By Shawn Paul, Director of Enterprise Physical Security, Safety & Emergency Mgmt. Risk & Integrity Services at Providence St. Joseph’s Healthcare and
Joe Anderson is the CEO of Reflex Protect®, maker of America’s only “hospital safe” compassionate active defense solution
Healthcare Safety Preparedness: If the nation has learned anything from the Covid-19 crisis, it’s that advance planning in safety preparedness is vital to our ability to respond to emergencies, whether they’re viral, violent, or otherwise.
Healthcare organizations in particular need procedures and sufficient up-to-date equipment to quickly respond to potentially confusing and fluid circumstances.
The coronavirus crisis has also illuminated the dangerous problem of workplace violence against medical caregivers, an issue that healthcare organizations now have a unique opportunity to address.
7 out of 10
Of all professions, healthcare workers are the number one victims of workplace violence across the country. OSHA reports that 70% of claims for injuries from violence occur in a healthcare setting. Until relatively recently, many nursing veterans (and the administrators responsible for their health and well-being) considered the occasional injury caused by an act of violence in a hospital “a part of the job.” Because all medical professionals want their facilities to be seen as safe places of healing, these disturbing stories often stayed unknown.
There is movement to change this. Across the country, new legislation is making battery of a caregiver a felony regardless of any injury occurred. This is similar to how assaults on law enforcement and the judiciary are treated.
Although laudable for bringing the problem into the light, we don’t need more felonies so much as we need fewer batteries. Preparations designed to deter, prevent, or stop an assault before it ever becomes a potentially injury-causing battery truly is the goal.
Prepare + Train
Healthcare workers receive little and often zero training on how to recognize and respond to violence in their workplace, but they should. Imagine instead if this training was part of their licensing curriculum prior to working in acute/hospital settings and mental health treatment locations. Discussions about planning and preparation could begin well before and segue into training in other facility policies and procedures.
For those who believe anti-violence safety preparedness should be left to “security personnel,” there are two very important reasons not to:
1) The response gap between the time when potential violence erupts and help arrives is often filled with terror and injury. Trained security cannot simply be everywhere instantly.
2) Many smaller or rural facilities have no onsite security at all. Local law enforcement is the closest help.
The April 2018 Sentinel Alert, published by the Joint Commission healthcare accreditation organization, declared that healthcare facilities must provide adequate training in response codes and anti-violence safety preparation to all healthcare workers, including but not limited to security. Few hospitals or healthcare organizations have yet taken this admonition fully to heart by establishing and integrating well-thought-out anti-violence safety preparedness policies, procedures, tools, and training.
And on April 16th of this year, the House passed HR1195, the Workplace Violence Prevention for Health Care and Social Service Workers Act requiring the Department of Labor to create an occupational safety and health standard that requires certain employers to take actions to protect workers and other personnel from workplace violence.
Your Own First Responder
Post-Covid implementation of new and better pandemic response procedures, as well as a newfound public appreciation for the role caregivers play (and the risks they take), provides a perfect opportunity for healthcare organizations to address workplace violence safety preparedness head-on.
While healthcare workers should understand that suffering injury due to violence is absolutely not “part of the job,” equally important is training to understand another simple truth: “You are your own first responder.” Not security, not your panic alarm, not law enforcement – you. And every second count. Seconds count in the case of an active shooter, for example, because one person is shot every 15 seconds on average in such an incident (more in any given burst). Medical workers need to know how to react immediately to the threat of violence, regardless of its source.
Compassionate Controlling Force
Healthcare workers should receive at least annual training in verbal and non-verbal de-escalation techniques, reasonable physical intervention methods, and the basics of “Run/Hide/Fight” and how it may or may not apply to a caregiver with a duty of care to her patients. Because of this special duty, however, caregivers (and security alike) should also have access to and training in defensive tools that offer compassionate controlling force.
In the past, this was called planned improvisation, and you were taught using improvised weapons. This type of instruction, ironically, itself often led to unnecessary trauma or injury. The best practice today is “low impact, no scare tactics” training using modern defensive chemical formulations specially designed for use inside sensitive environments (i.e. not pepper sprays), accompanied by fast-acting decontamination solutions. Reflex Protect offers such a solution.
Training in the use of and access to such tools is also not just for security but should support registration clerks, orderlies, and bedside caregivers alike. Everyone should be trained to act as his or her own first responder – the “response gap” allows no time to wait for help.
Creating A Culture of Health And Safety
A key element when creating a culture of health and safety is job safety analysis. In the healthcare setting, it’s crucial to assess job hazards even before they arise to reduce or eliminate risks to a manageable and acceptable level. It would help to have a tool that can break down a job into different operational steps and check potential safety hazards. In this way, employees can carry out suitable preventive measures and ensure patient safety.
Another essential element in building a culture of health and safety in the work setting, especially in healthcare facilities, is behavior-based safety, an aspect of behavioral psychology that promotes safer workplace behavior. Using a specially-designed app to collect behavioral data helps observe employees and record any behavior affecting workplace safety.
One of the most critical elements of establishing a healthy and safe work environment is accident and safety reporting. Every healthcare facility should have a centralized hub to record accidents and incidents and results of investigations and mitigation actions to reduce the likelihood of recurrence. Healthcare facility managers can employ apps or software programs to help them attain seamless and straightforward accident and safety reporting.
Learn more about creating a health and safety culture using apps and applying the best practices at https://www.etq.com/all-applications/health-safety/.
Another simple thing is training to protect ones’ personal space and reactionary distance. According to industry-standard MOAB training, the brain takes 1.5 seconds to recognize a threat, form a response, and physically respond. That’s why caregivers need to step back a minimum of four feet so an aggressive person can’t touch them and they have the ability to deflect and move if the assailant throws something or advances in a threatening manner.
Interestingly, this last point ties in directly to lessons learned from Covid-19. Healthcare workers are trained to move toward emergency situations. Over the past weeks, many nurses have had to relearn this training, remaining mindful to stop and first put on PPE before entering a Covid-19 patient’s room to protect themselves and their colleagues from infection. Likewise, in case of potential violence, caregivers require training in the counter-intuitive need to stop, back up, and create space so they can physically respond to the situation, including accessing and deploying a compassionate and controlling tool if necessary.
After The Storm
Healthcare facilities have a unique opportunity to start implementing much-needed policies, procedures, and training in the use of modern best practice anti-violence safety preparedness solutions, alongside the newly apparent need for focused pandemic response solutions. Post-Covid attention to physical design or redesign of spaces, including barriers, escape routes, and visitor management systems should be on the agenda to protect caregivers as well.
Effective Counseling and Support
Counseling and support are an essential part of healthcare. It can be used to help people suffering from a wide range of conditions, such as depression, anxiety disorders, and mental exhaustion. Counseling can also be a key part of maintaining mental wellbeing, and maintaining this during and after a pandemic can be extremely difficult.
Counselling offers the opportunity for anyone who needs it to speak out. Counseling can take many forms, but it all aims to provide the sufferer with the ability to manage their condition better by working through their thoughts and feelings in a safe space under the guidance of a trained professional. If you think you are a suitable candidate to become a counselor, you could consider earning your LPC degree online to assist people struggling to conquer their mental illnesses during these difficult times. The pressure people experience during and after a pandemic is exponential and often results in violence or self-harm. Counseling and strong support systems are crucial to overcoming the struggles people face.
Safety preparedness is always something easily left for another time. The lessons of Covid-19, however, make clear that the only good time to prepare for an emergency in the future is today.