Culture of Inquiry and Innovation

Welle Updates

With the new Center for Behavioral Health and Learning building opening this year, the Workplace Violence Prevention team has been working to make sure our team is equipped to safely care for all our patients. Welle, our Workplace Violence Prevention program, focuses on fundamental safety measures and techniques for handling escalated patient behaviors, with an emphasis on Trauma Informed Care. The Welle training team went through a Certification/Recertification course in November 2023 to stay up to date with best practice and deliver the most current information to our staff.

The Welle program serves as the cornerstone in readying all staff members who interact with patients and might work in the new facility, as well as High and Medium risk staff, as defined by our Workplace Violence Prevention Policy. Currently, about 2,100 High and Medium risk staff members have completed Welle training since 2022.

The Core Welle course for all new High and Medium risk hires incorporates practical disengagement techniques and real-time role-play scenarios. Low risk staff members will have access to an online version of the Welle training, anticipated to go live in Spring of 2024. Staff in High risk areas are beginning to go through the Refresher classes as well, which build on the core ideas of Welle, including new techniques for physical safety and de-escalation. Staff who have completed the program consistently indicate improved confidence in their ability to handle both verbal and physical de-escalation. The Workplace Violence Prevention teams continue to look for ways to help teams incorporate more Welle skills into their daily practices!

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BERT and Workplace Violence

We are excited to share the ongoing rollout of UWMC’s Behavioral Emergency Response Team (BERT), a consult service modeled off the rapid response team to assist caregivers with proactively deescalating behaviors that could pose a safety risk to inpatient areas and the ED. The BERT is designed to utilize trauma-informed interventions and least restrictive measures to maintain staff and patient safety.

At UWMC-Northwest, the team consists of one psychiatrically trained RN from Adult Psychiatric Unit, one STAT RN, and one Public Safety Officer lead. At UWMC-Montlake, the team consists of one STAT RN, Public Safety Officer lead and the provider on call. We have also had the pleasure of partnering with Spiritual Care for follow up on BERT consults at both ML and NW to provide ongoing emotional support to patients involved with the BERT.

All responders on both campuses have received formal BERT training regarding therapeutic communication techniques, behavioral health policies, and BERT documentation in EPIC.

At Northwest, the BERT has contributed to a notable 48.65% reduction in workplace violence (WPV) incidents resulting in first aid, medical treatment, or time lost from work between 2023 and 2022. At Montlake, the BERT has contributed to a 29.26% reduction in total WPV incidents as well as 105.88% reduction in WPV incidents resulting in first aid, medical treatment, or time lost from work between 2023 and 2022.

We look forward to tracking the long-term impact of the BERT on patient and staff safety!

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CBHL planning

This year was filled with anticipation for our new building and ensuring that staff were ready to support our new patient populations. Much of the education was focused on safety basics and skills around managing challenging patient behaviors. The Welle program continued to offer sessions every other week, teaching relationship building skills, de-escalation skills, and assessment of the psychiatric patient. This course included hands-on disengagement skills and live role play scenarios. This program was foundational in preparing all patient facing staff that may work in the new building.

This year also highlighted an introductory training program for nurses on leading therapeutic groups for patients. This primarily involved shadowing our CNS and therapy’s team while 2024 will transition to more active participation by staff nurses.

The new building will feature a larger footprint including access to a patio. Staff received education on managing patients that may be flowing from the unit to the outside, including understanding a new patio policy with specific patient to staff ratios. Other safety education was provided on patient rounding, emphasizing the importance of high-quality rounds, and verifying their location and disposition.

In 2023 the adult psychiatric unit (APU) adopted the TSAM onboarding model, with the goal of aligning with the rest of the organization and creating a more robust and quality onboarding experience. In addition to reviewing basic topics such as staff professionalism, patient identification, and head to toe assessment skills, new staff now complete a Transition in Practice course that reviews the basics of psychiatric nursing care.

Finally, all RNs were offered the opportunity to achieve the Psychiatric Mental Health Nursing certification. A study prep group has been offered twice yearly in addition to mentoring and guidance from the CNS to support this effort.

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Seattle Nursing Research Consortium (SNRC) 2023