Staying Safe: Reducing Assaults & Staff Injuries
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1 Staying Safe: Reducing Assaults & Staff Injuries Diane E. Allen, MN, RN-BC, NEA-BC Kathleen Cummings, BSN, RN-BC Presenters Have No Conflicts of Interest to Disclose Objectives Describe strategies used to engage staff in discussions about assaults Recognize how staff culture can impact the response to patient behaviors Identify three strategies that have helped staff avoid the use of physical interventions and reduce staff injuries Allen, Cummings 1
2 Make it Safe to Talk Who Was Assaulted? Allen, Cummings 2
3 Does Gender Matter? Assaults by Day of Week Which Shift Do You Think Experienced More Assaults? Days? Evenings? Nights? Allen, Cummings 3
4 Assaults by Shift Differences Between Shifts Structure Expectations Rules Enforcement Tolerance Presence of Supervisors, MD s, Clinicians Audience factors Laid Back Attitude Assaults to Staff Without Provocation/ Warning 22% While on Observation During ADLCare Level 6% 7% In or Enroute to Time Out 12% Response to Direction or Redirection 14% During Restrictive Physical Interventions 39% Allen, Cummings 4
5 True or False? Staff will get hurt if we don t use Seclusion or Restraint False Injuries to staff actually decrease when Seclusion/Restraint use decreases (Altemari et.al, 1998) Scope of Authority and Accountability of Mental Health Workers Which of the following are included in your job description? A. Bodyguard B. Amateur Wrestler C. Superhero Allen, Cummings 5
6 Evaluate Rules Things We Do at New Hampshire Hospital to Stay Safe Patient Affirming Culture Respectful Interactions Clinical Handoff Communications Emergency Medication Things We Could Do Better to Stay Safe Avoid Power Struggles Plan for Bad News Share Critical Information Never Intervene Alone Get Help & Have a Plan Allen, Cummings 6
7 Avoid Power Struggles Plan for Bad News Share Critical Information Allen, Cummings 7
8 When to Physically Intervene? GET HELP What Happens When We Physically Intervene? Allen, Cummings 8
9 What's the Worst Thing That Can Happen? Plan RN MHW PT Staying Safe Charge Nurse Responsibility Engage all clinical resources Recognize ineffectiveness of efforts Request assistance and transfer responsibility to Campus Police Provide support to Campus Police Allen, Cummings 9
10 Transition from Clinical to Police Intervention ANY Weapon Serious Life Safety Concern Too Big, Too Strong Too Violent Staying Safe Message Avoid physical intervention until a minimum of five staff is available Allen, Cummings 10
11 Staying Safe Program Outcomes Program Message Measured Outcomes Supporting Data Be respectful Avoid power struggles Plan for bad news Evaluate unit rules Getting hurt is not an expected is part of the Job Get help from at least five people before physically intervening with a patient Number of Assaults to staff decreased 64% Staff injuries related to assaults decreased 63% Calls for help (Code Gray) increased 21% Allen, Diane E. (2013).Staying Safe: Re-examining Workplace Violence. Journal of Psychosocial and Mental Health Nursing Reported Number of Assaults FY 2007: 357 FY 2012: 122 Reported number of staff injuries FY 2007: 56 FY 2012: 21 Number of Code Grays FY 2007: 344 FY 2012: 415 Key Points Organize focus groups Make it safe to talk Present the facts Ask staff what they think Listen and take notes Make recommended changes Reinforce the message Do it again Questions Allen, Cummings 11
12 References Allen, Diane E. (2013). Staying Safe. Re-examining Workplace Violence in Acute Psychiatric Settings. Journal of Psychosocial and Mental Health Nursing. 51(9), Allen, D., denesnera, A., Cummings, K., Darling, F. (2011) Transforming the Culture of Caring: Getting Hurt is NOT Part of the Job. Journal of Psychosocial and Mental Health Nursing. 49(1), Altemari, D. et al. (1998). Deadly Restraints. The Hartford Courant Johnson, Mary E. (2004). Violence on Inpatient Psychiatric Units: State of the Science. J Am Psychiatric Nurses Assoc, 10(3), Short, R., Sherman, M., Raia, J., Bumgardner, C., Chambers, A. & Lofton, V. (2008). Safety Guidelines for Injury-Free Management of Psychiatric Inpatients in Precrisis and Crisis Situations. Psychiatric Services, 59(12), Staggs, V. (2013). Nurse Staffing, RN Mix, and Assault Rates on Psychiatric Units. Research in Nursing and Health. 36: Allen, Cummings 12
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