Last month, a pregnant nurse at a psychiatric healthcare facility in Nova Scotia, Canada, had to be taken to a hospital herself following injuries she sustained at the hands of a patient in the facility. Although the nurse had a panic alarm, the device was held together with little more than masking tape and failed to work during the attack.
The incident is just one example of the numerous assaults carried out by patients and/or hospital visitors against nurses, doctors and other workers in healthcare facilities across North America in recent years.
According to the Occupational Safety and Health Administration (OSHA), 70 to 74 percent of the nearly 25,000 workplace assaults that were reported annually between 2011 and 2013 in the U.S. occurred in healthcare and social service settings. Additionally, OSHA reports that from 2002 to 2013, the rate of serious workplace violence incidents, which are defined as those requiring days off for an injured worker to recover, were more than four times greater in healthcare than private industry on average.
This epidemic of violence against nurses and doctors has also spurred healthcare security professionals to work together to develop comprehensive risk mitigation strategies that can be leveraged by hospitals and other facilities to stem this tide of attacks.
Just last month, the International Association for Healthcare Security & Safety (IAHSS) released a new industry guideline titled, “Violent Patient/Patient Visitor Management.” The guideline, which was developed by the IAHSS Council on Guidelines and incorporated feedback from IAHSS members, the Emergency Nurses Association (ENA) and the American Organization of Nurse Executives (AONE), encourages healthcare facilities to “establish specific violence prevention and aggression management policies, processes and practices to deter, identify and manage violent events.”
According to Tom Smith, Chair of the IAHSS Council on Guidelines and President of Healthcare Security Consultants, Inc., the release of this most recent guideline is very timely given that the Joint Commission also coincidentally issued a Sentinel Event Alert several weeks ago that also urges hospitals to proactively tackle the problems presented by physical and verbal violence against healthcare workers.
“Our guideline will support the Joint Commission’s Sentinel Event Alert in that it provides a little bit more detailed suggestions and guidance on how to develop a threat management process for evaluating these cases, who should be involved and provides a sample policy and process for identifying and mitigating violence and threats from patients and visitors,” Smith explains. “There’s a sample matrix for responding, so it really provides more detailed information for healthcare security practitioners who are thinking, ‘Gosh, what do I do? Who should be involved in developing our policy and evaluating patient threats?’”
Internal Flags
Specifically, the guideline recommends healthcare facilities use a system of flags to identify and mitigate acts of both verbal and physical intimidation. For example, a “Level 1” flag is characterized as awareness of behaviors such as loud curing, verbal threats, intimidation, and precursors to violent behavior, which is followed with a suggested action plan that staff be aware and utilize verbal de-escalation techniques where appropriate and that the patient and/or visitor be informed of the potential consequences of their behavior if it continues. These flag levels and their suggested action plans increase in severity depending upon the behavior of the patient or visitor and end with the facility terminating care for the patient or having the visitor removed from the premises.
The guideline also encourages hospitals to use the electronic health record to flag known disruptive behavior and relevant historical context associated with a patient and their visitors.
“All healthcare facilities these days have electronic medical records and the ability to create flags. A common one is for patient falls as well as certain types of infectious disease, so we think there should be one identifying patients that are at risk for violence or patients that have actually committed violent acts,” Smith adds. “I would say the best predictor of future behavior is past behavior and if we can identify patients and visitors who have been violent in the past that will help us take proactive measures. It will help people kick-start their internal program.”
The guideline also takes into consideration the fact that some patients may lash out due certain medical factors, such as someone who has Alzheimer’s or an adverse reaction to medication, and suggests that those factors or circumstances that may have contributed to those behaviors be identified in the system.
Sharing Information
Smith says another common problem in tackling this issue is that some healthcare organizations are so large that information about a patient who lashed out violently in one clinic or hospital ER may not even be passed on to another facility in the same healthcare system. This guideline will help them begin to remedy that.
“This connects the dots and helps people be aware and alert of incidents even within their own facility,” he says. “We find that people don’t know from one end of a facility to the other when someone has been assaulted or attacked and what this guideline suggests is we have a systematic approach and if a patient has one of these flags that it will pop up when they are being treated or make an appointment. We don’t want to treat them differently but we want to be smart and take appropriate measures to reduce the potential for future assault.”
Given the pervasiveness and severity of workplace violence in healthcare, Smith believes it is paramount that hospital staff receives appropriate training on how to handle aggressive patients and visitors; however, he says mandated training is sorely lacking in many facilities.
“Training, developing a plan for managing actively aggressive patients and visitors, and having a team approach is something that is lacking,” he adds. “Oftentimes, the larger organizations I see have these things in place but even some of them don’t have an active plan for managing this kind of violent behavior. A lot of places think, ‘well, that’s security problem’ and it’s really not. It’s an organizational problem and needs to be managed from the organizational perspective.”
About the Author:
Joel Griffin is the Editor-in-Chief of SecurityInfoWatch.com and a veteran security journalist. You can reach him at [email protected].
