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What’s New in the
Patient Safety World
November 2021
Panic Buttons to
Protect Healthcare Workers – But a Word of Caution
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.
References:
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
http://www.va.gov/oig/54/reports/VAOIG-08-01380-154.pdf
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
https://www.medpagetoday.com/meetingcoverage/aapl/95227
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