VIOLENCE IN HEALTH CARE FACILITIES: LSBN PRESENTATION

1. VIOLENCE IN HEALTH CARE FACILITIES: LSBN PRESENTATION JUZAR ALI ,MD;FRCP;FCCP Professor of Medicine LSUHSC CMO

3. Discussion /Debate originates at • Is there awareness of this problem ? “Not just part of the job” ; Comes under the wider umbrella of work place safety; more than just “throwing scalpels around”!! • Is training and technique adequate to address the problem ? • What are the safety and security steps needed ? • Is there a standard process we all have to adopt to address this ?

4. 2011 ANA Health & Safety survey

5. Level of Risk & Type variable • This is based on patient types, flow and point of care • May be increased in the Trauma /ED/ Intensive care Units/ OR /Surgical area • Different types of problems in Clinics 2004 OSHA report identifies three risks • 1. Increased number of Psych patients • 2. Rise in police use to hold aggressive individuals • 3. Facilities with 24 hour public access

6. a. Workplace Violence Type 1: Violent acts by criminals, who have no other connection with the workplace, but enter to commit robbery or another crime. b. Workplace Violence Type 2:Violence directed at employees by customers, clients, patients, students, inmates, or any others for whom an organization provides services. Examples: patient-on-staff; visitor-on-staff c. Workplace Violence Type 3: Violence against coworkers, supervisors, or managers by a present or former employee. Examples: physician-on-nurse; employee-on-employee d. Workplace Violence Type 4: Violence committed in the workplace by someone who doesn’t work there, but has a personal relationship with an employee—an abusive spouse or domestic partner. //ihssf.org/PDF/crimesurvey2014

7. Results from two important studies on hospital violence were released at the IAHSS conference held in May.

8. VIOLENCE IN HEALTH CARE FACILITIES: SOME DATA • JC SE Database : About 256 incidents have occurred since 1995 • Marked spike in the last three years : 37% increase • 2010 International Association of Health Care Security and Safety survey of 212 hospitals about 2720 assaults of all types • 3 % hospitals experienced shooting incidents • 59 % of shootings occurred within hospital walls • 91 % perpetrators were male • 25 % current or former pts • 5 % current or previous staff

9. One year survey of Emergency Room nurses • 97 % perpetrated by patients and relatives • 80.6 b% in patients areas • 23.2 % in corridors/hallways /elevators 14 % at nurses station • 38.2 % against ED nurses at triage levels , while 33 % while restraining or subduing pts 30 % while performing invasive procedures • Ref: Emergency Nurses Association’s ED Violence surveillance study 2010

10. 2009 JON data: Nurses most frequent targets; 50 % ED nurses encountered some type of physical abuse and 70 % verbal • The culture of accepting this as “part of the job” and not reporting or having action taken upon • Debate /confusion: Should I protect the patient or protect myself first ? • “Disruptive behavior committee” • Legal and Ethical implications

11. The rate of violent crime, assaults and disorderly conduct incidents at U.S. hospitals in 2013 was significantly higher compared to the previous year, according to research released by the IHSS Foundation at the International Association for Healthcare Security and Safety (IAHSS) 46th Annual General Membership meeting held May 18-21 in San Diego. The violent crime rate per 100 U.S. hospital beds rose 25%, from 2.0 incidents in 2012 to 2.5 incidents last year, while the assault rate increased from 10.7 to 11.1. The rate of disorderly conduct incidents experienced the biggest jump, from 28 per 100 hospital beds in 2012 to 39.2 (40%) last year

12. In a separate IHSS Foundation study that was also released at the IAHSS conference, 89% of the hospitals surveyed had at least one event of workplace violence in the previous 12 months. The perpetrator was often a patient (75%) or visitor (9%), and most incidents involved a threat/verbal abuse (41%) or physical assault (29%). If the incident involved a physical injury, the injured victim was almost always a security worker or non-security hospital staff member, and not the perpetrator. A weapon was used in only 4% of the incidents, and 7% resulted in legal action. Less than 1% resulted in regulatory follow-up IHSS Foundation at the International Association for Healthcare Security and Safety (IAHSS) 46th Annual General Membership meeting held May 18-21 2014

13. Nearly 500 safety professionals who responded to MySafetySign's 2015 Health and Safety Industry Survey. Notably, 90% of respondents indicated that their senior management considered safety important to their organizations J Loud www,mysafety Sign.com

14. ACUTE Behavioral Emergency • 3 step approach verbal engagement , collaborate relationship, de-escalation • 4 main objectives ensure safety all around; help the patient manage his/her emotions while maintaining control Avoid physical restraints Avoid coercive interventions • Richmond , Janet , Berlin J et al West Emerg Med 2012 Feb ; 13(1) 17-25 Verbal de-escalation of agitated pt Consensus statement of American ass for emergency psychiatry Project BETA work group

15. Table 2. Ten domains of de-escalation.27 10 Domains of De-escalation Fishkind A Calming agitation with words , not drugs: 10 Commandments for safety Current Psych 2002-2011;1(4)

16. SUMMARY • Risk assessment and threat identification • Identify and be aware of triggers /frustration/ medical or social stressors /operational stress wait time s • Buy in of the awareness at all levels top down • Zero tolerance ( by this the reduction can be 50% ) • Steps towards de-escalation … depends upon the threat 90 % problems and issues solved with engagement and discussion • Communication and all types of communication tools • Police /security/ timeliness • Code silver • Panic buttons/hand held alarms • Monitors/ electronic access stations • Metal detectors and the debate // really necessary , effective ? Controversial ; depends whom you ask Thank you , JA