By Kora Behrens, Clinical Nurse Manager, Medical Solutions
According to the Occupational Safety and Health Administration (OSHA), workers in healthcare settings are four times more likely to be victims of workplace violence than workers in other industries. Workplace violence includes disruptive, violent events as well as the verbal abuse that many healthcare workers face daily.
In April 2018, The Joint Commission issued Sentinel Event Alert #59, which deals with physical and verbal violence against healthcare workers. This alert focuses not just on violence, but also serves as an aid to help organizations to recognize and acknowledge violent behaviors, better prepare staff to handle the threat and risk to safety, and more effectively address the aftermath.
Effective management of violence starts with an investigation of the contributing factors that may exist to precipitate violent situations or behaviors. One of the biggest factors is the setting in which healthcare workers operate. It comes at no surprise that the emergency department and inpatient psychiatric settings have the most recorded incidents. The home care setting presents unique challenges because of the disorganized and uncontrolled environment the patient care occurs in. Sixty-one percent of home care workers report workplace violence each year. The LTC setting for cognitively impaired patients also presents special challenges to managing violence and the most common characteristic exhibited by perpetrators of violence is altered mental status associated with underlying dementia, delirium, substance abuse, or other mental impairments.
Such elements associated with the perpetrators and the healthcare setting in which they exist are just a few of the contributing factors to violence. Other factors associated with violence are stressful conditions, long wait times, lack of organizational policies and training, domestic disputes amongst patients and families, inadequate security, understaffing, staff working in isolated areas, lack of access to emergency communication, unrestricted access to hospital rooms and clinics, and lack of community mental health care. These contributing factors can lead to low staff morale, lawsuits, and high worker turnover which leads to burnout. To combat the factors associated with workplace violence, The Joint Commission suggests several actions to take to look beyond solutions that merely increase security presence.
The first suggestion is to clearly define what workplace violence is and to put systems into place across the organization that enable staff to report the violence. The goal in establishing systems and procedures within an organization is zero harm to patients and staff, create a culture of reporting all events of physical and verbal violence, encourage conversations about violence, develop protocols, guidelines, or tools that make identifying potential perpetrators simple and easy. Another key step to reducing these incidents is tracking them and keeping records of the incidents. Gathering information on the different incidents and keeping a centralized database will be extremely beneficial to analyze and track worker injury and workplace violence.
Tracking each event will help to look for trends in the contributing factors associated with the violent act. It is also important to remember that follow-up should occur with the victims associated with the act. This follow-up is necessary to provide support to the victims but also the witnesses and this may include psychological counseling, debriefing, and trauma-informed care if necessary. Once a follow-up or debriefing has taken place it is always essential to analyze the contributing factors to the incident. According to OSHA, this includes a worksite analysis and hazard identification but furthermore, it is a demonstration on the value that reporting plays in communicating to staff the risk assessment and interventions taken in similar situations. Once the data has been analyzed and the problem has been identified implementation of cost-effective, evidence-based solutions specific to the problems identified at the local or unit level should be initiated.
Launching a new solution is more complex than just putting the procedure in place. Training all staff including security personnel on de-escalation, self-defense, and response to emergency codes is the next step in improvement with workplace violence. Self-defense training may include de-escalation techniques, alarms, security support, safe rooms, escape plans, and emergency communication procedures. The emergency response codes should be practiced with a variety of mock violent situations so that staff are adequately prepared to react in any types of violent events. Amidst the adoption of new strategies, keeping abreast of any changes will help to establish quality and an evidence-based practice approach in preventing any violence within the healthcare setting.
Click here to learn more about The Joint Commission’s Sentinel Event Alert #59.