By Melissa Hagstrom, contributor
May 6, 2014 - Unfortunately, violence in the hospital setting is nothing new, and two recent nurse stabbings at two different facilities in Los Angeles have caused the health care community to take an even deeper look at safety programs and the technology in place.
Deena Brecher, MSN, RN, APN, ACNS-BC, CEN, CPEN, says that organizational culture, training and other elements must be combined with technology to successfully reduce violence against nurses. Photo courtesy of ENA
Surveillance systems, metal detectors, alarms and other high-tech security measures are installed at hospitals throughout the country, but Deena Brecher, MSN, RN, APN, ACNS-BC, CEN, CPEN, president of the Emergency Nurses Association (ENA), explained that technology may not be the definitive answer when it comes to thwarting violence against nurses and other clinicians.
“There’s only one environmental control measure that we found that actually makes a difference in the amount of violence in a department, and that is a panic button or silent alarm,” Brecher said, citing a 2011 study conducted by the ENA. One of the technological advantages of panic buttons is that they can be mobile, instead of being limited to panic buttons in triage or the nurses’ station.
According to the ENA research, 82 percent of incidents of physical violence actually happen inside a patient’s room, and most exam rooms are not outfitted with emergency alarms or panic buttons. Brecher noted that mobile panic buttons that can be physically worn on the nurse might provide another level of protection.
“In our study, we looked at all kinds of things including the presence of security and metal detectors, and we found that those things did not lower the odds of physical violence against nurses.”
Wearable devices may have more promise.
Security Management recently published a case study on the Radius Enterprise Mobile Duress (EMD) system from Inovonics, a mobile panic button for health care providers. It offers the ability to locate alarms activated by the wearer, provide notification of the alarm, and then direct responders to the duress event. The product launched last year at Denver’s Exempla St. Joseph’s Hospital and several other facilities.
Exempla’s security director, Eric Smith, CPP, was pleased to find that the EMD system “takes about 20 seconds from the time the button is pushed to security hearing the call,” and that it could be used to overcome radio “dead spots” for the security officers posted in the ER. A new St. Joseph’s hospital is due to open at the end of 2014, and Smith hopes to expand the system to more units in the new building.
Taking a holistic approach to reducing violence
The Bureau of Labor Statistics estimates that 900 deaths and 1.7 million nonfatal assaults occur each year due to workplace violence across industries, and The Center for Personal Protection and Safety reports that health care professionals are 16 times more likely to be attacked on the job than any other type of service professional.
In light of these statistics and the growing reports of violence, safety experts are urging hospitals to take a more holistic approach to security, one that encompasses technology, training, policies and drills.
Marilyn Hollier, CHPA, CPP, says that technology is just one piece of the puzzle when it comes to reducing workplace violence in health care facilities. Photo courtesy of IAHHS
Marilyn Hollier, CHPA, CPP, president of the International Association for Healthcare Security and Safety (IAHSS) and director of hospitals and health centers security at the University of Michigan, said that addressing workplace violence requires a multifaceted approach, and technology is just one piece of the puzzle.
“Mobile duress signals, cameras and emergency alert systems have the ability to lock down an area electronically; and these are all important tools in helping keep a hospital safe. But standing alone, these wouldn’t be effective. I really focus a lot more on education and training,” Hollier said.
“We focus here on early identification and early intervention,” she continued. ”We emphasize and train nurses to report any kind of threat or gut feeling that they have that a person may act out. We do CPI [Crisis Prevention Institute] training and try to get all of our nurses trained on non-violent crisis intervention where they recognize early warning signs and learn things to say to try and keep the situation calm until security can get there.”
Many hospitals are also now utilizing a security risk code in their EMRs that is used to flag a high-risk patient or family member who has acted out in the past.
Hollier encourages staff nurses to seek out training to help improve their verbal de-escalation skills and to partner with the hospital security department to help further minimize risk.
The ENA study found that the presence of reporting policies, especially zero-tolerance policies, was associated with lower odds of physical violence and verbal abuse. Brecher added that it is essential for hospitals to promote a culture where violence is not accepted or tolerated. “Hospitals that are able to do that are able to see a decrease in violence events.”
Organizations are also taking concrete steps to legally enforce policies specifically aimed at workplace violence. Just last week, three bills sponsored by the California Nurses Association/National Nurses United that would enhance patient safety, increase access to care and promote workplace violence prevention advanced in the California legislature.
The workplace violence prevention bill, SB 1299, sponsored by Sen. Alex Padilla, says that the California Occupational Safety and Health Standards Board must adopt standards requiring hospitals to establish workplace violence prevention plans that protect health care workers and other facility personnel from aggressive and violent behavior. Hospitals would also be required to document and report incidents of violence to Cal-OSHA.
“The most important thing is it has to be a team approach. This isn’t something that nurses, administrators or security teams can tackle by themselves,” Brecher said.
Resources and related articles:
The Center for Disease Control and Prevention (CDC) offers a free online workplace violence prevention course for nurses.
The ENA Workplace Violence Toolkit allows users to develop and implement a comprehensive plan.
What Will Stop the Violence Toward Emergency Nurses? - NurseZone article
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