Improving the Assessment and Triage of Patients with Mental Illness ...

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follow. The chapter concludes an overview of the change process carried out under the steps of the change model chosen which are: Initiation, Planning, Implementation and Mainstreaming. Chapter 4 examines the change project in terms of evaluation and considers the tools used for the purpose of evaluation. The final Chapter 5 relates to discussions and conclusions and looks at the strengths and the weaknesses of the project, recommendations for future improvement and my reflections on the change management project. This project was derived from an observed need to improve the triage and assessment of patients presenting with mental illness to the ED. To achieve these improvements I introduced three elements which were: a Mental Illness Triage Tool, a computerised pop-up screen in triage and finally nursing assessment documentation for the assessment of patients with mental illness. 1.2 Background and Rationale for carrying out the Change. In my role as a Clinical Nurse Manager in a busy Emergency Department I am cognisant of the necessity for change throughout the organisation generally, and, more specifically within my own department. While I considered a number of areas for this change project, having had regard to time constraints and cost implications, I was keen to implement a program that would have immediate benefits for both patients and staff while remaining as cost effective as possible. In the current economic climate, I believe that support might not have been forthcoming had I selected a project that required an extensive outlay of capital. The Emergency Department is a common site for the mainstreaming of patients with mental illness. Traditionally, individuals with a mental illness would have attended an acute assessment unit on the grounds of a mental institution. However, government-led changes have seen the amalgamation of mental institutions with acute hospitals. Many patients will attend their General Practitioner (G.P) with issues such as depression or anxiety. The G.P may decide to refer the patient to a psychiatrist, psychologist or counsellor in the community. 2
However there are a large number of patients who may require more intensive intervention and possible admission. These individuals will then present to the emergency department, often deciding not to attend the G.P, in order to access the mental health services within the hospital. The triage nurse is generally the first point of contact for patients with mental illness. The Manchester Triage System is used to assess patients with the allocation of a triage category based on level of acuity. At present there is no streaming of patients in the department which means that those with a mental illness will be triaged in the same way as individuals presenting with medical or surgical complaints. All triaged patients are then returned to the waiting room unless they need immediate intervention. They then wait until they are called through to the cubicle area to be assessed by a clinician. Patients with mental illness in the vast majority of cases will be reviewed by an emergency department clinician first and then if deemed necessary referred to a psychiatrist. Few patients are seen directly by the psychiatrist if they attend the ED. This may cause the patient further psychological distress due to long waiting times in an overcrowded and noisy waiting room Another issue in the emergency department in relation to caring for patients with mental illness is the lack of formal training and education the emergency nurse receives in this specialist area. While the triage nurse plays a pivotal role in the assessment of all patients, a possible lack of knowledge and understanding in relation to those presenting with mental health issues, may place the patient at a disadvantage. Traditionally triage was concerned with physical illness or injury and accordingly, psychological factors were secondary considerations. In an effort to address these issues, I firstly developed a triage system in the form of a computerised pop-up screen that can be accessed by the nurse if it appears that the patient is presenting with mental health issues. The triage nurse is then prompted to answer seven questions in relation to the patient. Six out of the seven questions require a “yes” or “no” answer, while the remaining question is to ascertain who is accompanying the patient. The reasoning behind this initiative was two-fold: firstly to ensure that the triage nurse would ask the more relevant questions and secondly, it was envisaged that it would potentially reduce triage time, as the nurse would spend less time on the hand written report. The second element to my project was the implementation of a “triage tool” which was adapted from the 3
Page 1 and 2: Royal College of Surgeons in Irelan
Page 3 and 4: Improving the Assessment and Triage
Page 5 and 6: Abstract Since the amalgamation of
Page 7 and 8: Table of Contents Abstract Acknowle
Page 9: Chapter 1 Introduction 1.1 Introduc
Page 13 and 14: Chapter 2 The Literature Review 2.1
Page 15 and 16: with mental health issues, who pres
Page 17 and 18: Australia. The data was collected b
Page 19 and 20: Following implementation of the Nat
Page 21 and 22: Consequently the subsequent chapter
Page 23 and 24: must analyse their surroundings and
Page 25 and 26: After consideration of the aforemen
Page 27 and 28: questioning the patient about their
Page 29 and 30: The benefits of successful implemen
Page 31 and 32: Establishing trust was significant
Page 33 and 34: Group One: Nursing documentation- C
Page 35 and 36: Developing the implementation plan.
Page 37 and 38: Communication As discussed in relat
Page 39 and 40: Nevertheless as a change agent and
Page 41 and 42: crucial. The change agent or change
Page 43 and 44: The observational audit carried out
Page 45 and 46: Limitations arise as the project wa
Page 47 and 48: 5.5 Conclusion Improving the triage
Page 49 and 50: Cartwright, T., Baldwin, D. (2007)
Page 51 and 52: Happell, B., Summers, M., Pinikahan
Page 53 and 54: McAuliffe, E., Van Vaerenbergh, C.
Page 55 and 56: National Institute for Clinical Exc
Page 57 and 58: Wand, T. (2004) Mental Health Liais
Page 59 and 60: Appendices Appendix A Mental Illnes
Page 61 and 62:
Appendix A Mental Illness Nursing A
Page 63 and 64:
Appendix C Recommendations in World
Page 65 and 66:
Appendix E Manchester Triage Algori
Page 67 and 68:
Appendix G Health Service Executive
Page 69 and 70:
Appendix I Change Management Projec
Page 71 and 72:
Appendix K Mental Illness Triage To
Page 73 and 74:
Appendix M Force Field Analysis Dri
Page 75 and 76:
Appendix O Questionnaire results re
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Appendix Q 16 Triage Category alloc
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