creating a culture for identifying workplace … · creating a culture for identifying workplace...

5/10/2017

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© CentraCare Health 2016 Confidential

CREATING A CULTURE FOR IDENTIFYING WORKPLACE

VIOLENCE RISKClare Jones, BSN, RN, Drug Diversion Prevention RN CentraCare Health

Joy Plamann, DNP, MBA, RN, BC, Vice President Acute Care/CNO CentraCare Health

Innovative Approaches to Management of Aggressive Behaviors in Health Care

May 16, 2017

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OBJECTIVES

• State two strategies to engage staff in creating a safer environment.

• State the purpose of conducting an environmental risk assessment.

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“WEREN’T YOU AFRAID?”4


In 2010, healthcare and social assistance workers were the victims of approximately 11,370 assaults; a greater than 13% increase from 2009

Bureau of Labor Statistics

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CREATING A SAFE ENVIRONMENT

• Physical environment

• Psychological environment

• Emotional environment

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ORGANIZATIONAL CULTURE

• Staff perceptions and attitudes about safety

• Open, honest discussions

• Bring suggestions forward

• Action

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ORGANIZATIONAL CULTURE

• Reporting• Ease of reporting• What action takes place

• Look for trends• Feedback loop

• Will I feel safe to report

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ENVIRONMENTAL SAFETY

• Not just physical building, think broader

• Community changes• Gangs• Drugs• Weapons• Social Unrest• Scale

• Partner with local agencies

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PHYSICAL ENVIRONMENT

• Physical space

• Processes

• Lighting

• Noise

• Clutter

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MAKING THE ENVIRONMENT SAFER

• Ask questions, conduct an assessment

• Facility design• Visibility of patients/visitors• Consider patient movement• Groups• Noise• Processes – duplication• Clutter - equipment

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HISTORY OF THE ASSESSMENT TOOL

5/2016 event on Mental Health Unit required a Root Cause Analysis

RCA Analysis indicated that: • Event location (Behavioral Health ICU) and design did not support staff safety

• Hospital annual risk assessment tool yielded minimal information

RCA Action Plan included:• Safety risk tour and assessment of event location by WPV Committee members

• Trial of the Occupational Safety and Health Association (OSHA) Workplace Violence Prevention Checklist tool for the assessment

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LEGISLATIVE AND REGULATORY RESPONSE TO WORKPLACE VIOLENCE:

State of Minnesota:

2015 Minnesota legislation (statute 144.566) mandates hospitals to:

• Design and implement preparedness and incident response plans for acts of violence that occur on their premises

• Provide training to their staff

Joint Commission Standard LD.03.01.01:

Directs hospital leaders to:

• Create and maintain a culture of safety and quality throughout the organization

• Develop a code of conduct that defines acceptable behavior and behaviors that undermine a culture of safety

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OSHA Response to Workplace Violence:

• Does not require employers to implement workplace violence prevention programs

• May cite employers for failing to provide a workplace free from recognized serious hazards

• Provides voluntary guidelines

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ASSESSMENT & REPORTING PROCESS

Interview • WPV team• Front line staff

Tour• WPV team• Front line

staff

Plan• WPV team• Unit leadership• Frontline staff

Report• WPV team• Unit & Facility

stakeholders

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RISK ASSESSMENT TOOL18


RISK ASSESSMENT REPORT

• Formalize reporting process

• Provide condensed overview of findings

• Capture communication timeline with appropriate stakeholders

• Identify action plans

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ST. CLOUD HOSPITAL RISK ASSESSMENT TOUR20


RISK ASSESSMENT ELEMENT:

Exterior building and parking area inspection:

• Is lighting bright and effective in outside areas?

• Are security escorts available to employees walking to and from the parking lot?

• Is the parking lot attended or otherwise secured?

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Facility/unit design:

• Can exit doors be opened only from the inside to prevent unauthorized entry?

• Are reception and work areas designed to prevent unauthorized entry?

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Facility/unit procedures:

• Is public access to the unit controlled?

• Are there rooms that are secluded from regular foot traffic, out of view, or out of range of hearing from the centrally-staffed and populated areas (nurses' station, triage, waiting room, etc.)?

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Unit/work area(s) inspection:

• Are bullet-resistant windows, Plexiglas partitions, elevated counters to prevent people from jumping over them or similar barriers used in high risk areas?

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ASSESSMENT ELEMENT:

Unit/work area(s) inspection:

• Are high risk areas free of objects that could be used as weapons?

• Is furniture in high risk areas arranged to prevent entrapment?

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ASSESSMENT ELEMENT:

Unit/workplace security measures:• Are there alarm systems?

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ASSESSMENT ELEMENT:

Unit/workplace security measures:

Failure Modes Effects Analysis: Weapons Screening Process

3 inpatient incidents: Loaded gun (conceal/carry) 4” pocket knife Metal money holder with small blade

Emergency Trauma Center, Family Birthing and Mental Health

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ASSESSMENT ELEMENT:

Staffing:

• Is the workplace often understaffed?

• Is adequate and trained staffing available to protect employees who are in potentially dangerous situations?

• Are trained security personnel and/or an assault response team accessible to employees in a timely manner?

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CHECKLIST ELEMENT:

Training and support:

• Are employees trained to report violent incidents or threats?

• Are employees trained in ways to prevent or defuse potentially violent situations?

• Does unit leadership encourage/support employee reporting of events?

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CONCLUSIONS:

1. Workplace violence is a significant concern for staff2. The assessment tool identifies unit and facility risks3. Front line staff are key participants in the assessment and

development of action plans4. Assessment results and action plans need to be

transparent, formal, and communicated with both internal and external stakeholders

5. Speak up

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Discussion

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REFERENCES

Konda, S., Tiesman, H., Reichard, A., & Hartley, D. (2013). U.S. Correctional Officers Killed or Injured on the Job. Corrections Today, 75(5), 122–123.

Mazer, Susan (2010). Ways to Improve Patient Safety: How the Environment Plays a Critical Role. Retrieved April 27, 2017 from http://healinghealth.com/images/uploads/files/hhs_white_paper_August_2010.pdf

Minnesota Statutes 2016, section 144.566; MINN. STAT. 144.566 (2016)

Stone, Patricia W., Huges, Ronda and Dailey, Maureen. (2008). Patient Safety and Quality: An Evidence Based Handbook for Nurses, Chapter 21. Agency for Healthcare Quality and Research.

United States, Department of Labor, OSHA. (December 2015). Preventing Workplace Violence: A Road Map for Healthcare Facilities. Retrieved April 17, 2017, from https://www.osha.gov/Publications/OSHA3827.pdf

UNITED STATES DEPARTMENT OF LABOR. (n.d.). Retrieved May 04, 2017, from https://www.osha.gov/SLTC/healthcarefacilities/violence.html

Workplace Violence against Health Care Workers in the United States. (2016). New England Journal of Medicine, 375(7). doi:10.1056/nejmc1606816

Workplace Violence. (2017, January). Retrieved April 17, 2017, from http://nursingworld.org/MainMenuCategories/Policy-Advocacy/State/Legislative-Agenda-Reports/State-WorkplaceViolence

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