Code Silver

Facilitating a Safe Healthcare Environment

Incidents of serious workplace violence were, on average, four times more common in healthcare than in private industry from 2002 to 2013—putting healthcare workers at an increased risk for workplace violence, according to the Occupational Safety and Health Administration.

The majority of these violent altercations are caused by interactions with patients or someone entering the hospital with a weapon, explains Tony York, president and chief executive officer at Denver, Colorado-based HSS, Inc., a security firm that specializes in healthcare security.

York, author of Hospital and Healthcare Security (Butterworth-Heinemann, 2015), points to several incidents that have made national news: A hospital employee in California who killed two colleagues and himself after losing his job. A gunman in Alabama who wounded two hospital employees and a police officer. An armed man—on a felony warrant—holding a child in the ICU of a children’s hospital in Wisconsin. These are just a few incidents that have made heightened security more crucial.

“The mission of your security program should be to facilitate a safe healing environment in which quality care can be administered,” York writes. “The need for increased security has provided an unprecedented challenge in the methods and philosophies regarding protection of our healthcare organizations.”

The most basic component of the healthcare protection system is a well-trained security force, he continues. The International Association for Healthcare Security and Safety (IAHSS) recently launched two new certification exams for security officers, as well as a new edition to its training manual for healthcare security officers.

Many hospitals go above and beyond compliance with state statutes that regulate security officers, requiring up to an additional 40 hours of specialized security and customer service training. Background checks and screenings for potential security officers are key to obtaining qualified personnel.

Developing a Security Management Plan

IAHSS and the Joint Commission recommend that healthcare facilities develop a comprehensive security plan, also known as a security management plan (SMP). IAHSS indicates this plan “should address systems, people, processes and security technology focused on the preventive, protective and response measures designed to provide a safe environment.”

The Joint Commission recommends healthcare facilities consider these strategies when developing an SMP:

  1. Identify risks. Form a multidisciplinary committee and conduct a risk assessment of the organization, and survey employees to determine how safe they feel while working. Maintain ongoing communication with local law enforcement agencies regarding community risk factors.
  2. Evaluate environmental design. Install security cameras and panic buttons, and develop systems for signaling, alarms and monitors. Design the triage and other public areas to minimize risk of assault, and improve lighting in hallways, rooms and parking areas.
  3. Promote a culture of safety. Develop a system for alerting security personnel when violence is threatened, and design staffing scenarios to prevent personnel from working alone. Ensure staff are comfortable reporting appropriate events to management and law enforcement.
  4. Implement training. Work with local law enforcement to help train staff to recognize and resolve conflicts.
  5. Plan for post-event activities. Promote open communication and encourage counseling if an employee has been threatened or assaulted.

York also recommends that hospitals include elements of financial planning and underscores the need to explore opportunities to work with outside law enforcement.

“Without the framework of a strategic security policy and infrastructure, a program simply becomes one of day-to-day reaction, often resulting in a nonproductive and costly effort,” York explains in his book.

Training your non-security staff is also important, adds Chris Sonne, director of emergency management at HSS, Inc. “Staff who are well-trained will respond and recover better. They will learn to develop situational awareness to know where to hide or exit should a threat arise.”

The Joint Commission requires its accredited hospitals perform risk assessments and have plans in place for security of staff and patients. The primary goal, according to IAHSS, is to “identify and prioritize assets of the healthcare facilities’ primary mission and operations, identify threats to and vulnerabilities of those assets, and develop reasonable risk-mitigation strategies to protect those assets.” But this can’t be done without support and assistance from hospital leadership.

“Healthcare organizations are starting to realize that security officers are critically important to ensuring safety inside the facility,” York explains. “You have to ask yourself, ‘How do we want security to be part of the overall mission of care?’ ”

Securing the Emergency Department

The American College of Emergency Physicians (ACEP) reports that more than 75 percent of emergency physicians experience at least one violent workplace incident in a year. In addition, in 2013, more than 70 percent of ED nurses reported physical or verbal assault by emergency patients or visitors. This reflects an overall increase of violence in society tied to gangs, drugs and alcohol use, and a larger number of armed private citizens. The lack of quality mental health facilities also results in more patients in the emergency medical system.

Add to this patient pain and discomfort, 24-hour access to the emergency department, family member stress and anger, long wait times and cramped space, and you increase the odds for violence and disruption to occur.

York recommends that hospitals utilize dedicated security officers to monitor and patrol the emergency department. “Make sure they are highly visible, but also able to quickly respond to an incident,” he explains.

IAHSS also suggests addressing specific security design needs for the emergency department, including:

  • Entrances equipped with video monitors displaying live camera images for public viewing and awareness
  • Clear distinction and signage between walk-in and ambulance entrances
  • An ambulance entrance that is restricted to authorized emergency medical services and hospital personnel
  • Access to medical treatment areas—including all doors, interior elevators and stairwells—controlled by and restricted to hospital personnel
  • A designated safe room, equipped with a duress button, telephone and reinforced doors, which can be locked from the inside as a place for staff, patients and visitors to retreat in the event of immediate danger

York also recommends metal detectors for people entering the treatment area of the emergency department, but notes that some organizations wrestle with the idea of using them. “It’s amazing the items that people carry on their person. Some people simply forget they are carrying a concealed firearm.”

Experts advise that other sensitive areas—behavioral health units, pharmacies, pediatric wards—should also follow similar guidelines and look for specific ways to protect patients and staff.

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