used. These classes are also being taught differently in Anoka. Carol Olsen will follow up with this.
f. Pressure points are acceptable for bites and hair pull, not for gaining compliance.
g. The budget on cameras is more than the established contract with the vendor. This must be agreed upon with administration and they are asking for an exception. Cameras’ not moving forward has been brought up to the commissioner and she will look into this. Management does not want to wait for new construction.
4. MSH Unit 900 staffing concerns (1:1’s Pt & staff ratios)
a. There is concern that staff are leaving different work stations to cover 1:1’s and managing a rotation. It is sometimes difficult to pass along vital information on the patient. How can we hand off communication (i.e. what behaviors to look for) that is clear to staff? This would take away second guessing for the staff, especially coverage staff. Management will be evaluating 1:1’s and their effectiveness/their purpose. How to make sure a patient is not dependent on a 1:1 will also be looked at.
5. MSH Unit 800, incident review/update
a. The RCA has been completed but management must first have a meeting with joint commission scheduled for next week. The police investigation is not completed and will take a while. Management has not heard when The MN Dept. of Health and Licensing investigation will wrap up. Employee misconduct investigation is also not finished. OSHA’s final report is also unfinished.
b. Staff does not feel that practices are being changed and would like to see something done immediately. Management stated that there has been training on completing rounds and engaging patients on the unit.
c. AFSCME would like to know when investigations in general are completed. The staff is only notified through a conversation, nothing in writing unless there is a discipline. Human Resources will communicate further with the union on how to notify a steward when an investigation is closed.
d. Staff did a great job handling a recent patient threatening to shank or other violent acts. Management is working with local jails to see what they have for bed availability. They would like to possibly pay for some beds to house volatile patients. MSH would still need to provide treatment but the patient would be under the jail’s supervision. This will take some time and negotiation.
6. Work rules/ location/ assessable
a. Work rules are located on the I Drive under GEN. Management will look into putting work rules on the SharePoint site.
7. MSH/NOC work expectations
a. Different ideas will be looked at for keeping staff alert/awake. If a staff is on a 1:1 and has to watch a patient sleeping, it is difficult to stay alert.
b. Can staff read? Management will look further into this.
8. Review the grievance process involving the TTS’s
a. The process for 1st and 2nd step grievances will go through Meghan Goodrich and then the TTS. Meghan will be setting up and attending meetings at the 1st and 2nd step.
9. Review/request the NASMHPD report
a. Management will make it available once it is available. The report will be submitted to everyone.
10. How is management addressing the Joint Commission findings citing leadership LD.03.01.01 and LD.04.04.03 as having a direct input on staff/patient safety
a. There have been 2 citations and 1 recognition that Unit 900 has too many admissions/crisis patients with no other place to put women. These patients are being assessed individually.
b. All risks on 900 are not clearly being identified. Staff was asked to do a proactive risk assessment of violence on 900. The last meeting was April 17th. The group has come up with issues that need to be addressed. The staff in this group includes 2 Security Counselors, the BA, TTS, Rita Olsen, Gloria Zimmerman, nursing, and a psychologist. The main areas looked at include the need for a consistent psychiatric provider, the unit needs to develop clear patient expectations that will create staff consistency to bring down the chaos, and developing a treatment model for individual patients based on who they are and what their purpose is in progressing treatment.
1. Consultant’s forensic nursing home report and vacation/scheduling
a. The next step management would like to take is to meet with staff and lay out two different options for the schedule. One option is a schedule with every other weekend off. That option would create 3 vacation slots Monday-Friday, 1 vacation slot on the weekends. The second option is a 6-2 rotation. This option would create 3 vacation slots all days of the week.
b. In order for these options to happen, an additional FTE LPN and 3 .8 HSS’s need to be hired.
c. Management would like to set up a meeting for next week to meet with staff.
2. Stewards list for investigations review/utilization
a. The list of stewards to sit investigations has been distributed to everyone. AFSCME will be updating the general steward list and deleting stewards who are no longer active. There are no changes to the investigation list. It was made clear that not all stewards sit investigations.
3. MSH Omni cell company the recognition or lean of responsibility
a. Have not received a release of liability. Please make sure the equipment clicks twice because a lot of the time the drawer is not shutting all the way. Management has not heard of this happening recently. Pharmacy has made sure that they are not over filling the bin.
b. If an OMNI cell fails to work properly, call the pharmacist if possible. It is recommended that staff use a different OMNI cell when one fails.
c. Management found a different option for a med window. It was placed on Unit 800 and liked so enough for all med windows has been ordered.
4. Avatar system readiness/implementation
a. Have not heard anything. MyAvatar is going live August 23rd.
5. Admin/HIMS update on office space/move
a. A proposal was submitted that would set up a temporary admin crisis unit HIMS area. This is being priced out. Would like to locate medical records on campus to this facility. Currently do not have funding for a storage system. There are no new updates on if or when this will happen, it will not be anytime soon.
b. The long range plan was that this would happen in phase two of bonding.
c. There are currently 42 tons of paper medical records on campus
6. Name Badges
a. This recently was mentioned at a DCT meeting. Management supports last names being taken off of badges for non-licensed staff. Those licensed must have their credentials on their badge. Replacing badges will be costly.
7. Scheduling, overtime, and inverse FAQ’s
a. Contact the OD if there are any issues. 3 out of 5 shifts are approved.