CKHS Takes a Multipronged Approach to Reducing Violence in the Workplace
Danger is hardly the first adjective that many outsiders associate with the field of nursing. Yet, every day, nurses in healthcare facilities across the nation encounter any number of situations that have the potential for danger. Whether it’s tending to a combative patient or dealing with angry family members, nurses need to be adequately prepared to protect themselves from harm in the workplace.
At Crozer-Keystone Health System, the prevention of violence in the workplace has been part of the orientation for every new employee for many years. However, a little over a year ago, the health system placed a new emphasis on preventing violence when it started experiencing a rise in the number of altercations in its emergency departments, behavioral health and inpatient units.
“As patients are brought into the trauma center, we sometimes get visitors who are also very aggressive or agitated,” says Debra Lillback, RN, MSN, trauma program manager, Crozer-Chester Medical Center. “We saw these types of situations escalate last year to a point where everyone – staff, patients and other visitors – became very uncomfortable.”
To understand the scope of the problem, department leadership at each hospital held debriefing sessions with staff when incidents occurred. This information was subsequently shared with hospital and health system administration and resulted in the forming of an ad hoc committee focused on preventing violence in the workplace.
The committee, which was comprised of representatives from shock trauma, security, patient safety and administration, was charged with identifying opportunities to improve the safety and security of the work environment for staff and patients. Among the committee’s first tasks was a review of the visitor policy.
“We had a good policy in place but needed to make adjustments for the evening and overnight hours,” says Mark Mitchell, director of Emergency Preparedness, Crozer-Chester Medical Center. “We implemented a visitor ID system in the emergency department to help us keep track of visitors. We also put an internal lockdown procedure in place so that the entrances to the nursing units were secure after hours.”
By expanding its security team, the health system was able to strengthen its presence at entrances and on key units. It also designated certain clinical units as “badge access areas” to restrict visitor entrée and further protect patients and staff.
To help staff respond appropriately to certain crisis situations, system-wide policies were created. The Code Silver policy outlines the appropriate actions that staff should take when an individual comes onto hospital grounds with a weapon intending to do harm. Code 13 identifies the actions that should be taken when a patient or visitor becomes combatant within the hospital setting. When a situation escalates beyond the capabilities of hospital security, local police are available to assist.
Education has played a major role in the health system’s efforts to ensure a safe workplace. Over the past year, the health system has twice offered a program for staff called “Emerging Violence in Healthcare: Strategies for Prevention.” This program empowers staff to take a balanced approach to patient-focused care and personal safety. Additionally, the program offers tactics for reducing safety risks associated with high-risk patients and illegal drug use in the community, as well as techniques for de-escalating potentially violent situations and recognizing signs of stress related to an incident.
In April, nurses from across the system took part in a mini crisis intervention training session. On an ongoing basis, the health system also offers lectures, lunch and learns, and training sessions for staff who are interested in the subject of workplace violence.
“Periodically, the Joint Commission and other regulatory bodies will publish papers or articles on the subject of workplace violence,” says Mary Moser Grimes, RN, director of Quality at Delaware County Memorial Hospital. “These are distributed to our unit managers who use the information to supplement and reinforce key points with their staff.”
Beyond security and education, ongoing communication is key to ensuring a safe, secure work environment. According to Kathy Donohue, BSN, MBA, CHCQM, director of Quality at Taylor Hospital, one tool that has proven particularly effective is staff rounds.
“Every week, Joan Meighan – our director of Risk Management – and I will try to visit a floor in our hospital and spend time casually talking with the staff about their concerns,” she says. “We try to make this exchange as nonthreatening as possible so we don’t wear suits and typically choose a quieter time of day when the staff isn’t too busy. Administration is aware that we do these rounds but they don’t accompany us. This adds to the transparency and comfort of staff members who really want to speak their minds.”
Ultimately, the greatest factor in preventing workplace violence is staff awareness.
“Our staff needs to be alert and use their instincts,” Mitchell says. “We can provide education and additional security, but ultimately when staff members see something unusual, they need to call security and have them check it out. It’s always better to have security called even when they were not needed, than to have needed security and nobody called.”
Ensuring a Safe Environment
The following list outlines additional steps that Crozer-Keystone Health System has taken to ensure a safe work environment:
- Panic alarms have been placed strategically throughout all of the hospitals and staff receives regular training on their use.
- Panic alarms are provided to individuals who work in remote or high-risk areas of the hospitals (i.e. basements or on the North Campus at Crozer-Chester Medical Center).
- Lighting has been assessed and improved on all hospital campuses.
- Alarms (both permanent and portable) are tested weekly; regular preventative maintenance is performed monthly.
- Hardwired alarm buttons have been added in units that are considered at risk (such as Preadmission Testing, Post-Anesthesia Care Unit, Short Procedure Unit).
- Security escorts are available to walk staff to and from their vehicles on request.