VIOLENCE PREVENTION IN THE HEALTHCARE SETTING

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1 VIOLENCE PREVENTION IN THE HEALTHCARE SETTING presented by Michael Mock, Security Manager

2 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?

3 WHAT ARE WE DOING RIGHT CURRENTLY

4 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

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

6 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.

7 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

8 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)

9 Physical Security Examples Large, visible signage directing staff and visitors to emergency assistance *All alarms tested monthly

10 Physical Security Examples Wall Mount Push Button Under Desk Push Button Personal Duress Alarm

11 Physical Security Examples Emergency Station in Parking Lot Lockdown Button in ED Security Post

12 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

13 Response Plans Armed Intruder Bomb Threat MCI Missing Person Disruptive Person Fire Missing Person Infant Violence Threat

14 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.

15 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.)

16 Safety Improvement Tools

17 WHAT IMPROVEMENTS CAN WE MAKE IMMEDIATELY?

18 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

19 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

20 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

21 Communication Model Nursing General Staff VPT / Education Security Support Staff

22 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)

23 Compiled Violence Data *Data for example purposes only

24 WHAT IMPROVEMENTS SHOULD WE WORK TOWARD IN THE FUTURE?

25 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.

26 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

27 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

28 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

29 Signage Example Birthing Center Welcoming signage that notifies the area is secure and politely explains how to gain entry.

30 Overhead Paging / Campus Alert Tools Tie together interconnected buildings (PA Systems) Used for multiple alert notifications Visual alarm notifications campus wide

31 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

32 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

33 Questions or Comments? Michael Mock

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

Violence in the Workplace. Presenters: Michael Mock and Ryan Aga, R.N. Thursday, March 10, a.m. Violence in the Workplace Presenters: Michael Mock and Ryan Aga, R.N. Thursday, March 10, 2016 9 10 a.m. Michael Mock Michael Mock joined St. Luke's Hospital in 1997 as a security officer. In 2005 he took