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CO- ENA Safe Work Environment updates October 10, 2013. Heather Finch RN, BSN, CEN Billie Ratliff, LCSW Shawna Zautcke, RN, CEN. Intro. Who we are. Objectives Highlights from the ENA Safe Work Env. Intensive held- June 2013 How we relate or incorporate info

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Co ena safe work environment updates october 10 2013

CO- ENA Safe Work Environment updatesOctober 10, 2013

Heather Finch RN, BSN, CEN

Billie Ratliff, LCSW

Shawna Zautcke, RN, CEN


  • Who we are

  • Objectives

    • Highlights from the ENA Safe Work Env. Intensive held- June 2013

    • How we relate or incorporate info

    • Workplace Violence and the work done at Memorial-UCH (ED WPV-Task Force)

    • Identify current legislative status/future initiatives (Sharon Sperry)

Thank you

ENA Connections, August, 2013

Presented topics

(Mona Kelley, MSN, RN)

Presented Topics

How to manage difficult patients

  • T.A.C.T. Therapeutic Alternatives in Crisis Training

    • Helpful to decrease restraint use in ED

    • Stresses descalation and behavior awareness

  • Informative to know other programs are available

  • Memorial uses CPI

Team safety at the bedside
Team Safety at the Bedside

  • Strong Teamwork

    • Improve outcomes, patient satisfaction, staff satisfaction, reduce liability, reduce errors

    • TeamSTEPPS™

    • Communication Tools


      • SBAR

      • POLO

Team safety conflict resolution
Team Safety & Conflict Resolution

  • Develop safe environment where staff feel comfortable to question safety issues

    • DESC Script

      • D-Describe the specific resolution

      • E-Express your concerns about action

      • S-Suggest other alternative

      • C-Consequences should be stated

    • CUS

      • I am concerned

      • I am uncomfortable

      • This is a Safety Issue

Team safety coaching


Team Safety & Coaching

  • Defined – A process that enables learning and development to occur and thus performance to improve

  • Goals

    • Help ensure the team has what they need to be successful

      • Skills, Knowledge, Opportunities, Capabilities

      • Positive, real time feedback, sets them up for success

Medication safety

(Susan Paparella, RN, MSN)

Medication Safety

“Most errors result from complexity of healthcare system and not individual recklessness or incompetence”

Create safer systems

Manage “at risk” behavior

Strategies at Memorial include

Red baskets

Two patient identifiers

High risk medications checked by 2 RN’s

Pediatric medications checked by 2 RN’s

The healthy nurse

(ENA Topic Brief, February2013)

The Healthy Nurse

  • Compassion Fatigue

  • Healthy work environment

  • Human Error

  • Just Culture

  • Transformational Leadership

Risk analysis

(Kathy Szumanski, MSN,RN,NE-BC)

Risk Analysis

  • Reviewed Methods of Risk Analysis

    • Proactive Risk Assessment (PRA)

    • Root Cause Analysis (RCA)

    • Apparent Cause Analysis (ACA)

Liability risks of emergency nurses risk control strategies
Liability Risks of Emergency NursesRisk Control Strategies

  • Scope of Practice

  • Documentation

  • Communication

  • Increased monitoring for patients

    • Administered pain meds

    • Psychiatric crisis

    • Return within 24, 48, 72 hrs

Our story
Our Story…

Our Journey

Dept – Central, CU4, North ED

Basic staff makeup/ basic organizational structure


  • Definition

    • “Any act of aggression , physical assault, emotional or verbal abuse, coercive or verbal abuse, coercive or threatening behavior that occurs in a work setting and causes physical or emotional harm.” (ENA, 2010, Emergency Nurses Association position statement).


  • Nurses are 3 times more likely to experience violence than any other professional group

  • Healthcare workers are more likely to be attacked at work than police officers or prison guards (NIOSH, 2002)

  • Healthcare workers suffer 4 times more non-fatal assaults than the private sector (US Dept of Labor Statistics, 2001)

  • Estimated that 70% of violent events in health workplace are underreported (Luck, Jackson, and Usher, 2007)

Who we are
Who we are…

Interdisciplinary team includes:

Employee Health, Safety, Security, ED Central (RN and Tech), ED North (RN), Behavior Health, ED Team Lead, CNS, FNE, ED physician champion, Risk & Quality/Regulary –support


  • Mission of ED Workplace Violence Task Force

    • Support overall employee health and well-being with a focus on workplace violence Prevention, Recognition, Response, Reporting and Recovery


    • **Patient to Staff

    • Staff to Staff

    • Visitors to Staff


ST GOAL – improve WPV incident/injury reporting in the EDs (rationale – need accurate reporting data in order to develop effective interventions).

LT Goal – use improved reporting data to develop effective interventions aimed at helping staff be better prepared to prevent, manage and respond to WPV as well as reducing WPV


  • Pre-Survey (22 line-item survey monkey)

  • Education – 90 day

    • Define, Zero tolerance/support, Reporting process, addressing barriers,

    • Huddles, email, CBT

  • Post- Survey

Additional interventions
Additional Interventions

  • Following up on reports…

  • Communication with police re: reporting

  • Safety Alerts

  • Data trending to include incidents not just injury

    • Consolidating data….

Reporting data
Reporting data

Still pending….

Anecdotally…..reporting incidents via our internal quality reporting system increased.

Next steps
Next Steps…


Lateral violence

Trend reporting

Modify reporting form

Expand work to other units

A word from sharon
A word from Sharon…


Future intiatives