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State & Psychiatric Hospital Compliance Collaborative’s Reading Tips Newsletter (RTN) April 2014, Volume 8, Issue 4
SPHCC Reading Tips Newsletter Banner

**WHAT’S NEW for April 2014

  • Article of the Month (Mbrs & Guests)
    • SAVE LIVES: Clean Your Hands – WHO’s global annual campaign –5 May 2014 [Home Health Deemed Surveys Document Hand Hygiene Lapses – Perspectives, April 2014, Vol 12, #4, Pg 10 [Recommended for: IC, RN, StEd]
      The article highlighted here purposed to announce/remind Home Healthcare that since 2/24/14, failures to follow appropriate hand hygiene protocol (in Home Healthcare) were being cited under IC.02.01.01, EP2.  This is in addition to other requirements for a hand hygiene program under NPSG.07.01.01.  Since these requirements are also applicable to our psych hospitals we decided to review it.  In doing so, we discovered [Pearl] the Five Moments for Hand Hygiene.  This tool is a simple and straightforward way to help ensure/increase staff awareness of the essential times for cleaning their hands.  We strongly encourage you to download  the tool and participate in the annual global campaign next month.  Let us know what you think of the tool and about your experience if you go with the campaign.
    • Click for our REVIEW(Mbr/Gst); the FULL ARTICLE(Mbr); to share a COMMENT(Mbr/Gst).
  • Interaction Items (Mbrs & Guests)
  • Member Inquiry: Request for client ratios and/or minimum staffing levels used for nursing and direct care workers
    One of our members recently raised this issue.  It is a frequently asked question that we have not updated in a while.  Please share the ratios you use and/or any references for ratios you have found useful. Members and Guests may click here to make and follow responses to this inquiry.  Thank you!
  • Poll Result: Have a Facebook Account? Yes = 46%. No = 58%
    Since most respondents did not have/use Facebook accounts, provision of RTN reviews, updates, etc. via that social media venue will be placed on hold for now.


  1. PR: Top Standards Compliance Issues for 2013 Ftxt [REF: JCSC LDR, SFT]
  2. PR: Hand Hygiene Lapses (Helpful Tool)  Ftxt [REF: IC, RN, StEd]
  3. TS: Maintaining Records for Waived Testing  Ftxt  [REF: MD, RN, StEd]
  4. TS: Tracer Methodology 101: Data Use…  Ftxt [Pearl: JCSC, PI]
  5. TS: CJCP – Focus on the “Medical Staff” Chapter  Ftxt [REF: CJCP, JCSC, MD]
  6. EC: OSHA Worker Safety in Hospitals Program Launched Online: Online tools include comparison of OSHA’s requirements with Joint Commission standards  Ftxt  [REF: EOC, CJCP, SFT]


**SupporTips – Mbrs & Guests

  • S-Tip#16: Listserve Lite/Interaction Items – Sometimes, just receiving news and information is not quite enough.  Sometimes you would like to know what others think, feel and might be doing related to an issue.  Sometimes you have valuable experience that would be useful to share.  At times like that, a listserv or discussion board might come to mind.  Unfortunately, it takes more time and dedication to follow these vehicles, sort through the irrelevant med/surg issues and delete unwanted e-mails than most of us have.  The interaction Items section of these highlights is designed as a more focused alternative.  Think of its periodic polls and member inquiries as a Listserv-Lite more specifically for our psychiatric programs. We encourage you to contribute and help us achieve the critical mass needed to make such forums rich and rewarding. To suggest a topic for discussion, simply Contact Us. We want to hear from (and respond to) you. Thx!

** Key: Ftxt=Full Text Link PR=Perspectives (JcE), TS=The Source (JcS), EC=EC News (JcE), CM=CMS, JO=JC Online, TP=JC Topics **[More Abbreviations] **

RTN Quick Jump•• Top•• RecRd•• Page 1•• Page 2•• Page 3•• Bottom••JcE••JcP••JcS

4 responses to “RTN1404_A_Highlights”

  1. Here is our Staffing Plan for our hospital. We have struggled through the years tracking “acuity” and trying to find a software system that might help us do that in order to find a true mathmatical way to staff the programs. Here’s what we have done but we are open to learning about any other processes out there. Thanks!


    Nursing Service assignments and the provision of nursing care are commensurate with the qualifications of nursing personnel and are designed to meet the patient care needs.

    Qualified Registered Nurses are scheduled to be on duty at all times to render nursing care requiring the judgment and specialized skills of a Registered Nurse. The Director of Nursing assures provision of nursing services 24 hours a day, 7 days a week with a minimum of a least one RN assigned to each patient care building. Nursing Service staffing is sufficient to assure prompt recognition of an untoward change in a patient’s condition and facilitate appropriate intervention by the nursing, medical or hospital staff. Staffing, scheduling and daily allocation of personnel is accomplished through the Centralized Staffing Office. Staffing levels have been developed according to the needs of the individual clinical area.

    Staffing Plan – 2013-2014

    Lincoln Regional Center is a 24 hour hospital for the mentally ill. General Psych Services (GPS) General Psych Services has a 36 bed male admission program in Building 10, 63 bed male program in Building 5, and a 37 bed female admission program in Building 3. Sex Offender Services treats a 85 bed residential Sex Offender population in Building 14.
    The hospital is staffed with front line Nursing Service staff called Security Specialists. Security
    Specialists have a homebase but can work anywhere on campus as needed to provide coverage. There is a an ADON assigned to each acute care building. The staffing mix also includes Registered Nurses and Licensed Professional Nurses.


    Centralized Staffing

    The Centralized Staffing Office is responsible for the day to day staffing and scheduling operations for Sex Offender Services (SOS) and GPS. The office is open Monday through Friday with hours accessible for all shifts. Nurse Supervisor’s or RN’s are responsible for staffing on weekends, holidays, and times when Centralized Staffing is not available.

    The Daily Placement Sheet (DPS) is used to document daily staffing activity. The Staffing Office provides each service area a DPS identifying staff assignment for each shift. Any alterations to these assignments in the programs must be made on the DPS. The DPS acts as the official staffing documentation record.

    Staffing Numbers

    Daily staffing ratios for GPS & SOS have been determined. This is the number of staff that is consistently assigned to a particular building or work area. It may be necessary to adjust these requirements in the event of a community disaster or emergency, such as a blizzard or tornado. The decision to adjust the minimum staff required as listed below lies with the Director of Nursing. The following staffing needs have been determined to meet the minimum requirements for each work area*

    Security: Security Specialists
    Work Area Day Eve Night
    S 1, 2 & 3 16 16 10
    S 5 6 6 4
    SOS-R, E & W 6 6 5
    SOS-B14, 1st floor 6 6 5

    Total 34 34 24

    Work Area Day Eve Night
    Bldg. 3 – 2nd floor 3
    Bldg. 3 -1st floor 5 5 3
    Bldg. 10 7 7 4

    Total 17 17 10

    *minimum adjusted to patient census

    Building 5: Nurses*
    Day Eve Night
    5 5 2
    Building 14: 2 1
    Building 3: 3 3 1
    Building 10: 2 2 1
    The above nurse requirements are the minimum, not the customary staffing. LPN’s are utilized for medication room coverage, assistance to nurse and to maintain patient coverage.

    On- Call Employees

    On-call Security Specialists and nurses are used to provide supplemental staffing. On-call employees are provided orientation and training to their designated work areas. On-call employees are expected to stay current on mandatory job requirements and to follow all Lincoln Regional Center policies and procedures.

    On-call employees are scheduled through the Centralized Staffing Office.

    Patient Statuses

    The above staffing numbers are the minimal amount required. Patient acuity in the form of a 1:1 or Highly Restrictive status will require one additional staff for each status ordered.

    The Director of Nursing or ADON’s may increase staffing numbers for other increased acuity needs to ensure the safety of patients and employees.

    • Stacey,
      Thank you for your response. I agree with you 100% that this is a difficult subject! I will share our results once we have them completed.
      Thanks again,

  2. Stacey – Sharing your actual staffing plan was a great idea/response, I hope others will do the same. I suspect pasting it into our comments section disturbed the formatting and so understanding the numbers is challenging in some parts. If you send me the original I will see if we can go in and align things more appropriately. Thank you, thank you. – R. Fields


    Hi Richard,

    For the PA state hospital system:

    1 psychiatrist per unit which is on average 30 patients

    1 medical physician per 2-2.5 units

    2 nurses (day and evening shifts) per unit

    4-5 aides per unit

    These are rough numbers off the top of my head which I will need to verify. There may not be 2 nurses per shift every day, but that is what they strive for. A few years ago there was a push to increase the numbers for physicians, but I have resisted that and so far it has remained at the stated ratios except for when we are understaffed so everyone has to pick up more.

    Hope that helps. Let me know if you want to discuss further.

    Dale K. Adair, MD | Medical Director| Chief Psychiatric Officer

    Department of Public Welfare | Office of Mental Health & Substance Abuse Services

    PS: I just got verification that those numbers are the goals set by the facilities.


    Dale – Thanks much for your response and (as indicated in your follow-up e-mail)for taking the additional time and confirming it with your DON. – RAF

    • Thank you Dr. Adair. We have been working on our staffing ratios for some time now and comparative data has been difficult to find. This was very useful!

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