The first step is admitting your organization has a problem, says VCU Health's chief quality and safety officer.
Since 2016, VCU Health has launched more than four dozen workplace violence initiatives.
Healthcare organizations carry a heavy workplace violence burden, with about three-quarters of U.S. workplace assaults occurring in healthcare settings, according to the Occupational Safety and Health Administration. Workplace violence is prevalent in emergency departments—78% of emergency physicians have reported being targets of workplace violence in the prior 12 months.
"There is not one single silver bullet that makes your environment safer," says Robin Hemphill, MD, chief quality and safety officer at VCU Health.
Over the past five years, Hemphill says the Richmond, Virginia–based health system has taken several essential steps to address workplace violence: realizing that the organization had a problem, forming a committee to illustrate that the problem was systemwide rather than local, promotion of incident reporting, and letting the staff know that abuse is not part of their job.
"A lot of this is selling initiatives to your senior leadership and having them turnaround to become your biggest advocates," Hemphill says.
The initiatives are focused mainly on violent patients but also include measures to address staff-on-staff violence. Data shows the efforts are making a difference:
- Using its electronic medical record, VCU Health flags patients who are at risk of violence, and VCU Police and security staff round on those inpatients. In January, VCU Police and security staff conducted 1,300 checks on potentially violent patients.
- From fiscal year 2012 to FY2015, 15%–32% of VCU Health assault cases resulted in the employee missing time from work. In the current fiscal year, which concludes in June, 1%–2% of assault cases have resulted in the employee missing time from work.
- In summer 2016, VCU Medical Center launched the Behavioral Emergency Rapid Response Team (BERRT) to address inpatients with urgent behavioral health needs and to help reduce workplace violence. In BERRT's first year, police assault charges at the medical center dropped more than 60%.
Over the past five years, VCU Health has launched more than 50 workplace violence-related initiatives, which include the following:
BERRT: The BERRT program is modeled after VCU Medical Center's medical response team, which responds to medical crises at the bedside. BERRT features psychiatric nurses who are mainly deployed in two scenarios. First, the psychiatric nurses round on patients who have been flagged as potentially violent to see whether there are any additional needs related to patient care plans. Second, BERRT team members respond to in-the-moment situations where a care provider sees a potentially dangerous situation.
"The BERRT team comes to the bedside and helps the care team members to make sure everyone involved is safe," says Trina Trimmer, RNC-MNN, MSN, nursing safety operations and resources director at VCU Health.
Violence Prevention Committee: This panel meets monthly and has about 50 members. Several departments and stakeholders are represented on the committee, including executive leadership, legal, nursing, occupational injury, physicians, psychiatry, risk management, and VCU Police.
Emergency department security rounding: Patients are flagged in the electronic medical record at three levels, with Level 1 patients at the least risk of violence and Level 3 patients at the highest risk. When Level 3 patients present at the emergency department, VCU Police and security are notified and round on the patients.
Emergency department metal detectors: Installation of ER metal detectors not only addressed a potential threat but also sent a clear message to patients, visitors, and staff members, says Lisa Davis, MEd, RN-BC, nurse manager for VCU Health's Psychiatric Nursing Consultation Service. "When we put the metal detectors in the ED, that was huge. It was very visible and showed that we wanted to take care of people," she says.
Reporting: In 2018, VCU Health implemented electronic reporting for workplace violence incidents with the launch of the Post Assault Huddle Form. The form gathers data on violent incidents and engages staff members to identify strategies to reduce future risk.
The filing of a Post Assault Huddle Form triggers electronic notifications, says C. Taylor Greene, occupational injury prevention and safety manager at VCU Health.
"One sends a PDF file of the Post Assault Huddle Form to the key stakeholders, including the VCU Police, our chief nursing officer, and the supervisor of the victim. There's also a notification that goes out to the claimant of the form that thanks them for submitting the report and lets them know what is being done," he says.
Reporting of violent incidents is not mandatory, but it is "strongly encouraged," Hemphill says. "Reporting is not supposed to be a shackle, where you get abused by somebody then get in trouble for not reporting it. We want people to give us this information, but we don't want a punitive response for failure to report," she says.
Signage: VCU Health approved the deployment of zero-tolerance violence prevention signs last fall, Greene says. "The introduction of those signs started at 14 of the primary entrances of our inpatient facilities. We did an additional rollout of a slightly different version of the signs at our 45-plus ambulatory locations," he says.
Visitor identification: In February, VCU Health rolled out visitor badging on a trial basis, Greene says. "It's very similar to what is utilized in school systems, where you come into a facility, drop an ID in a scanner, and get a sticker badge with your picture, the destination you are traveling to, and the time that you arrived. We are using self-expiring badges that say 'void' on them after 24 hours," he says.
An upcoming initiative will focus on peer support for staff members who have experienced workplace violence.
"Although we have seen great progress in the number of the initiatives we have launched and have seen an anticipated increase in reporting, our staff members are now asking for peer support," Trimmer says.
VCU Health wants to move beyond focusing on why patients were becoming violent and what could be done to flag them and introduce intervention resources such as BERRT, she says. "Now, we are hearing our staff members say they want help for the team member who was a victim. The staff wants to know what we are offering for victims. We have initiated a group to work on that issue and we have looked at other organizations to see what they have in place."
Christopher Cheney is the senior clinical care editor at HealthLeaders.
VCU Health has launched a series of workplace violence initiatives over the past five years.
The percentage of VCU Health assaults that result in missed employee time has dropped from a high of 32% to as low as 1%.
In January, VCU Police and security staff conducted 1,300 checks on potentially violent patients.