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The headline reads “COVID-related attacks prompt hospital to issue panic buttons” (Salter 2021). Violence against healthcare workers has been increasing in recent years and really surged during the COVID-19 pandemic, particularly as people rebelled against mask mandates and vaccine mandates. So, a Missouri hospital has added panic buttons to identification badges worn by employees who work in the emergency room and inpatient hospital rooms. Pushing the button immediately alerts hospital security and launches a tracking system that sends help to the endangered worker.
Good idea – but with a caveat: make sure that system is in working order every day. In our February 4, 2014 Patient Safety Tip of the Week “But What If the Battery Runs Low?” we described the following scenario: You implemented a “panic button” system to protect your behavioral health workers from assaults by patients on your locked behavioral health unit. The worker is in a situation where she fears potential harm from a patient and presses the panic button. However, the battery in the panic button is dead. Fortunately, other staff were within audible range of her shouts for help and responded before she was assaulted. The lesson is that any alarm or alert system, regardless of whether it is battery-operated or otherwise, needs frequent testing to ensure it is in working order.
And review of the death of a patient who wandered out of a San Diego hospital several years ago (Luke 2014) illustrates several problems related to reliance on alarms. First, the patient’s bed alarm never sounded. Then, once staff realized the patient was missing, they tried unsuccessfully to page Security and then tried to contact Security by pushing a panic button twice, also with no response. When state inspectors investigated, they found that the panic button had been broken for 8 days. In fact, they found the hospital failed to routinely test the buttons and failed to repair them when broken and that one out of every four panic buttons at the hospital didn’t work.
And a VA audit of MRI safety was initiated after a 2008 incident (Report No. 08-01380-154) in which a patient crawled out of an MRI scanner after his calls for help went unheeded because the panic button was inoperable and no maintenance checks had been done on the intercom system or the panic button.
The system used by the Missouri hospital is tied to their real-time locating system (RTLS). Such systems include both wired and wireless configurations. And the panic buttons have variable battery lives. Those on ID badges are said to have a battery life of 1 to 2 years. Those on bracelets have battery life on the order of 90 days.
Battery life of 1-2 years! Don’t get complacent. We’ve all seen batteries that fail far before their expected expiration dates. And if you are waiting for a year to test batteries, you’ll likely be lulled into thinking you have no problems.
But even if the battery on the panic button is working, there could be problems at the receiving end that prevent or delay a response. Our June 16, 2020 Patient Safety Tip of the Week “Tracking Technologies” discussed the various sorts of technology used in tracking systems. These include radiofrequency, infrared, Bluetooth, and GPS technologies. Some may use your Wi-Fi network. An important thing to remember is that, with any of these technologies, there may be “dead zones” where transmission does not occur. So, you need to be very wary of where such dead zones are when you implement a panic button system.
You’ll also need to educate your staff on use of the panic buttons and how and when to test them. And keep in mind that some assailants may grab the badge containing the panic button.
We’ve long been fans of tracking technologies and think they are still vastly underutilized in hospitals and other healthcare venues. Our June 16, 2020 Patient Safety Tip of the Week “Tracking Technologies” discussed the myriad of potential uses for such devices and systems. If you have already installed such a tracking system or are considering one, you probably should consider including the panic button capability. Just beware that you must regularly check the operating status of all components of the system.
The psychiatrist’s office is another site vulnerable to violent interactions with patients or families. A recent article (Frieden 2021) summarized recommendations presented by Vince Kennedy, DO, at the American Academy of Psychiatry and the Law annual meeting options for psychiatrists to consider to protect themselves from potentially violent patients. It does recommend use of panic buttons but discusses multiple other considerations.
Salter J. COVID-related attacks prompt hospital to issue panic buttons. AP News 2021; September 28, 2021
Luke S. Broken Bed Alarm Blamed for Walkaway Patient's Death. Thomas Vera died after he became disoriented and walked away from his hospital room at UCSD Medical Center in May 2013. NBC San Diego 2014 Published September 15, 2014, Updated on September 16, 2014
Report No. 08-01380-154. Department of Veterans Affairs Office of Inspector General. Healthcare Inspection Alleged Patient Neglect During a Magnetic Resonance Imaging Exam Michael E. DeBakey VA Medical Center Houston, TX. Report No. 08-01380-154. June 27, 2008
Frieden J. Psychiatrists Have Lots of Options When it Comes to Office Security
— Consider both physical and non-physical measures. MedPage Today 2021; October 23, 2021
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