Open Recommendations

The Chief of Staff directs staff to complete the Columbia-Suicide Severity Rating Scale within 24 hours before discharge and monitors for compliance.

The Chief of Staff directs staff to address ways to make the veterans environment safer from potentially lethal means in safety plans and monitors for compliance.

The Facility Director directs staff to comply with Lethal Means Safety training and monitors for compliance.

The Facility Director directs staff to comply with Skills Training for Evaluation and Management of Suicide training and monitors for compliance.

The Facility Director directs staff to comply with VA S.A.V.E. training and monitors for compliance.

The Facility Director ensures Interdisciplinary Safety Inspection Team requirements are met and monitors for compliance.

The Facility Director implements processes to ensure the Interdisciplinary Safety Inspection Team applies Mental Health Environment of Care Checklist standards to all sections on the inpatient mental health unit and monitors for compliance.

The Facility Director uses VHA guidelines to develop a facility-specific policy for the use of restraint chairs.

The Facility Director directs staff to comply with Mental Health Environment of Care Checklist training requirements and monitors for compliance.

The Facility Director establishes a mental health executive council that operates in accordance with Veterans Health Administration requirements.

The Facility Director ensures development and implementation of a multi-year recovery transformation plan.

The Associate Chief of Staff for Behavioral Health ensures a minimum of four hours of recovery-oriented, interdisciplinary programming on weekdays and weekends on the inpatient mental health units.

The Facility Director ensures inpatient mental health units are in good repair and the environment reflects recovery-oriented principles.

The Facility Director ensures veterans privacy in restraint rooms on the inpatient mental health units.

The Associate Chief of Staff for Behavioral Health develops written guidance to ensure staff and veterans safety during outdoor breaks.

The Facility Director formalizes processes to monitor and track compliance with state involuntary commitment laws.

The Chief of Staff ensures the completion of comprehensive inpatient mental health treatment plans and monitors for compliance.

The Chief of Staff ensures documentation of discussions between prescribers and veterans on the risks and benefits of newly prescribed medications and monitors for compliance.

The Chief of Staff ensures mental health treatment coordinators are included in care coordination.

The Chief of Staff ensures discharge instructions for veterans include appointment locations written in easy-to-understand language.

The Chief of Staff ensures discharge instructions for veterans include the purpose for each listed medication in easy-to-understand language.

The Chief of Staff ensures discharge instructions for veterans include an explanation when both trade and generic names are used for the same medication.

The Chief of Staff ensures staff complete the Columbia-Suicide Severity Rating Scale within 24 hours before discharge and monitors for compliance.

The Chief of Staff ensures safety plans address ways to make the veterans environment safer from potentially lethal means and monitors for compliance.

The Facility Director ensures staff comply with timely completion of VA S.A.V.E. training requirements and monitors for compliance.