Violence in the Workplace. Presenters: Michael Mock and Ryan Aga, R.N. Thursday, March 10, a.m.

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1 Violence in the Workplace Presenters: Michael Mock and Ryan Aga, R.N. Thursday, March 10, a.m.

2 Michael Mock Michael Mock joined St. Luke's Hospital in 1997 as a security officer. In 2005 he took on a new role as a security coordinator and in 2011 he was promoted to security manager. Michael has been instrumental in the growth and forward thinking of the St. Luke's security department. He leads a team that has steadily lessened the number of behavioral events; despite having higher numbers of violent patients. Michael has been certified in Management of Aggressive Behavior (MOAB) since 2006 and is also a certified MOAB Instructor-Trainer since In his personal life he and his wife, Amy, are active with their 4 children in church, 4H, Cub Scouts, raising chickens and coaching basketball. Ryan Aga Ryan Aga has more than 18 years of experience in the field of emergency nursing with over 10 years at St. Paul Minnesota s only level one pediatric and adult level one trauma center, Regions Hospital. Ryan s professional history includes past greater twin cities emergency nurses association chapter president, emergency nursing educator and a seasoned nurse leader in emergency medicine. Ryan is currently the nurse manager of the Regions emergency department. Ryan graduated with his Bachelor of Science degree in nursing from Minnesota State University Mankato and his Master of Science degree in nursing leadership and management from Western Governors University in Salt Lake City, Utah. Ryan was recently named Minneapolis/St. Paul Magazine 2015 nurse of the year for emergency medicine. This past year Regions Hospital activated their code silver response plan three times; two of which were activated in the emergency department. Ryan will guide us though one of these experiences, and highlight how Regions Hospital is preparing staff for ongoing workplace violence occurrences.

Questions: What are we doing right currently?

3 VIOLENCE PREVENTION IN THE HEALTHCARE SETTING presented by Michael Mock, Security Manager Overview Completed first MHA GAP Analysis August 2014 Questions: What are we doing right currently? What improvements can we make immediately? What improvements should we work towards in the future? 1

4 WHAT ARE WE DOING RIGHT CURRENTLY What are we doing right currently? (18 months ago) Access Controls Confronting Violence Before it Occurs MOAB Training for Nursing & Security Physical Security Relationships with Other Departments Response Plans Uniform Security VIRT Team / Injury Prevention Team 2

Access Controls Only one (1) point of entry after-hours (8:30 PM) Visitors ID badged after-hours Badge readers at high-risk locations 24/7 locked high-risk units ER, ICUs, Maternal Child Health,

5 Access Controls Only one (1) point of entry after-hours (8:30 PM) Visitors ID badged after-hours Badge readers at high-risk locations 24/7 locked high-risk units ER, ICUs, Maternal Child Health, Mental Health, & Pharmacy Additional Lockdown capability in ER and Urgent Care Key or code access only Confronting Violence Before it Occurs Through MOAB recognition skills many events are de-escalated before they evolve into violence. A Red-Man Training Suit; available for instructors and student use. 3

6 MOAB Training for Nursing & Security Eight hours on hire Two to four hours annually (depending on unit they work) 18 of 31 Security Officers are Certified MOAB Instructors Two Security staff are Certified MOAB Train-the-Trainers Physical Security Emergency Callboxes in all elevators in some parking lots and stairwells Cameras (160+) including PTZ s in sensitive locations Stationary panic alarms (40+) at high-risk locations Personal duress alarms on high-risk units ER, Mental Health, and Urgent Care Security radios in select locations ER, Operators, Maternal Child Health, Mental Health, and 1-to-1 Nursing Assistant patient watches) 4

7 Physical Security Examples Large, visible signage directing staff and visitors to emergency assistance *All alarms tested monthly Physical Security Examples Wall-Mount Push Button Under Desk Push Button Personal Duress Alarm 5

systems Carpenters: Door hardware and other locks Grounds: Shrubbery obstructions, signage Maintenance: Alarm panels, light fixtures Nursing:

8 Physical Security Examples Emergency Station in Parking Lot Lockdown Button in ED Security Post Relationships with Other Departments Administration: Awareness of budget needs; risks of inaction Bio Med: Badge readers, access control systems, panic and duress alarms, camera systems Carpenters: Door hardware and other locks Grounds: Shrubbery obstructions, signage Maintenance: Alarm panels, light fixtures Nursing: Coordinated interventions to behavior, understanding roles of others during events Safety: Collaboration on Emergency Preparedness planning & running coordinated drills 6

9 Response Plans Armed Intruder Bomb Threat MCI Missing Person Disruptive Person Fire Missing Person - Infant Violence Threat Uniform Security Six Uniform Officers on campus at all times One interior, four exterior, & one dispatch/camera officer in the ED Minimum one year schooling or experience Four dedicated one-on-one training days; on job shift training follows All officers CPR, IAHSS, and MOAB certified Additional trainings: Armed Intruder, Capture Shield, Customer Service, Decontamination, Helipad Safety, Infant Abduction, and Safe Weapons. 7

Prevention Team Meets quarterly Initiates procedures to avoid repeated injuries Compiles data from reported work injuries

10 VIRT Team / Injury Prevention Team VIRT Violent Intervention Response Team Meets as needed (after acts or threats of violence) Responds to incidents that have happened Looks for ways to avoid similar incidents Provides debriefing IPT Injury Prevention Team Meets quarterly Initiates procedures to avoid repeated injuries Compiles data from reported work injuries (poor technique, poor equipment, and violent behaviors) Approves use of new tools (hoods, lifts, gloves, etc.) Safety Improvement Tools 8

11 WHAT IMPROVEMENTS CAN WE MAKE IMMEDIATELY? What improvements can we make immediately? Criteria: Low to minimal cost Doesn t conflict with existing practices Can be rolled out quickly to all involved parties Improvements: Aggregate data in our Incident Reporting System Improve on our existing teams; form a dedicated Violence Prevention Team Prioritize (at highest levels) violence in the workplace 9

12 Aggregate Data in our Incident Reporting System Data reveals what improvements are needed Environment Restructure Security Tools Staff Education Staff Training Events are sorted by severity, year of event, and unit the event occurred on Risk Management compiles every reported incident Improve on our Existing Teams Add Additional Reps: Clinic Manager, ED Clinical Supervisor, ED Manager, Homecare RN,HR Manager, LPN, Mental Health SDF, and Quality Management Specialist Communicate: Group account; used with great frequency Meet: Quarterly and as needed Merge: Existing IPT and VIRT Teams into VPT (Violence Prevention Team) IPT: Human Resources Specialist, Nursing Director, Nursing Vice President, Security Manager, and Support Services Vice President VIRT: Environmental Services Director, Human Resources Director, Mental Health Nurse Manager, Quality Management Director, and Security Manager 10

13 Communication Model Nursing General Staff VPT / Education Security Support Staff Prioritize Violence in the Workplace Administration represented on VPT Vice Presidents of Nursing & Support Services Create an education piece for all staff Executive Team briefed by those members frequently Express the costs associated with violence Added time (to managers, HR specialists working through issues of lost employee time) Lost time (PTSD, work injury) Patient retention (hear and/or observe of violent behavior) Staff turnover and morale (feel unsafe) 11

14 Compiled Violence Data *Data for example purposes only WHAT IMPROVEMENTS SHOULD WE WORK TOWARD IN THE FUTURE? 12

15 What improvements should we work toward in the future? Discontinue services to violent patients (where possible) Education for all staff Equipment / Infrastructure for Security Overhead Paging / Campus Alert Tools Prioritizing / Educating after-hours leadership Risk Assessment tool for all patients. Discontinue Services to Violent Patients (where possible) History of violence is the greatest indicator of violence Threats of violence often preclude acts of violence Patient records talking to each other can form a picture prior to forming a picture after a sentinel event Work with Risk Management, Department Managers, and Medical Staff to discontinue services 13

16 Education for All Staff Violence is not part of the job Violence is not ok Here is what violence looks like Threats Posturing Actions Here is what you do when you see it Report immediately Interventions Emergency response options Equipment/Infrastructure for Security Budget for expansion of all effective security tools Alarms Callboxes Lockdowns Communicate security measures effectively to patients For their privacy Through staff-to-patient communication Through thoughtful, conscientious soft-touch signage To limit movements so patients can rest Proactively install security measures into building expansions or remodels 14

17 Signage Example Birthing Center Welcoming signage that notifies the area is secure and politely explains how to gain entry. Overhead Paging / Campus Alert Tools Tie together interconnected buildings (PA Systems) Used for multiple alert notifications Visual alarm notifications campus-wide 15

Prioritizing/Educating After-Hours Leadership Educate Administrative Nursing Supervisors to begin de-escalation, debriefing, or other interventions

Management to develop a Violence Predictor Risk Assessment Tool Admitted Patients Clinic / Outpatients Emergency / Urgent Care Patients Surgical

18 Prioritizing/Educating After-Hours Leadership Educate Administrative Nursing Supervisors to begin de-escalation, debriefing, or other interventions ASAP Develop a Security Alert procedure that can be referenced for after-hours guidance Risk Assessment Tool for all Patients IT / Nursing / Risk Management to develop a Violence Predictor Risk Assessment Tool Admitted Patients Clinic / Outpatients Emergency / Urgent Care Patients Surgical Patients Risk Assessment Tool to be used each shift by nursing Risk Score to determine level of intervention needed Tool to be used across EMR systems 16

19 Questions or Comments? Michael Mock

20 The Front Lines of Violence Ryan Aga MSN, RN, CEN, CPEN, PHN Nurse Manager Regions Emergency Department Patient threatening staff brandishing scissors at staff, yelling, extremely psychotic, I m going to kill you 1

21 Patient getting vital signs assessed in triage by ED tech- ripped BP cuff off and attempted to strike techs head with a cane Patient eating feces, ripped IV out, walking naked around ED threatening to kill staff. Putting fingers in rectum and telling staff he wants sex 2

22 Patient presented to ED for nausea and vomiting, half way though treatment the patient took out a knife and brandished weapon at M.D. Patient extremely agitated started throwing tables and chairs at nursing station hospital security guard thrown to floor 3

23 he s got a gun he s got a gun My story May 29 th

24 Code Silver ED! Response ED vocera transmission code purple --pt s got a gun Triage off duty officer quick response Triage emptied get the hell out of here Officers with other inmates (A8, D4) Hospital security flooded with calls is this real? Code Silver ED! Response Staff in safe rooms/under counters Chaotic staff running into each other (MD injured concussion), patients leaving Unsure of all clear message Good ED response, in-patient staff not prepared, unsure what code silver was, didn t hear it over the public address system 5

hospital communications within minutes of the 9-1-1 call ED divert/back to

Employee assistance social worker on site the next morning Crisis

25 Code Silver ED! Recovery Very disturbed staff (staff left, couldn t finish shift) CNN calling hospital communications within minutes of the call ED divert/back to normal operations CEO/Senior leadership presence ( ) Code Silver ED! Recovery Defusing Employee assistance social worker on site the next morning Crisis intervention counselor 1 week following, 3 rd week following Still counseling staff Many hospital debriefings Drained ED leadership team 6

26 Code Silver ED! Lessons learned Common language Solid communications plan Room numbers Policy/educate/drill Staff check down post event Patient rounding Letter sent High alert for inmates Wanting to frequent the bathroom Big Picture of Prevention and Mitigation Hospital wide multidisciplinary WPV steering team Data Collection and Analysis Facility Culture and Accountability Violence assessment tool Staff Education De-escalation/personal safety tactics what law enforcement is using Incidence response Lockdown/active security threat Defusing s/debriefings Additional law enforcement officer 7

27 Huge thank you to our law enforcement partners! 8

VIOLENCE PREVENTION IN THE HEALTHCARE SETTING

VIOLENCE PREVENTION IN THE HEALTHCARE SETTING presented by Michael Mock, Security Manager Overview Completed first MHA GAP Analysis August 2014 Questions: What are we doing right currently? What improvements