Farnsworth: That depends on what the individual hospital accepts as a level of risk. The risk acceptance involves the risk assessment-understanding the neighborhood (including hospital grounds) and the dynamics of crime within the neighborhood. There are situations in which visitors are completely controlled-each person granted access is identified, logged, tagged and possibly even escorted to and from his or her authorized visitation area. In other situations, visitors are never challenged, controlled or restricted in any way. Most hospitals fall somewhere between those two extremes.
Mogavero: Relatives who will be spending the night are issued a color-coded wristband corresponding to the patient's area. Anyone found in the hospital after visiting hours without a band is escorted back to the floor or out of the building.
Potter: Most hospitals are still open campuses except at night. Since September 11, some have returned to the old visitor badging systems, but they are very manpower intensive. Some type of visitor badge should be required in all patient and non-public areas. However, often the more chronic problem is getting the staff (especially physicians) to wear their photo-ID badges. There is always a great effort to ensure 100 percent compliance during a JCAHO survey, but it rapidly tapers off afterwards.
Matthews: JCAHO requires that an institution have a method to identify patients, visitors and staff. The degree of complexity that a hospital elects to use should be driven by the risk assessment they conduct.
ST&D: Should visitor badges be day specific, or even unit specific?
Farnsworth: I have surveyed hospitals that have nothing specific on their badges and others that have such specificity that there are X number of visitor badges for an individual room or rooms. There are badges that are designated for a specific unit-such as my own unit-specific Women's Services badges-which assure that the infant is only handled by a member of the L & D staff. Some badges have specific spaces for recording the patient's name and room number, the visitor's name, with a specific date, color-coding or an invisible ink that displays after a certain period of time.
Mogavero: I personally prefer the day-specific visitor badges that expire after 24 hours.
Potter: Yes, if possible. Temporary badges that fade after 24 hours are very effective.
Matthews: Elements that will greater protect the integrity of the pass system are welcomed. Color coding for the day of the week or using self-canceling print devices can discourage the wrongdoer from trying to use an old pass to get in. Like the ID, if the pass is set up so that the visitor can not only open doors but can obtain a cafeteria or parking discount, that will make the pass of value to the visitor.
ST&D: What do you see as the most important aspects of hospital security? Please discuss what measures hospitals can and should take for any of these areas.
Farnsworth: The JCAHO requires each facility to conduct an annual risk assessment. As a result of the assessment, each facility must designate their high-risk areas. Normally this designation is placed upon the L & D, Pharmacy and ED areas, although I have seen almost every single hospital area so designated. I normally recommend that hospitals keep this designation to as few areas as possible because JCAHO also mandates that each area so designated receive specialized security training for staff, both upon hire and annually thereafter. In surveys, I have also seen medical records, information systems, and even grounds listed as high-risk areas.
Mogavero: For any area that needs security, the hospital should provide a high level of continuous training and good equipment, a visible presence of the officers on campus, quick response time when there is a problem and a pro-active approach to security. We use an access control system with proximity readers on entrances to the hospital. We have an extensive CCTV system with many cameras, being auto domes or PTZ.
Parking lot security is the location of the greatest potential liability.
Adequate lighting and high-visibility patrols (a bike patrol is ideal)
are essential. Offering escorts for patients, visitors and staff, especially
at night, is great PR and even greater security.
The Emergency Department should have a 24-hour security presence. Well-trained and properly equipped security officers are less expensive than off-duty police officers and can do a much better job keeping order in a healthcare environment. Every treatment room should have an alarm button to summon security, and officers must be trained in effective response procedures.
Administration and HR have been targets for workplace violence by angry patients and disgruntled employees. Both should have some type of access control, CCTV coverage and duress alarms.