AGGRESSIVE BEHAVIOR TOOLKIT WSHA & ASHNHA PARTNERSHIP FOR PATIENTS PRESENTED BY: COURTNEY ULRICH

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1 AGGRESSIVE BEHAVIOR TOOLKIT WSHA & ASHNHA PARTNERSHIP FOR PATIENTS PRESENTED BY: COURTNEY ULRICH

2 HIIN AND PARTNERSHIP FOR PATIENTS The Partnership for Patients initiative is a public-private partnership working to improve the quality, safety and affordability of health care The Partnership for Patients program focuses on the achieving two goals: Making Care Safer Improving Care Transitions The Hospital Improvement Innovation Network works at the regional, State, national or hospital system level to accelerate national progress and momentum towards continued harm reduction in the Medicare program and help identify solutions and disseminate them to other hospitals and providers

3 WSHA STRATEGIES AND GOALS FOR WORKFORCE SAFETY Safe Table Learning Collaborative with all hospitals March 23 rd, 2017 next Safe Table in Seattle, WA Monitor worker injury rates by hospital Goal: Reduce worker injuries related to workplace violence by 20% by September 2017 Disseminate tools and resources, including best practice toolkits on workplace violence prevention Goal: Increase number of effective workplace violence prevention programs by 50%

4 AGGRESSIVE BEHAVIOR TOOLKIT Purpose: Document to disseminate to hospitals throughout WA and AK to help develop workforce violence prevention programs Development: In depth literature review Called on experts with knowledge and expertise in the field Highlights from hospitals with solutions already in place Goal: Developed 14 best practices & prevention methods for a successful workplace violence prevention program

5 TOOL #1: COMPLIANCE Issue 45 of Joint Commission s Sentinel Event Alert Federal OSHA standards vs. State approved OSHA standards WA: State approved OSHA standards and follows the required Workplace Violence Plan required by the law RCW AK: State approved OSHA standards but follows the Federal OSHA standards in regards to Workplace Violence

6 TOOL #2: ENGAGEMENT Engagement needs to come from two sources in hospitals and healthcare facilities: Executive Team: must develop a clear message focused on commitment to the safety of patients and workers Frontline Staff: participating in task forces to promote open dialogue and understand the importance of incident reporting

7 TOOL #3: ORGANIZATIONAL STRUCTURE Integrated approach and focus on safety requires tight interaction between Security, Quality and Employee Health Typical hospital organizations silo these three departments Re-structuring to help coordination or using taskforces or workgroups to integrate ideas

8 TOOL #4: INTEGRATING QUALITY MANAGEMENT High Reliability Organizations help improve clinical outcomes and address quality issues Joint Commission s 2012 document: Improving Patient and Worker Safety: Opportunities for Synergy, Collaboration and Innovation HRO tools and principles can also be used to address initiatives in aggressive behavior HRO five operational processes

9 TOOL #5: MARKETING SAFETY Importance of initial communication to staff on aggressive behavior prevention programs Utilizing internal marketing departments to provide staff contextual information defining the program: Signage Handouts Videos

10 TOOL#6: INFORMATION TECHNOLOGY Many organizations struggle with reporting and incident management systems: Inconsistency of information Multiple computerized reporting systems Need to identify the root cause of the incident in order to solve the problem: Alter existing system to accommodate entire organization Adopt a new system to integrate across departments

11 TOOL #7: INCIDENT REPORTING Accurately capturing incidents requires standardization and communicated definition of aggressive behavior Organization needs to be aware of roadblocks to reporting aggressive behavior incidents: Reporting is complicated and time consuming process Little to no action will occur to change the reported behavior Staff fears the negative consequences of reporting an incident

12 TOOL #8: ASSESSING THE RISK Assess the risk of intentional and unintentional scenarios in healthcare setting Components of a successful assessment can include: Staff feedback from multiple disciplines Analysis of five years of incident reporting Boots on the ground analysis of facility security and safety measures in place

13 TOOL #9: PREVENTION & CONTROL Outcomes and conclusions determined from risk assessment will fuel prevention and control methods Prevention & Control methods can be categorized into three main interventions: People-centered (staff, visitors, patients) Operational Facility layout

14 TOOL #10: TRAINING & COMMUNICATIONS Gaps in training will be evident after determining the correct prevention & control methods Training & Communication methods can include: Online or Classroom based Role Playing De-escalation techniques Physical defense training Understanding predictive factors to the onset of aggressive behavior

15 TOOL #11: INCIDENT RESPONSE Many hospitals have discovered the effectiveness of using incident response protocols Incident response protocols can be used and setup similar as Code Blue or Code Red currently in place Aggressive behavior is complex and no single incident response protocol solution works for all hospital environments

16 TOOL #12: POST INCIDENT FOLLOW-UP True commitment of the executive team to a culture of safety is shown through post incident follow-up Communications to staff following an incident should be treated as second victim Developing internal resources dedicated to aggressive behavior follow-up Provide outside support services to workers following an incident Post incident follow-up is critical to continuation of accurate incident reporting

17 TOOL #13: ADDRESSING MENTAL HEALTH CHALLENGES Dealing with mental health patients in acute care setting is a growing epidemic Hospitals are not equip to deal with patients longterm causes depleted resources and staff Determining solution of care differs in each hospital environment at the forefront of state initiatives

18 TOOL #14: RECORDKEEPING & SUSTAINABILITY Joint Commission standards and Federal OSHA regulations require recordkeeping Accuracy of these reports directly impact proper assessments effective implementation Sustainability requires transparency of the organization dashboards, continuous data tracking, ongoing training of staff

19 NEXT STEPS Working on getting the finalized toolkit completed by April 1 st Toolkit will be posted onto WSHA s website and copies can be found there Let ALL WSHA and ASHNHA members know when the toolkit is available Continue to add to the toolkit as we see fit with any additional knowledge and hospital successes we find Safe Table in Seattle, WA on 3/23/17

20 QUESTIONS? Courtney Ulrich, MHSA Washington State Hospital Association