Safety Program Codifies Risk of Hospital Violence

In the past two years, this column has focused much on workplace violence in the hospital—an issue that until recently received scant attention beyond the people who were immediately threatened. 

Fortunately, awareness is growing. The mainstream media has picked up on the story, thanks to the efforts of groups like the Emergency Nurses Association (ENA), which has provided detailed accounts about the frequency of onsite violence against clinicians and other staff. ENA’s alarming 2007 survey in which 86% of respondents reported having experienced workplace violence is frequently cited by news outlets.

Now, when violence occurs in a hospital, media no longer report it simply as an isolated and unpredictable incident, but as part of a larger and disturbing trend of hospital violence that is taking place across the country. And, as more data is compiled about the extent of these attacks, the media will intensify its coverage because it resonates with the public. 

This is all good. Acts of violence in places of healing are still occurring at an alarming rate, but most people who are in a position to address the issue no longer are in denial. That is an important first step. An informed and angry public will demand change, and that means that hospital leaders who ignore workplace security do so at their own peril.

If an employee, a patient, or a visitor in your hospital is attacked, be assured your local news media (probably unions, too) will examine previous incidences of violence at your hospital to look for patterns, and demand to know why you took no previous action to address an issue you should have known about. And, they’d be right in asking.

Recently, the Journal of Emergency Nursingreported on an innovative program at the University of Wisconsin Hospital and Clinics to address an uptick in violent incidents against staff, patients, and visitors at the Madison, WI-based health system’s emergency department. Working from Centers for Disease Control data which shows that emergency departments are the most frequent location for violence in healthcare, UWHC formed an interdisciplinary team of nurse leaders and front-line staff to address the issue.

They developed a safety program that uses a green-yellow-red color-coded alert system that shows the security status with lights in strategic places in the ED. For example, when ED staff encounter patients with behavioral problems, victims of violent crime, surge-capacity issues, gang activity, multivictim trauma, and other events that could lead to a higher of risk for violence, physicians, nurses and security staff briefly huddle to discuss changing the department's status from green (business as usual) to yellow (potential for disruptive behavior) to red (potential for loss of control of any part of the ED). When security status changes, a three-second alarm and change in light color alert staff to the new situation.

“The training may not prevent unexpected violent outbursts, but staff are better able to identify people at risk of individual violent behavior and know when to cue a potential change in security status,” said Tami Morin, ED clinical nurse manager at UWHC.

Bingo!

Front-line healthcare professionals like the folks at UWHC tend to be practical problem-solvers. They understand it’s probably not realistic to think that workplace violence in the hospital can be eradicated. However, raising staff awareness, and training staff in appropriate responses will give them the tools they need to react accordingly to protect themselves, their colleagues, patients, and visitors.