What’s New in the Patient Safety World
July 2010
JCAHO Sentinel Event Alert On Violence in the Healthcare Setting
Joint Commission’s most recent Sentinel Event Alert is on Preventing Violence in the Health Care Setting. When we first read through it we weren’t overly impressed that it added a whole lot to just using common sense. However, when we actually walked through their checklist at one facility, it really did open our eyes. You’d be surprised how many of those “common sense” recommendations have not been implemented!
Many organizations provide training on de-escalation techniques for their behavioral health and emergency department staffs. However, how many of you provide it to your HR staff? And to your med/surg staff, who often have to deal with angry family members. Or your peds/ob staffs who may have to deal with broken families, custody disputes, etc. One can readily see there are a whole host of healthcare workers in our facilities who could benefit from such training in de-escalation techniques.
Most hospitals, particularly those with behavioral health units, have codes for summoning help in the event of an unruly patient. But how many have one dealing with a weapon situation or hostage situation? In the simple unruly patient scenario the code is usually calling for people to respond in person to the unit. But in the weapon/hostage situation you usually do not want additional physical presence of responders. In fact, the code tells them to stay away. When we asked staff about the latter, many were unaware that such a code even existed.
We found especially valuable their reference to ECRI’s “Violence in Healthcare Facilities”. When we did a hospital walk-thru and talked about where we might add additional surveillance cameras, almost everyone made the statement “just having dummy cameras is valuable”. However, ECRI actually discourages that, stating that “the false sense of security imparted by dummy cameras or unmonitored/malfunctioning real cameras has been the basis of many lawsuits.”
The ECRI paper also talks about a hospital developing a formal “family triage team”. That team responds to potentially violent situations and uses a 4-tiered tool to tie the response to the nature of the aggressive or agitated behavior being exhibited.
One area we particularly struggle with is the employee who is the victim of domestic violence or spousal abuse. Staff need to be well-trained to identify the signs and symptoms of domestic violence. While referring suspected victims to EAP programs should be done, there are also dangers to the facility if the abuser seeks out the victim in the workplace. The ECRI paper gives some practical advice on steps the healthcare facility can do in such circumstances.
In most cases where a worker in a healthcare facility perpetrates a violent act, there were warning signs that someone had notice beforehand but failed to pass that information on (just as with many serious adverse medical events someone knows something is wrong but does nothing about it for various reasons). There is, of course, a dilemma in that lawsuits have also often resulted from actions taken before violence has actually occurred.
The ECRI paper also has a good section on hostage situations.
In the event you have to evacuate your facility because of a violent event, you may find useful a couple guides just released in June by AHRQ. The Hospital Evacuation Decision Guide helps hospitals plan for an orderly evacuation both before an anticipated event (like a hurricane) and after the event in disasters to the hospital or surrounding community. The Hospital Assessment and Recovery Guide provides guidance on assessing the hospital for return and other issues related to recovery.
References:
The Joint Commission. Sentinel Event Alert. Preventing violence in the health care setting. Sentinel Event Alert 2010; Issue 45 June 3, 2010
http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_45.htm
ECRI Institute. Healthcare Risk Control System.Violence in Healthcare Facilities. Health Care Risk Control. September 2005
https://www.ecri.org/Forms/Pages/Violence_in_Healthcare_Facilities.aspx
AHRQ. Hospital Evacuation Decision Guide.
http://www.ahrq.gov/prep/hospevacguide/
AHRQ. Hospital Assessment and Recovery Guide.
http://www.ahrq.gov/prep/hosprecovery/
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