Ask Jill
12.11.2018

Does NMC Need to Improve the Care of Patients with Mental Illness?

Yes, as despite being known for delivering quality care, we recently failed to measure up to standards in our treatment of patients with mental illness. This is unacceptable to me as a nurse and as your community hospital’s CEO, and for this I must apologize. Today, I would like to speak to you about NMC’s status relating to the care of patients with these needs, as I am your hospital CEO in the good times as well as in the challenging times.

To preserve patient rights, safety, and dignity, the Centers for Medicare and Medicaid (CMS) has stringent standards on how hospitals can interact with patients who are suicidal or suffering from psychiatric ailments. This includes restrictions on when law enforcement can be called into a hospital in potentially violent situations. Recently, CMS surveyors found our approach to specific patient situations at NMC not to have met the CMS standards of care. That is unacceptable and has created a serious level of concern both at CMS and at NMC.

We are currently working through a plan of improvement regarding our approach to caring for patients with these needs. I have met with our full management team and our Emergency Department team and made it clear that meeting these standards to keep all patients and staff appropriately safe is a top priority.  While this concern has a focus in our Emergency Department based on how patients with these needs tend to present at the hospital, the fundamental concerns impact care across our entire organization. We are fully committed to meeting CMS’s standards. We are improving our processes for caring for psychiatric patients, strengthening the documentation, and increasing our auditing of that care. We are advancing our staff’s training in the de-escalation of difficult situations. We are partnering even more closely with Northwestern Counseling & Support Services to draw upon their expertise. We are accelerating renovations within the Emergency Department to provide a safer room for care of patients with specific needs. We are expanding our ability to use our own trained staff to properly assist in situations and strengthening our contract for onsite security services. We are further refining our policies on restraining patients and the role of law enforcement in the hospital, in alignment with fine work done in these areas by Rutland Regional Medical Center that CMS called out as an example.

As I have shared previously, Vermont hospitals – including NMC – face significant challenges in caring for patients with serious psychiatric needs. Al Gobeille, Vermont’s Secretary of the Agency of Human Services, understands these challenging situations, saying “Vermont’s hospitals are seeing more people with higher acuity mental health needs coming to Emergency Departments for care. This is causing significant stress on the system and we need to continue to work together across sectors to address it.” Secretary Gobeille is correct. This concern is very real here at NMC and we are an active partner in efforts to improve Vermont’s systems to better ensure adequate access to the mental health facilities and resources required for these patients.

All hospitals have a responsibility to keep both patients and staff safe. This takes careful consideration and constant diligence, as some patients can exhibit violent or combative behaviors which put themselves and others at risk for harm. I am proud of the efforts of our staff to provide all patients with exceptional care. NMC has been recognized for our quality of care and we are constantly striving to improve. The culture we foster, one of continuous improvement, requires many important values including integrity and accountability. We understand we have not met these CMS standards. It is clear to all of us at NMC that we must take these important improvement steps right now, as we are committed to providing exceptional care for every patient. We owe that to you as our community and we will deliver on that commitment. Your trust at all times in the care we provide is of utmost importance to me and to all our NMC team. I believe in this great team. Thank you for your continued support.

— Jill Berry Bowen, RN, NMC’s Chief Executive Officer