Nurses from Saint Francis Hospital and Health Centers in Poughkeepsie, N.Y., have developed a Code Green Response Protocol for patients who have acute behavioral needs or may be experiencing an escalation in their behaviors. “A patient may be acting irritable and restless, and the primary nurse is unsuccessful in meeting the patient’s needs. We don’t want the RN to wait until the behavior gets out of control,” says Judy Canham, RN, PMHCNS-BC. If a nurse needs assistance with a patient who is challenging but not verbally or physically threatening or intimidating, the hospital-wide protocol gives step-by-step guidelines, including mental health directors or coordinators’ beeper numbers to page during regular and off hours. The consult may be by phone or face to face, depending on the patient’s needs.

The primary nurse informs the mental health nurse about the patient, and the mental health consultant may recommend behavioral interventions or a change in treatment plans that, along with an MD consultation, may include medication adjustments or a psychiatric consult. The nurse helps in obtaining clinical resources and making decisions.

If a patient is displaying verbally or physically threatening or intimidating behaviors, the primary nurse calls a Code Green, and the Code Green team, which is made up of a mental health RN who is the team leader and two mental health unit PCTs, immediately go to the unit. The primary care nurse provides the team leader with a clinical snapshot of the patient, including diagnosis, medications, precipitants to the behavior, attempted interventions, and the patient’s response. The mental health nurse directs the Code Green response, which consists of verbal intervention/de-escalation; use of PRN medications; restraints; and debriefing, depending on the situation.

“The program has successfully educated medical surgical staff on how to manage challenging situations,” says Nancy Magliocca, RN, MS, director of inpatient behavioral health, who created the protocol with the mental health team.