So yesterday, our Delirium Early Detection and Prevention Project held its second meeting. We got some issues clarified about how we’re going to communicate with each other, such as email and/or Sharepoint and others. The nursing representative (who was standing in for the regular member) then dropped a bomb by notifying us that there might be more than one delirium intervention project going on around the hospital.
Shortly after that, I got paged out to an emergency, a Code Green. I think I was in the meeting all of about 15 minutes. I had made an agreement with another physician that she would be the co-leader—but she is out of town this week at a conference, of course.
A Code Green is a behavioral emergency in the hospital. It means that a patient is violent somewhere in the hospital and we have a standing team that responds to a Code Green page through the hospital operator after being notified that the Code Green team needs to be mobilized. It’s sort of a weaponless SWAT team many of the members of which get specialized training in non-violent management of violent patients. Many of the principles governing the physician role in Code Greens are outlined in the video presentation entitled “Assessment and Management of the Violent Patient” on the right hand side of this page.
The irony is that the vast majority of Code Green calls are about patients who are violent or so grossly disorganized they are a danger to themselves or others—because they’re delirious or demented or both. This call yesterday was no different. And the other difficulty is that our group had briefly discussed a rule called the “100 Mile Rule” The 100-mile rule says that team members should inform their staffs that they are not to be interrupted unless it is something important enough to interrupt them if they were 100 miles away from the office. This rule is not always appropriate, but it can prevent interruptions for trivialities or issues that could have waited. It’s all about ensuring effective team meetings.
Firstly, I have no staff. Secondly, I’m a doctor on a busy psychiatric consultation service, which is crisis-driven and part of its function is to respond to emergencies all over the hospital. For me the 100 mile rule means that I have to be able to cover 100 miles in less than 3 minutes if I’m paged to a Code Green.
We don’t have a 100 mile rule.
Despite the abrupt departure of the physician leader to an emergency all about delirium in an elderly demented patient, the rest of the delirium project members did just fine. The charter to guide the project is evolving more quickly into a finished document that will guide the team.
The good news about the Sharepoint site is that we’ll probably use it a bit more up to its potential in the coming weeks. We essentially have decided upon a superb set of delirium management guidelines that is bursting with flavor! It has evidence-based literature covering delirium risk factors, assessment principles and tools, interventions including multicomponent strategies, and even a Delirium Knowledge Assessment Test. And it’s even a University of Iowa product, thanks to The John A. Hartford Foundation Center of Geriatric Nursing Excellence (HCGNE) at the UI College of Nursing. It also looks like funding may be forthcoming from the Geriatric Education Center.