Vital sign monitoring is the assessment of body temperature, heart rate, respiratory rate and blood pressure, and is often considered to be the baseline for determining a patient’s health status. When mental health patients have their vital signs assessed it’s typically done once upon admission to a care facility, making it difficult to assess current medical status, or any changes, without a series of vital signs.

Chilliwack General Hospital team: (left to right) Lanny Hellewell, RN, Patient Care Coordinator, Ashley Grittner, RPN, Sonya Zihrul, RPN, and Lee Erikson, Manager.

A safety event reported in BC PSLS brought this issue to light for staff on the Mental Health and Substance Use unit at Chilliwack General Hospital. Lee Erikson, Manager, says the event prompted her and her team to make improvements to medical monitoring of mental health patients to ensure they would receive medical attention when needed in a timely manner.

“This is a story that was told to me when I joined the unit in 2013, says Lee. “One of our psychiatric patients began to deteriorate quite quickly and things didn’t go as smoothly as they should have. We realized then that we needed to update our policy for taking vital signs of mental health patients and streamline communication with the doctors on duty for unexpected medical situations.”

From the beginning, Lee says it was imperative for staff to feel involved and committed to the initiative as a way to improve patient safety on the unit. To help, she brought in Warren Hill, Director of Clinical Operations and a quality improvement specialist with expertise in the PDSA model for improvement. “As a new manager,” says Lee “I wanted staff to know that I believe in collaborative practice and that we are all accountable and responsible for our own actions and any changes we wanted to make to improve quality of care.” 

Using the PDSA model, Lee and her team worked together to figure out: 

Quality Improvement Worksheet used by the mental health team for the PDSA process at CGH.

What are the best times to take vital signs?

How long should vital signs be monitored?

What are the best ways to flag patients who need medical attention? And, 

How can this change of practice be incorporated into nursing routines?

The team determined that taking vital signs for 72 hours following admission would give them a good sense of which patients needed medical attention, and alert them to any changes in a patient’s status. In addition, the team agreed that it would be best for one doctor to treat psychiatric patients with sudden/unexpected medical needs, rather than assigning patients to the doctor on duty that day. These changes are now standard practice across the acute mental health program at Fraser Health.

“Patients with mental health needs are looked after by a treatment team – a psychiatrist, registered psychiatric nurse, social worker, recreational therapist and perhaps an occupational therapist. If the team believes there needs to be greater continuity because of medical concerns, they make that decision as a treatment team and request one physician.”

Lee is a BC PSLS Handler who encourages staff to report safety events. With such a diverse portfolio, she says daily walkabouts drive her day – she spends much of her time visiting with staff and patients and says there’s a real openness to improve and learn.

“Staff are very diligent in doing vital signs and head-to-toe assessments of our psychiatric patients and they’ve caught a number of things early on. They support each other. They are open to making improvements and using PSLS to improve patient care – it is a culture of safety.”

Congratulations to Chilliwack General Hospital!