Every day, U.S. hospitals deal with violent patient incidents and threatening behaviors that affect the safety and well-being of staff, patients, and visitors. According to current literature on the topic, violence is occurring in all care settings, even in oncology and maternity units, and not just in the emergency department (ED).
Increases in the number of fatal incidents such as the shooting at Brigham and Women’s Hospital reinforce the need for healthcare facilities’ disaster preparedness and emergency operation plans to include threats, acts of violence, and active shooter incident planning.
When preparing for aggressive acts, especially an active shooter incident, step one in an effective plan is prevention. A good place to start is with a security risk assessment by a qualified expert who will determine what the vulnerabilities are and make recommendations to reduce risk. This type of assessment is more than just hiring a security company to assess the entrances, physical layout, and need for security cameras. It’s important to include an assessment of the specific healthcare services provided and the types of patients served to determine the potential triggers.
Some questions to address during assessment are:
Are services acute or long term? Are visiting family members especially vulnerable to feelings of helplessness or despair? Are mental and behavioral health services offered? Is there socio-economic, racial tension, or ethnic factors to consider?
Protection is the ultimate goal and depending on the setting, there are a number of different measures that can and should be taken. Measures might include signs prohibiting firearms, metal detectors, security cameras, panic alarms, and restricted access. The most important weapon against violence, however, is (1) training, (2) training, and (3) training. It’s easy for busy healthcare professionals to become complacent about their physical safety in a caring environment.
Employees need to know their role if there is an event and what to do. Drills are essential. Hospitals with proactive programs often enlist the resources of community based police departments and emergency response teams who have exceptional skills and response training. Collaborative drills can strengthen reaction skills, test communication systems, and help identify areas which need honing.
Training should start as soon as employees are hired by implementing a workplace violence prevention training program that is part of the formal orientation process. The same training should also be provided to any current employees. It’s recommended that all security staff job descriptions and employment requirements contain formalized training criteria, physical job descriptions, and continued education requirements to ensure preparedness of staff.
Here are some tips to consider when implementing a facility-wide safety plan:
- Provide better visibility and good lighting, especially in areas of high risk such as the pharmacy area, or in isolated treatment areas.
- Implement safety measures to deter handguns inside the facility; for example using metal detectors.
- Install plexi-glass in the payment window in the pharmacy area.
- Use of security devices such as panic buttons, beepers, surveillance cameras, alarm systems, two-way mirrors, card-key access systems, and security guards.
- Place curved mirrors at hallway intersections or concealed areas.
- Control access to work areas.
- Provide training for staff in recognizing and managing hostile and assaultive behavior.
- Provide adequate staffing even during night shifts. Increase staffing in areas where assaults by patients are more likely (e.g. Emergency Department).
- Increase worker safety during arrival and departure by encouraging carpools and by providing security escorts and shuttle service to and from parking lots and public transportation.
- Ensure accurate reporting and documentation of all violent behavior.
- Make patients aware of zero tolerance policy for violence.
- Establish liaison with police authorities and contact them when indicated.
- Obtain previous records of patients to learn of any past violent behaviors.
- Establish a system to chart or track and evaluate possible assaultive behaviors, including a way to pass on information from one shift to another.
- Implement a violence prevention plan to develop strategies to deal with possibly violent patients.
At a fundamental level, healthcare facilities should ensure that policies and procedures address all aspects of operations with regard to violence prevention, training, education, screening, reporting, responding, investigation, discipline, monitoring, and review processes. This may seem like an overwhelming task but by assessing all your risks, you can improve the care you provide and the safety of those on your staff and in your care. If you need help, OmniSure is always here to help assess and help you implement an actionable plan to address aggressive patients.