Ohlone College Newark Center for Health Sciences and Technology Archives - HCO News

Violence Against Healthcare Workers Increases

Violence against emergency room nurses and other medical professionals appears to be increasing as the number of drug addicts, alcoholics and psychiatric patients show up regularly in emergency rooms across the country, according to a recent survey of industry professionals. This rising trend is why many places of work have taken to implementing executive protection training so that staff know what to do in situations of violence.

The survey, produced this year by the federal Substance Abuse and Mental Health Services Administration, illustrates that visits to ERs for drug and alcohol-related incidents rose significantly from 1.6 million in 2005 to nearly 2 million in 2008. This increase is attributed by some to economic conditions in the United States, which are related to the closure of hospitals, cuts in mental health jobs, elimination of addiction programs and cutbacks in other important services.

According to a study released in September by the Emergency Nurses Association, between eight and 13 percent of emergency department nurses are victims of physical violence.

The Emergency Department Violence Surveillance Study also stated that 15 percent of the nurses that reported experiencing physical violence claimed that they sustained a physical injury as a result; and 45 percent of the cases never result in any legal actions against the perpetrator.

ENA president, Diane Gurney, herself a registered nurse, says that she is alarmed by the number of cases which hospitals have neglected to respond to violence in their emergency department, and believes that it will take much more than just hospitals implementing safer working conditions for their health-care staff. If you’ve been hurt as a result of the lacking working conditions, it might be a good idea to talk to someone such as a Las Vegas Workers Compensation Lawyer to get some better insight into how you might legally tackle the situation.

I think this is a much more complex issue, says Gurney. It requires a cultural change involving multiple people from nurses, to physicians, to hospital administration, to the public, to law enforcement, to legislature. Cultural changes dont just happen overnight the process begins with data on which to base decisions regarding strategies and interventions for providing safety to our nurses, patients and other health care providers. ENA is committed to providing data so everyone will be informed about the importance and the scope of the issue.

Joseph Bellino, president of the International Association for Healthcare Security and Safety an industry group that is dedicated to managing and directing security and safety programs in healthcare institutions agrees with Gurney, and bluntly adds that slapping, screaming and groping are not part of the job, and nurses have come to a point where they are saying enough is enough.

Bellino says that hospital safety begins with training healthcare workers to recognize signs of violence and to thwart off those potentially violent situations with both body language and the tone of voice. He added that nurses, physicians, administrators, and security guards should work together as a team and have a strategy in place if violence does occur. He says that any reluctance by hospital administrators to press charges be addressed by police, prosecutors, courts, hospitals and even nurses.

Carol Bosley, an Alabama emergency room nurse, says that she has witnessed her share of violence and verbal abuse. Bosley vividly recalls the night a woman, accidently overdosed on painkillers, and was brought into the ER unconscious by her frightened neighbor. The woman was admitted for the standard 72-hour observation period and became combative with staff when she awoke and was denied narcotics.

When this patient came down from the drugs and realized she was trapped without a way to get her pain-killers, she suddenly stopped cooperating and became verbally abusive with the staff, Bosley says.

Bosley described how things got worse when hospital staff suggested the husband get involved with the case manager to have his wife involuntarily-committed to an inpatient rehabilitation facility.

Once this guy realized he had to do the work, he snapped and went on a rampage, yelling at us that he was going to kill the entire staff if his wife walked out, Bosley says, confessing that she was terrified.

I looked over my shoulder for days and was afraid to go home for fear this guy might be waiting there in the bushes, she says.

Three weeks later, in an unrelated event, a man made his way into another local hospital and shot his wife, she says.

Speaking as a nurse, Bosley says that there isnt nearly enough counseling for families facing crisis.

The emphasis is on the patient and not enough on the patients family, she says. Many of the families that come in have poor coping mechanisms.

Measures to stop violence against healthcare workers have been occurring on many fronts since ENA conducted its initial study in 2006. The American College of Emergency Physicians has recommended safety measures, including 24 hour security guards, coded ID badges, bulletproof glass, and panic buttons for medical staff to push. Henry Ford Hospital, in Detroit, Mich., has curtailed violence with the use of metal detectors. Experts believe that the key to eliminating violence in the hospital workplace is by nurses and other healthcare workers adopting a zero tolerance attitude.

When it comes to health care workers, the ultimate goal should be to provide a safe environment in which to care for patients says Gurney. A zero tolerance policy had proven to be very effective. I would not only like to see a zero-tolerance policy as a standard for all hospitals, but also to see OSHAs recommendations for an effective violence program implemented as well.

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Steps to Improve Infant Security

DURHAM, N.C. – Just weeks after a Louisburg, N.C., woman attempted to snatch a baby from a mother’s room at Duke University Hospital’s Birthing Center, hospitals across the country are investigating the strength of their own infant security protocols and systems.

The abductor is now in custody and facing criminal abduction charges, due in large part to the quick response of Duke Hospital nursing staff, according to authorities.

Similar situations are becoming more and more rare, according to data from the National Center for Missing & Exploited Children. There have been 127 infant (birth to 6 months) abductions at healthcare facilities between 1983 and 2009, only three of which occurred last year.

In healthcare facilities, the NCMEC reports the No. 1 place for infant abductions is the mother’s room, where 73 abductions occurred over the last 26 years, followed by nurseries (17 abductions), pediatric units (17 abductions), and elsewhere on hospital grounds (20 abductions).

The findings aren’t surprising, says Jeff Aldridge, founder and CEO of Security Assessments International, a hospital security consultancy, and a former safety director for the University of North Carolina hospitals.

“Parental education is one of the most important tasks that we do in hospitals,” says Aldridge, who has worked with more than 600 facilities. “[The mother] really is the first line of defense.”

Abductors target the mother’s room because when a mother enters a hospital, she becomes subservient, Aldridge says.

“She’s told what to do when at the hospital,” says Aldridge, adding that mothers in hospitals are programmed to recognize and respond to authority figures. Abductors take advantage of that disposition, stealing scrubs and medical equipment to appear more like doctors or caregivers to their victims.

Aldridge has witnessed the hospital infant security industry grow from nearly non-existent to a business of producing cutting-edge devices. Most common are Radio Frequency ID tags.

Once an RFID tag is attached to an infant, the tag transmits regularly to a system connected with the maternity unit, says Kevin Smith, product manager with Stanley Healthcare Solutions, a supplier of infant security systems.

“This tag continually listens for devices placed at exists, and for the presence of mother tags,” Smith says. “The tag also checks that it is correctly applied to the infant, and regularly transmits its own status to a network of receiving devices placed throughout the OB department.”

“If the tag detects a nearby exit or an unauthorized removal attempt, it will send out an immediate burst of messages via the network of receiving devices, notifying the software,” Smith says. “The software will then respond as configured by the hospital by declaring an alarm, activating network devices at exits to engage door looks, pulling up CCTV footage, displaying response procedures, etc.”

Over the years, RFID tags have continued to evolve, becoming more integrated into the other aspects of the maternity ward’s overall security structure. Hospital staffers are now able to use proximity cards to log into their terminal’s infant security program to review CCTV footage, Smith says. This CCTV footage can then be authenticated by Video Forensic Experts and used as evidence against the perpetrator.

Bands are now equipped with cut-band technology and tamper-proof strips, ensuring that they can’t be removed or broken without triggering alarms. Tags are designed to transmit every few seconds to the primary system so if their signals are intercepted, alarms will be set off. Tag-to-tag association has also grown, allowing for mother and child tags to be synchronized to avoid mother-child mix-ups.

“This bonded pair of tags provides local and automatic notification to mother and nurse that the correct infant has been returned to the correct mother,” Smith says.

At Proven Saint Joseph Medical Center in Joliet, Ill., James Cureton, director of security, is responsible for ensuring the safety of the patients and staff of the 440-bed, 963,000-square foot hospital.

“For any system to be effective, there are a lot of things that have to go into it,” says Cureton, who has worked in security at the hospital for six years. “Foremost, any good infant abduction system has to have good policies and procedures backing it up.”

Regular maternity and pediatric staff training sessions and drills should be held to prepare for a potential abduction.

“We educate patients to never give children to someone who doesn’t have appropriate ID,” Cureton says. “Patients don’t give their babies to someone without those IDs.”

The cost of an infant security system varies by the physical size and layout of the facility, with a typical range between $150,000 and $300,000 for a medium-sized OB department, Smith says. Factors that can affect installation include the age of the facility and the materials used in construction.

The next evolution of infant security is integrating the networks into the day-to-day clinical workflow of the OB department, Smith says.

“The census list of tagged infants in the system is becoming an interactive electronic ‘whiteboard’ to assist departmental workflow,” he says. “Customized fields like nurse and room assignments, doctors, or risk factors enable the hospital to provide specific information to nurses, doctors and managers.”

Hospitals will also see the system software migrate from only being available at nurses’ station terminals to useable on hand-held devices, allowing staff to interact with the security system without leaving their patients side, says Smith.

Even with the current technology, many hospitals are still behind the curve, says Aldridge, who estimates that less than 50 percent of facilities nationwide are equipped with infant security systems.

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Active Security at Healthcare Facilities

Healthcare Facility Safety is a Multi-Faceted Issue

Safety and security issues must be considered systemically. There are a myriad of variables that come into play in a healthcare environment. Safety is not relegated to one problem with a corresponding safeguard; it functions as an active system.

Secure Design

An urban hospital, for example, might create an outer ring with bollards and rails that appear decorative but are strong enough to stop a vehicle from crashing into an entrance.

Although, in the past, security cameras were typically used to investigate events after the fact, emerging intelligent video technology is beginning to give cameras a preventive capability. Installed together with surveillance cameras set high on the building, these software applications are capable of looking for problems an abandoned package, fight on the street or an explosion around the hospitals exterior.

A suburban hospital may create a secure exterior setting with landscaping, fencing, lights and cameras.

Security concerns influence the placement and design of parking decks and lots. Parking facilities require adequate lighting and cameras that can be seen, for the sake of deterrence. Some facilities reserve designated secure parking areas at night, when there are fewer visitors, to provide a safer walk to and from buildings.

The building envelope serves as another security barrier. Depending on the environment, intrusion alarms and an electronic access control system can protect doors closed to the public. Some businesses are even making use of things like these A&D Door Systems to help improve their security when it comes to things like keeping certain doors closed to the public. Windows may also be equipped with intrusion alarms.

Controlled Access

Higher levels of controlled access to hospitals are also being implemented at many facilities for example some are installing Daosafe turnstiles to make sure only authorised individuals are allowed to enter. In urban hospitals, controlled visitor access into the building is the norm. Oftentimes, controlled access includes metal detectors. Standard practice requires staff to wear identification badges and to question anyone without a badge.

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At Miami Childrens Hospital, visitor access is carefully controlled to protect young patients. Visitors must check in and show a valid drivers license. The hospitals visitor access control system also requires a badge with a photo of the visitor that is created on site. In some extreme cases, visitors could access the hospital with an alternative photo identification such as an IdGod photo ID, however, it would also require additional permissions along with the security badge.

Inside the secure perimeter, automated inventory control systems, such as Pyxis or Omnicell, serve as a deterrent to theft and waste.

These systems require staff to enter a patient number when removing medicine from a cabinet. They are particularly useful in emergency rooms, where EMTs may grab handfuls of supplies to restock their vehicle in anticipation of the next call, and can result in substantial annual cost savings.

Government regulations call for strict security to protect patient information as well as the hospitals financial information. Electronic access control systems are being installed to protect rooms where data is stored. Inside, cameras provide a second layer of protection.

Preventative Measures

More inner-city hospitals are using metal detectors and X-ray machines to prevent people from carrying guns, knives and other weapons into the hospital. Depending on the facility, screening equipment might be located at both the main entrance and the emergency room entrance.

Alongside this, many healthcare facilities across the country continue to use security guards, that may have been hired from professional companies like Iron Horse Security. Their CEO, Robin St Martin (check out Robin St Martin’s tweets here), has stated that his company has the mission of being able to help keep organizations and its employees and visitors free from harm. This is essential when it concerns the healthcare industry whose workers strive to save the lives of every individual who walks through the door, not put them in harm’s way.

The main Johns Hopkins Medical Center campus in Baltimore uses this kind of equipment at exits to prevent people from carrying equipment and unauthorized drugs out of the hospital.

Planners and designers must also consider protecting staff and physicians from patients and visitors. Inner-city hospitals must deal with the threat of gangs attempting to finish an unsuccessful murder by charging into an emergency room where the victim is being treated. Proper entry-point design can help protect hospital personnel by separating them from people coming through the door.

Enclosed reception, registration and triage areas with bulletproof glass can provide secure separation. While hospital administrators often resist such designs, receptionists and nurses have begun to ask for it.

Examination and patient rooms throughout the hospital, from the emergency room to the inpatient tower and the outpatient wing, can also be outfitted with an eye to security. Fixed and moveable furnishings, counters and sinks can be arranged so that the physician or nurse is closer to the door and can get out quickly if necessary.

This layout is often favored in psychiatric settings. Panic buttons in appropriate locations in the emergency room and exam rooms can provide another layer of security.

In pediatrics and OB/GYN units, hospitals are installing radio frequency identification systems with sensors that follow radio signals emitted by bracelets worn on babies and young children. When a child leaves his or her assigned area, an alarm will alert staff and security. The system then tracks the movement of the child throughout the building.

Safe Design

Single-handed room design for inpatient rooms, operating rooms and exam rooms has been implemented widely for safety considerations to prevent errors by staff and physicians.

Other design features focus on life safety. Fire alarm and sprinkler systems, for instance, must fit the facility. Elevators must shut down when a fire alarm goes off and stairwells must facilitate safe evacuations with adequate lighting.

Infection control is also a key safety element of mechanical system design in hospitals. Inpatient units typically include isolation rooms for patients who need to be protected from infection, or who might pose the threat of infecting others.

Different types of isolation rooms deal with these problems. In the emergency room, for example, tuberculosis is a paramount concern. Patients who might be infected are placed in rooms with negative pressure. Air pressure inside the room is lower so air from the hospital flows into the room but not back out, preventing the tuberculosis from getting out.

HIV-AIDS patients require the opposite. Since their immune systems are compromised, their isolation rooms must protect them with positive air pressure, which causes air to flow out of the room.

Isolated mechanical systems also play a role in safe design. In the event of a terrorist attack with a biological weapon or infectious outbreak, patients suffering from a dangerously infectious agent would flood the hospital grounds seeking emergency help.

The first layer of protection is provided with space for an outside triage area that is housed in portable facilities to keep infectious patients out of the hospital. In developing the hospital site plan, designers reserve space adequate for this kind of triage task outside the emergency room.

However, during the confusion caused by a disaster, no one can guarantee that infected patients wont get into the building. As a second line of defense, the overall mechanical design should isolate the emergency room from the main hospital.

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