Reducing Violence in Healthcare - Allied Universalpages.aus.com/rs/761-TOW-449/images/Point Of...
Transcript of Reducing Violence in Healthcare - Allied Universalpages.aus.com/rs/761-TOW-449/images/Point Of...
Mike Dunning, CEM, CHPASenior Director, Healthcare
Reducing Violence in Healthcare
2019
Lisa Terry, CHPA, CPPVice President, Vertical Markets, Healthcare
Presented by:
Lisa Terry, CHPA, CPPVice President
Vertical Markets - Healthcare
Mike Dunning, CEM, CHPASenior Director
Vertical Markets - Healthcare
Core Concept…
Violence is the precursor to Violence
Violence in Healthcare: Evaluate the Problem
The Centers for Disease Control and Prevention (CDC) National Institute for Occupational Safety and Health (NIOSH) defines workplace violence as “violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty.”
The U.S. Department of Labor defines workplace violence as “an action (verbal, written, or physical aggression) which is intended to control or cause, or is capable of causing, death or serious bodily injury to oneself or others, or damage to property.”
Workers in healthcare settings have 20% higher chance of being victims (IAHSS)
12% of emergency department nurses experienced physical violence1
59% experienced verbal abuse—during a seven-day period1
21% of RNs and nursing students reported being physically assaulted over 12 months2
Over 50% reported being verbally abused over 12 months3
Healthcare accounts for nearly as many injuries as all other industries combined3
75% of aggravated assaults and 93% of all assaults against health care workers from patients or customers4
1 2009–2011 Emergency Nurses Association survey of 7,169 nurses.2 A 2014 American Nurses Association’s Health Risk Appraisal survey of 3,765 registered nurses and nursing students
3 Source: Bureau of Labor Statistics data for 2011–2013, covering injuries that required days away from work.42017 BLS 2. National Crime Victimization Survey (2018) 3. TJC Sentinel Event Data 2018
Violence in Healthcare: Evaluate the Problem
Point of Care Violence
In 2016, U.S. hospitals and health systems alone expended approximately$2.7 billion in respondingto violence
Consider…
48 HC Worker fatalities in 2017 due to violence (30% of HC fatalities)
31 due to homicides (compared to 458 in ALL industries) • 6 – domestic partner• 5 – co-worker or work associate • 6 – inmates• 14 – others (patients and visitors)
22 were from gunshot wounds, others include blunt force,asphyxiation or strangulation and other traumatic injuries
16 suicides
USAF.FEMA.GOV, Data.BLS.GOV
The Motivators…
Violence is motivated by… • Revenge• Anger• Ideology• Mental Illness• Desire to be famous
TJC Sentinel Event Data 2018, AHA Study on Violence in Healthcare
The most common characteristic exhibited by perpetrators of workplace violence is altered mental status associated with dementia, delirium, substance intoxication, or decompensated mental illness.
One study showed that patients in police custody within a health care setting are involved in 29% of shootings in emergency departments, with 11% occurring during escape attempts.
Contributing Factors…
TJC Sentinel Event Data 2018, AHA Study on Violence in Healthcare
• Poor lighting or other factors restricting vision in corridors, rooms, parking lots and other areas – especially in parking areas
• No access to emergency communication, such as panic alarm, cell phone or call bell
• Unrestricted public access to hospital rooms and clinics
• Stressful conditions, such as long wait times or crowding in the clinical environment or being given “bad news” related to a diagnosis or prognosis
• Staff working in isolation or in situations in which they can be trapped without an escape route
• No training/discussion on de-escalation and situational awareness
Contributing Factors…
• Lack of organizational policies and training for security and staff to recognize and de-escalate hostile and assaultive behaviors
• Domestic disputes among patients or visitors
• The presence of firearms or other weapons
• Inadequate security and mental health personnel on site
• Understaffing, especially during mealtimes and visiting hours
TJC Sentinel Event Data 2018, AHA Study on Violence in Healthcare
Culture Challenges
I want to feel safe
Protect Me!
I’m Important
I don’t want to be here!Be nice
to me!
What do I do?
I’m Angry
Compliance Challenges
• How are you protecting staff and patients: “Right to receive care insafe setting” and “Right to work in a safe setting”
• An environment where a reasonable person would consider safe• Vulnerable patients, including newborn and children• Must protect emotional health and safety as well as physical
• Physical restraints – have you defined training & competencies (in writing)• Armed accounts will be targets for CMS and TJC
• Especially Tasers and firearms• “Panel” review every incident • NO pepper SPRAY• Have a written policy• Use of Force and Review Policy/Protocol
Violence Management Program: Evaluate ROI
Healthcare workers more likely to take time off work after experiencing acute and chronic episodes of violence in the workplace (BLS)Workplace violence in healthcare causes
high turnover (BLS)Violence results in low staff morale and
lawsuits (OSHA)
Root Causes for Cracks in the Environment
Lack of Program with Processes
Lack of Training
Lack of Reporting
Lack of Specialized Response
Slow Response Time
The Advisory Board, 2017
The Solution…
… requires a change in mindset
Consider...
Mindset must get away from “Reactive” only
• Prepare• Respond• Recover
Building a Proactive Program
• Establish a Threat Assessment Team
• Build the Training Program
• Develop the Plan, Policies/Procedures
Healthcare Threat Assessment Team
• Focus on protecting patients, staff and visitors
• Proactively identify potential threats or acts of violence
• Establish proactive steps to prevent violence
• Ensure clear paths of reporting and communication
Objectives of a Threat Assessment Team
Guiding Principles based on Gene Deisinger, Ph.D1. Targeted violence can often be prevented2. Violence is a dynamic process3. Targeted violence is a function of several factors4. Corroboration is critical (identify and verify)5. Threat assessment is about behaviors, not profiles6. Cooperating systems are critical
Healthcare Threat Assessment Team
Based on Gene Deisinger, Ph.D.; The Handbook for Campus Threat Assessment & Management Teams
7. Does the person pose a threat?8. Keep victims in mind9. Early intervention and identification 10.Multiple reporting mechanisms 11.Multifaceted resources 12.Safety is a primary focusBased on Gene Deisinger, Ph.D.; The Handbook for Campus Threat Assessment & Management Teams
Healthcare Threat Assessment Team
Threat Assessment Tool
Example
Poll Question
30,000+Sites Served
Do you have a standing Threat Assessment Team in your facility?YesNo
Focus training on:
Prevention
Recognition Response
Reporting
Training
1. Identify potential issues and early awareness
2. Adhere to reporting protocols
3. Activate an Emergency Response
4. Document threats and incidents
5. Emphasize all threats should be taken seriously
6. Share learning and key findings from historical issues
7. Continuously train on plans, policies and procedures
Training
Resources
Policies, Procedures and Plans
• IAHSS Industry Guidelines01.01.09 Violence Healthcare
01.01.09.01 Targeted Violence
01.09.09.02 Management of Weapons
01.09.03 Threat Management
02.02.04 De-Escalation Training
05.03 Violent Patient Visitor Management
Resources
• OSHA 3148 & 3827 (HR
1309 still in proposal)
• CA H&SC 1257.7 and
1257.8
• TJC Sentinel Event Alert
#59
• ENA WPV Toolkit
• HASC WPV Toolkit
Resources
The Policies, Procedures and Plans must include:
• Detect
• Deter
• Delay
• Respond
• Recover
Detect…
Active Screening
Notification & Alert Systems
Access Control & Visitor
Management
Security
Situational Awareness
Active Engagement
De-escalation
Reporting
Everyone
Detect…
Active Screening
Notification & Alert Systems
Access Control & Visitor
Management
Security
Situational Awareness
Active Engagement
Reporting
Everyone
Active Presence
Physical Screening
Tools/Weapon
Security
Active Presence
De-EscalationSocial Services
Service Recovery
Reporting
Everyone
Detect… Deter…
Active Screening
Notification Systems
Access ControlVisitor
Management
Security
Situational Awareness
Active Engagement
Reporting
Everyone
Active Presence
Physical Screening
Tools/Weapon
Security
Active Presence
De-EscalationSocial Services
Service Recovery
Reporting
Everyone
Deter…
Poll Question
30,000+Sites Served
Does your facility utilize a stand-alone magnetometer to screen persons entering your Emergency Department?YesNo
Basics – Exterior/Parking Areas
• Signage posted at driveway entrances stating that video surveillance is in use
• Signage posted about “no weapons” policy for the facility• Well-lit parking areas with good visibility from the facility• Security team performing visible patrol activity in marked
vehicles- consider having vehicles with light bars activated• Designated assembly areas for evacuation are maintained
and highly visible
Basics – Access Control
• Visitor access limited to controlled entry points• Employee access points monitored to prevent “tailgating” and other
unauthorized access• Weapons screening in place for visitors• Reception areas are well marked and reception personnel are trained
to recognize potential signs of impending violence/aggression• Patrol activities are conducted regularly to ensure that no entry
points are compromised • Badge audits/key audits are conducted regularly to ensure that all
access control is accounted for
Basics – Reception/Waiting Areas
• Reception personnel are trained in recognizing signs of potential violence and making notification
• Reception personnel have drilled in RUN/HIDE/FIGHT• Reception areas are well marked • Access into interior facility areas is controlled- visitors/patients
cannot access interior spaces without interacting with a reception person
• Security personnel patrolling the area regularly• “See something-say something” is enforced
Basics – Patient Care/Treatment Areas
• Access controlled and visitor policies enforced• Department staff are trained in recognizing signs of potential
violence• Department staff are trained and have a plan for patient care in the
event of a threat – not just Run/Hide/Fight• Department staff have “safe areas” identified that they can secure
against a threat• Department staff are trained to immediately report potential issues• Department staff conduct drills, table top exercises, and “what if”
scenarios regularly
Basics – Administrative/Billing/HR Areas
• Access strictly controlled into administrative areas, except in public roles• Security is made aware of employee counseling/termination issues• Controlled space is used for sensitive conversations with security available • Billing disputes and financial issues are conducted in private areas with
video monitoring/panic alarms available• Access to senior leadership strictly controlled• Administrative/management personnel are trained and drilled in
RUN/HIDE/FIGHT• Personnel are trained and drilled in hasty exit/exterior assembly procedures• Aggressive complaints/calls/communications are reported• Facility has an emergency management plan in place• Security review/assessments are conducted regularly
Poll Question
30,000+Sites Served
Does your facility actively utilize an electronic visitor management system to screen visitors entering the property?YesNo
Problem Areas with Security Rounding
Conducted at “Random”Priorities are not placed on certain areas, all areas treated as equal
Primary Focus on “Other” issuesSecurity spends majority of time on non-security related tasks
!
!
Three Key Components of Security-Driven Rounding
Formal Check-In on Each Unit
Initiate focused check-ins with charge nurse or manager: proactively identify potential risks and develop relationships
Target Hotspots of Concern
Round on every unit but disproportionally spend time on units where staff have expressed specific concerns or a history of activity
Formal Handoff at Security Shift Change
Communicate to flag safety and security concerns each shift
Active Presence
Physical Screening
Tools/Weapon
Security
Active Presence
De-EscalationSocial Services
Service Recovery
Reporting
Everyone
Detect… Deter… Delay…
Active Screening
Notification Systems
Access ControlVisitor
Management
Security
Situational Awareness
Active Engagement
Reporting
Everyone
Emergency Protocols
Communication
Security
Access ControlPhysical BarriersAlarms
Shelter In PlaceSafe Rooms
Escape Routes
Everyone
Detect… Deter… Delay…
Emergency Protocols
Communication
Security
Access ControlPhysical BarriersAlarms
Shelter In Place
Safe RoomsEscape Routes
Everyone
Advance Planning – Shelter in Place
Poll Question
44
30,000+Sites Served
Has your department identified “safe areas” for staff to utilize in the event of an emergency?YesNo
Response…
Response Protocols
911Containment
When to call for help
Weapons & ToolsCommunication
Evacuation
Security
Response Protocols &
ExpectationsShelter in Place
Barriers & BarricadesEvacuation
Weapons & Tools
Communication
Everyone
Specialized Responses for:
Criminal Activity
Immediate Hostile Threats/Violence
Behavioral Health Patients in Crisis
Violent Situation Response Teams
Code TeamTeam of clinical and non-
clinical staff specially trained in de-escalation techniques and ready to
be dispatched 24/7 to support colleagues
dealing with a threatening, disruptive, or
violent situation
Code Team Roles
Team LeadCoordinates team huddle, develops response action plan response, assigns responsibilities.
Clinical Supervisor or Charge NurseBriefs responders on actual or potential threats contributing to escalating behavior AND any patient condition the team needs to be aware.
Frontline RespondersResponds to codes and assists with de-escalation and restraint.
SecurityProvides show of force and ensures environmental safety.
Violent Situation Response Teams
Active Shooter/Assailant - Drills
Form Committee
Invite outside contributors
Form plan and objectives
Conduct table-top
Train staff
Conduct mini drills with objectives
Critique and re-plan
Plan full drill with committee
Invite outside contributors
Inform the staff, patients, media,
public and agencies
Plan for PTSD
Critique and re-plan
Never start with a full drill
Table tops - Walk-throughs - Department Level - Full Scale
Post Response…
Is everyone OK?
Did we respond appropriately?
Did we miss an escalation trigger point?
What was the root cause of the outburst?
Recover…
Communication
Evaluate staff
Evaluate response
Improve plan
Security
Communication
Employee Assistance –
PTSD
Damage assessment
Back to normal –can take years
Everyone
You will have a crime scene…
Ongoing care
Evacuation
Business Continuity
Culture Challenges…
American workers feel safer with violence prevention programs at their companies.
WPV Survey, SHRM, March 2019
Results…
35% increase in feeling of safety by staff
45% increase in confidence of security by staff
32% increase in patient satisfaction scores
42% reduction in patient restraints
35% decrease in workplace violence injuries
69% decrease in worker compensation budget
The Advisory Board, 2017
Violence Manifests In Many Ways…..
The American College of Healthcare Executives (ACHE) Encourages Executives to Take the Following Actions:• Clearly Define Workplace Violence• Assess the Scope and Prevalence of Violence the Facility• Raise Awareness that Workplace Violence is a Public Health Issue• Identify and Remediate Risk Factors• Provide Training on How to Recognize and Mitigate Workplace
Violence• Evaluate, Measure and Report Progress
Final Recommendations…
• Have a workplace violence prevention program in place• Threat Management/
Threat Assessment Team• Threat Assessment
• Review contributing factors and plan for them
• Provide training to all employees on how to respond to incidents
• Communicate with workers about what resources are available
Reducing Violence in Healthcare
2019
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