Hospital Improvement and Innovation Network (HIIN) The Integration of Worker and Patient Safety We Share 4 Safety

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1 Hospital Improvement and Innovation Network (HIIN) The Integration of Worker and Patient Safety We Share 4 Safety Today s Topic: Aggressive Behavior April 7, 2017 Presented By: Brad Hunt, MBA bhunt@riskcontrol360.com Courtney Ulrich, MHSA culrich@riskcontrol360.com Kelly Austin, PsyD kaustin@klaconsulting.com Ext. 3

2 Agenda Hospital Data Aggregate Review Reducing Patient Assaults on Staff: A Deeper Look to Advance our Resolve Kelly Austin VP Training/Senior Risk Manager - KLA Risk Consulting Questions Next Steps

3 Data Aggregate Review

4 Data Aggregate Review Snapshot ALL Hospitals - Combined Baseline Data Performance Data Total Incidents /17 2/17 Frequency Rate Severity Rate $16,552 $10,204 $616 $167 Average Cost Per Claim $4,841 $2,913 $2,367 $1,285 Patient Handling Incidents Frequency Rate Severity Rate $2,850 $2,153 $111 $7 Average Cost Per Claim $5,190 $3,927 $5,164 $764 Aggressive Patient Incidents Frequency Rate Severity Rate $1,209 $783 $53 $6 Average Cost Per Claim $4,095 $2,570 $2,161 $1,000 Slips, Trips, Falls Frequency Rate Severity Rate $4,777 $3,601 $158 $47 Average Cost Per Claim $7,489 $5,031 $2,571 $3,820

5 Reducing Patient Assaults on Staff A Deeper Look to Advance our Resolve Kelly L. Austin, PsyD Vice President Training/Senior Risk Manager

6 Agenda A little about KLA Risk Brief Update: Reality of assaults WPV program gaps Aggressive behavior: our next 6 months

7 Who Are We? KLA Risk Consulting Risk Management/Safety Consulting and Training Kim L Arnold, CEO/Pres: 31 yrs in risk management Sandi Arnold, VP, Operations: 34 yrs as hospital HR Exec Kel 11 years risk management; PsyD Grew up in hospital Mother hospital HR Exec 34 yrs Expertise and focus Aggressive patient behavior prevention and response Member: Emergency Nurses Association Society of Trauma Nurses

9 Reality of Assaults 1824 First documented patient and visitor aggression toward nurses 2015 Study Violent crimes in hospitals 2011: 2.0 per 100 beds 2015: 2.8 per 100 beds

10 Reality of Assaults BLS (Bureau of Labor Statistics) 2005 to 2014 rates of workplace violence among private industry hospitals

11 Reality of Assaults Still a part of the Culture Responses: Is WPV part of the job in the ED? This has been an accepted way for a long time It goes on enough that I m getting desensitized to it Comes with the job It s tolerated to help the flow of the ED I feel the culture in the ED provides a feel of it not being a big deal when it happens

12 Reality of Assaults What are we doing about it? Prevention and response tactics in place Zero tolerance WPV policy WPV committees Training on policy ORC signs posted Reporting procedures» No fear of reprisal for reporting De-escalation training (annually) Process to code aggressive patients

13 Reality of Assaults And the list continues Prevention and Response Tactics in Place Code violent response team Behavioral health response team Security presence Panic buttons Metal detectors Safe room(s) Facility design

14 Reality of Assaults With all that is being done, why are assaults on hospital staff still on the rise and our staff still being injured? Increase in alcohol and substance abuse patients Increase in psych patients (boarding) Increased wait times People are less tolerant (empathetic)

15 More importantly We still have GAPS in our WPV programs!

17 WPV Program Gaps Agenda Three gaps Why should we care about the gaps?

18 WPV Program Gaps GAPS WPV program main areas (OSHA) Active leadership support and worker participation Worksite gap analysis Hazard ID and prioritization Hazard prevention and control Staff education/training Recordkeeping and program evaluation

19 WPV Program Gaps 3 GAPS Active leadership support Reporting Training Not all hospitals have these gaps Too many still do

20 WPV Program Gaps Active Leadership Support Leaders Critical role in everyone s safety and satisfaction Don t believe assaults on staff are that big of an issue Leaders support or lack thereof Can change the tide of staff behavior and satisfaction Positive and safe Negative and fearful

21 WPV Program Gaps Leadership Involvement In Their Words From a nurse: Witnessed a patient slam a fellow nurse repeatedly against a metal door. Embarrassed" hospital administrator later tried to ignore the assault. Wanted to pretend nothing happened. It was that whole blame-thevictim mentality. From a nurse: If nurses believe that their hospital leaders tolerate violence, loss of trust will follow.

22 WPV Program Gaps Reporting Assaults under-reported Just part of the job (culture) Not clear what to report Nothing will change No time Hospital systems not connected for ease of data collection

23 WPV Program Gaps Training Types of training WPV policy and procedures Verbal de-escalation training KLA Risk identified four main gaps in training

WPV Program Gaps #1 Security, panic buttons, etc...not available to staff within the critical 1-10+ seconds of an assault.

24 WPV Program Gaps #1 Security, panic buttons, etc...not available to staff within the critical seconds of an assault. After 15 seconds of a patient punching me in the head, I will never walk again without the use of a cane. I couldn t get to the phone to call Security I pushed my panic button, but the patient had enough time to push me against the wall and choke me. I thought I d never see my kids again.

25 #2 No comprehensive delineation between a patient and an aggressor. Who falls under combative patient label? Dementia Alcohol-related TBI Drug-related Psych patients

26 #2 No comprehensive delineation between a patient and an aggressor. There are two groups under combative patient One main differentiator The differentiator is INTENT.

27 WPV Program Gaps Differentiation: Intent Unintentional actions No intent to harm Intentional actions/assault Intent to harm Alcohol and drug-related Some psych patients Our responses are different with each group

28 WPV Program Gaps #3 Staff lack (enough) effective techniques to defend against or defend and exit an assault. Do not have knowledge and training to defend-exit against most intentional assaults Staff being injured, many severely

29 WPV Program Gaps #4 Lack of emphasis in training what is reasonable in responding to an assault. Many hospital leaders do not want their staff to touch patients at any cost This comes mainly from fear Staff will respond inappropriately; over-respond An excessive use of force claim or lawsuit will be filed against hospital Negative press When properly trained, risk of inappropriate staff responses to verbal and physical assault is greatly reduced

30 Training note KLA Risk s training Hospital Assault Response and Prevention (HARP) Closes the gaps just discussed

31 WPV Program Gaps Why should we care about gaps? Hospital Staff Patients

32 WPV Program Gaps Consequences to Hospital Direct/Hard Costs Worker s comp increases OSHA citations/fines Liability claims/lawsuits Nurse Awarded PTSD Benefits After Series of Assaults by Patients

33 WPV Program Gaps Consequences to Hospital Indirect/Hidden/Soft Costs Lower staff productivity Compromised patient care Lower patient satisfaction scores Staff turnover/shortages Inability to attract nurses and other staff Negative publicity

34 WPV Program Gaps Consequences to Staff Physical Psychological/Emotional Physiological

35 WPV Program Gaps Psychological/Emotional 37% of assaulted nurses: job productivity Fear for safety Difficulty: Concentrating on work Thinking clearly Controlling emotional reactions with patients/co-workers Providing emotional support to patients/families That attack changed how I approach nursing. I now often practice defensive nursing. For example, I no longer turn my back on patients. I often wonder if the patient I am with will suddenly turn violent. Gates, Gillespie, Succop (2011)

36 WPV Program Gaps Psychological/Emotional Assaulted Nurses: 20% PTSD symptoms 12% Full PTSD Gates, Gillespie, Succop (2011)

37 WPV Program Gaps Psychological/Emotional In Their Words My livelihood was robbed. I am jumpy and easily startled. I did what I felt was ethically and legally appropriate for care and did nothing that was extra. I feared for my own safety. I felt watchful and on guard. I felt irritable and angry. I tried not to think about the patient punching me. I respond differently to stressful situations now. Gates, Gillespie, Succop (2011)

38 WPV Program Gaps Physiological The PTSD Brain Assaults change the brain Structurally Hippocampus volume Ventromedial prefrontal cortex volume Functionally Unable to distinguish past and present experiences Exhibit fear, anxiety and extreme stress

39 Consequences of Assault Consequences to Patients Staff fearful and distracted by assaults = Compromised patient care Medication errors Patient infections Increased length of stays Increased use of restraints Patients (bystanders) can sustain injuries Gates, Gillespie, Succop (2011)

40 WPV Program Gaps What can we do? Choose to no longer tolerate assaults on staff Mindset: One assault on staff is one too many Understand first-hand what your departments are experiencing Determine where we have gaps Prioritize those gaps Begin closing each gap

41 WPV Program Gaps Closing WPV Program Gaps Is doable Involves everyone; consistency Takes time Benefits are innumerable Will reduce number of assault situations Will reduce injuries to staff Plus so much more

43 Question Let s keep it simple Process this 6 months = process as slips/trips/falls You send materials regarding WPV and assaults KLA will review Determine the 10 WPV gaps for our focus The process will continue

44 Question Let s keep it simple By May 31: to Kelly and Courtney Your WPV materials for review WPV program SOPs (code violet, report/document, post-assault process) Education/other committee meeting notes Data on past year or two of assaults on staff Copies of signs/flyers regarding assaults/violence Training materials» If not materials, main topics in training Other important materials

Question Let s keep it simple HARP training Kelly to send an e-mail Training details Your response Interested in

45 Question Let s keep it simple HARP training Kelly to send an Training details Your response Interested in scheduling HARP or not We will work together to schedule training Flexibility beyond 6 months of aggressive patient behavior

46 HARP Any questions? Kelly s kaustin@klaconsulting.com Courtney s culrich@riskcontrol360.com

47 Next Steps

48 Next Steps Upcoming Events: Data Submission #6: April 16 th Claims 1/1/16 3/31/17; Hours Worked: month of March) Webinar #6: May 5 th Aggressive Behavior Member Highlight Aggressive Behavior Information Submission: May 31 st Due to Kelly Austin and Courtney Ulrich Reminder with additional details to come STF Action Plans monthly reviews of progress Mentor Eligible Hospitals from STF Period: Mount Carmel; ProMedica; Salem Regional Medical Center; Southern Ohio Medical Center Continue to reach out to each other for additional help on gaps

WORKPLACE VIOLENCE PREVENTION. Health Care and Social Service Workers

WORKPLACE VIOLENCE PREVENTION. Health Care and Social Service Workers WORKPLACE VIOLENCE PREVENTION Health Care and Social Service Workers DEFINITION Workplace violence is any physical assault, threatening behavior, or verbal abuse occurring in the work setting A workplace