title: Measurable results: Reducing staff injuries on a specialty psychiatric unit for patients with developmental disabilities.
abstract: BACKGROUND
  Quality improvement initiative focused on staff injury reduction on a specialized inpatient psychiatric unit which offers acute stabilization for children and adolescents with complex high-risk behaviors.
  
  
  OBJECTIVE
  To utilize quality improvement principles and interventions to reduce staff injuries on a specialized inpatient child/adolescent psychiatric unit.
  
  
  METHODS
  Direct care clinical staff within an inpatient psychiatric unit for patients with co-occurring developmental disabilities and psychiatric illness were the focus of the initiative. Direct care clinical staff and clinical administrators were the active participants in the quality improvement initiative, focusing upon the interactions between staff and patients.
  
  
  METHODS
  OSHA-recordable injuries were documented to guide initiatives and measure outcomes on weekly run charts with raw data measures of all staff injuries and the number of days elapsed between injuries. Rapid Plan, Do, Study, Act (PDSA) cycles were utilized to test interventions and guide decision making.
  
  
  RESULTS
  Three months of a structured and systematic intervention trial produced the first adopted interventions in August 2011. The following six months reflected a 65% reduction of staff injuries (from 2.2 injuries per week to 0.77 injuries per week). Between January and August 2011, there were eight OSHA-recordable injuries with an average of 26.5 days between injuries. The average number of days between OSHA-recordable injuries has increased from 26.5 days at baseline to 124 days.
  
  
  CONCLUSIONS
  An initiative utilizing quality improvement principles reduced staff injuries on an inpatient specialized psychiatric unit. Reliability principles, system adaption, and engagement of the frontline nursing clinicians have proven to be foundational and vital to guide the initiative.
authors.affiliation: Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Adam K
authors.initials: AK
authors.lastname: Hill
authors.affiliation: Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Lind
authors.affiliation: Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: DaVona
authors.initials: D
authors.lastname: Tucker
authors.affiliation: Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Pamela
authors.initials: P
authors.lastname: Nelly
authors.affiliation: Research in Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Daraiseh
mesh_terms: D000293:Adolescent; D002648:Child; D002658:Developmental Disabilities / Q000150:complications; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D001523:Mental Disorders / Q000150:complications* / Q000628:therapy; D016272:Occupational Health; D060051:Occupational Injuries / Q000517:prevention & control*; D010564:Personnel, Hospital / Q000706:statistics & numerical data*; D011567:Psychiatric Department, Hospital / Q000706:statistics & numerical data*; D058996:Quality Improvement; D064450:Workplace Violence / Q000517:prevention & control*
keywords: OSHA-recordable injuries; acute crisis stabilization