NOVEMBER 19, 2024
Originally published by our sister publication Anesthesiology News
Although the majority of violent acts toward healthcare providers occur within the acute care setting, with security teams in place and a variety of colleagues available to help, outpatient clinics also are exposed to violence. Developing a plan and having well-trained staff are necessary to ensure the safety and preparedness of clinic teams, according to a presentation at the 2024 annual meeting of the Society of
Originally published by our sister publication Anesthesiology News
Although the majority of violent acts toward healthcare providers occur within the acute care setting, with security teams in place and a variety of colleagues available to help, outpatient clinics also are exposed to violence. Developing a plan and having well-trained staff are necessary to ensure the safety and preparedness of clinic teams, according to a presentation at the 2024 annual meeting of the Society of Gastroenterology Nurses and Associates.
Turning an Incident Into Opportunity
Jeanne Greer, RN, the director of gastroenterology operations at Cooper University Healthcare, in Mt. Laurel, N.J., recognized the need for violence prevention training after her staff was attacked by a patient post-anesthesia due to a propofol reaction. In recovery after a procedure, the patient—a 32-year-old man with no history of reactions or drug misuse—jumped off his stretcher, pulled out his IV and began punching nearby staff members. He also attempted to hurt other patients. Luckily, Greer said, two technicians who formerly worked in security were able to restrain the patient. However, several staff were injured, and those who were involved entered a “shock state” for weeks after the incident, she said.
In response to the event, Greer worked with stakeholders to develop a violence council to ensure the staff was prepared if another incident arose. Her main goal was, “How do we build confidence in our staff and patients?”
The violence council developed a protocol for their facility. First, they started ongoing violence drills for staff, assigning roles staff members would take during a crisis. For example, one nurse would be assigned to call 911, another to protect other patients, and a third to prepare medications. Second, they installed signage instructing patients about what to do in case of a violent outburst and installed panic buttons in the front office and in several clinic rooms. Finally, they met with local police to discuss their role during a violent outburst.
In the initial incident, the police were hesitant to intervene because they weren’t sure what the patient’s psychiatric status was and what type of intervention was appropriate. Because of this, staff had discussions with the police, and it was determined that if a situation arose that was called a “post-anesthesia outburst,” that wording would allow them to assist appropriately with subduing the patient alongside the healthcare team.
Multifaceted Approach To Prevention
Emily Salisbury, RN, the director of clinical operations in endoscopy services at the University of Utah Health, in Salt Lake City, has developed and implemented several methods in preparing her staff to face violence confidently within the clinic space. Salisbury said that installing panic buttons and planning out scenarios are good starting points.
Apart from assigning roles for staff members, she also recommended designing a “system of escalation,” she said, that delineates who staff should contact and what steps to take when faced with aggressive patients or visitors.
Training can be augmented with the help of an outside training company, she said, noting that BERT Workplace Safety Solutions worked well for her healthcare team. One detail her staff learned in training for these events is to practice safe distances from patients and visitors at all times, she said. It’s important to remember to never place yourself in a position with no access to an exit, she explained.
Finally, she recommended performing pre-calls with upcoming patients to determine a patient’s mindset and training staff in verbiage to de-escalate aggressive patients. Salisbury said she believes that a great tool in de-escalation is simply listening to patients and visitors. “It allows them to vent their frustrations,” she said. “Many of these individuals are going through difficult times and may just need a space to express their frustrations.” However, she encourages enforcing firm boundaries with patients and visitors and following up any aggressive event with thorough documentation.
“Continued practice and good communication,” she said, “can empower staff and improve their confidence going forward.”
By Ronni Benson, RN
Greer and Salisbury reported no relevant financial disclosures.
