Testing a New Tool for Keeping Staff and Patients Safe in the Pediatric Emergency Department

This week I would like to highlight some outstanding work being done in our pediatric Emergency Department led by Mark Fisher, MSN, RN, CEN, TCRN, Senior Nurse Manager of Emergency and Pediatric Services.  

Our Pediatric ED team is actively redesigning care to improve the experience of behavioral health patients and their families. 

Because of an increase in violence in Emergency Departments, particularly against nurses and nursing assistants, de-escalation techniques are being used to manage aggressive and agitated patients.  Triage nurses, who are charged with assessing the patient, use screening tools to identify the patient who may become aggressive.  One of these tools is STAMP (Staring, Tone and volume of voice, Anxiety, Mumbling, and Pacing). Knowing when a patient is likely to become violent is imperative to enacting de-escalation strategies. 

Using the tools of our Lean Management System (LMS), the Peds ED is testing the implementation of STAMP as one of their areas of focus (Include pic of chart). Mark recently responded to some questions to give us a better idea of their work and what they are learning.  

Q:  How did you hear about STAMP and how long have you been using it in the peds ED?
A:  We performed a literature review on the best predictive tools for pediatric violence in behavioral health. In addition, we reviewed Joint Commission materials for best practices and they showed STAMP as a validated tool. We are using the Model for Improvement to test its value.

Q: What are some of the lessons you have already learned since its implementation?
A:  The tool allows for easier end-user interpretation of current behaviors of the pediatric patient.  

Q: As part of LMS what are you measuring when it comes to STAMP?
A: Our goal is to predict potential violence to better place our patients within our care settings for safety.

Q:  As part of your improvement work, are you comparing STAMP to what you had been using previously?
A:  Our current standard work includes using the Broset violence score, which is intended for use in adult patients. We identified this gap in practice using LMS and therefore we are on this journey of improvement. 

I want to thank Mark and his team for their hard work and their test of change. We look forward to the results after they have been analyzed.  

Let’s thank… 
This week is Pastoral/Spiritual Care Week.  Please join me in thanking Chaplain J. Joseph Hart and all the members of our Spiritual Support team for their hard work and dedication to meeting the spiritual needs of our patients. No matter the faith, our Spiritual Support team is always there to provide compassion and comfort to patients and their families as they face a serious illness or life-threatening injury. To learn more about our Spiritual Support Services, please visit their web page.