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No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education
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No Hit Zone: Reinforcing a Culture of Safety through Awareness and Education

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Presented by University of Louisville pediatrician Kelly Dauk. This program was created in collaboration with Dr. Erin Frazier and the Kosair Children's Hospital Child Abuse Task Force. This teaches …

Presented by University of Louisville pediatrician Kelly Dauk. This program was created in collaboration with Dr. Erin Frazier and the Kosair Children's Hospital Child Abuse Task Force. This teaches healthcare workers how to intervene when they witness an adult or parent become angry or hit a child or another adult.

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  • Has anyone here every been in a situation where parent or adult becomes angry, raise their voices, or hit a child or another adult in your presence during a hospital stay or clinic visit??? Everyone tends to look at each other on who will react. It makes families in other rooms very uncomfortable. There has not been education or training on how to deal with this situation.
  • Many other hospitals have seen this situation and hence Rainbow started this program.
  • It is similar to taking finger nail clippers on an airplane—at security they can’t decide if the clippers are for use on the nails or if it is a weapon.
  • This is the best way to keep a situation under control before children get hit.
  • I have begun using the scripts frequently in my clinic for de-escalation. The more frequently I use them- the more comfortable I become doing this. I have frequently taken kids out of a room to take a walk with me, to get stickers, or to color while I write notes to give the parents a few minutes to settle down. Many time parents have thanked me for taking the child for a few minutes.
  • It may be helpful to have an area where you keep crayons, books, movies etc for children if needed. Families usually get frustrated or upset when other stressors are present. Always remember there may be much more going on in the family. This is a good time to offer help and resources.
  • The sooner you get involved with a disruptive patient/family member the easier it is to de-escalate the situation and help the family with the situation that is causing stress.
  • We acknowledge the parents right to discipline their child but this does not include spanking while in our facilities.
  • If people steal the poster—let them take the poster and get more.
  • Transcript

    • 1. No Hit Zone Reinforcing a Culture of Safety through Awareness and Education
    • 2. Objectives • History: What prompted “No Hit Zone” policy? • Elements of the “No Hit Zone” Project • Educate on how to intervene when necessary LOUISVILLE.EDU
    • 3. No Hit Zone Dilemmas • Many healthcare workers have encountered situations where parents or adults become angry, raise their voices, or hit a child or another adult in your presence without clear guidelines of what to do. • Our goal is to help equip healthcare workers with some tools to use during these encounters. LOUISVILLE.EDU
    • 4. “No Hit Zone” Beginning • In 2005 Rainbow Babies introduced a “ No Hit Zone” policy for their hospital • Since then the program has been spread to over 30 hospitals across the country LOUISVILLE.EDU
    • 5. Goals • Assist in lowering the frequency of disruptive behaviors in our hospitals and clinics • Assist in maintaining a safe and caring atmosphere for patients, families, and staff • Elevate the standard of care in all places where children interface with health care workers LOUISVILLE.EDU
    • 6. • Hitting and disruptive behaviors puts healthcare providers in a difficult situation; therefore, no type of hitting is allowed in our facilities • Disruptive behaviors, such as, physical discipline yelling, jerking of body parts, etc. can lead to more physical and aggressive behaviors LOUISVILLE.EDU
    • 7. “No Hit Zone” Elements • Poster – Widespread • Brochures-Parent Resources – Available throughout clinic facilities focusing on alternative types of discipline LOUISVILLE.EDU
    • 8. No Hit Zone Policy PURPOSE The purpose of this policy is to create and reinforce an environment of comfort and safety for patients, families, and staff working in our facility. DEFINITION No Hit Zone: an environment in which no adult shall hit another adult, no adult shall hit a child, no child shall hit an adult, and no child shall hit another child. LOUISVILLE.EDU
    • 9. No Hit Zone Policy POLICY STATEMENTS When hitting is observed, it is everyone's responsibility to interrupt the behavior as well as communicate hospital policy. PROCEDURE All staff will be made aware of the clinic policy that is in place to ensure and reinforce an environment of comfort and safety. Staff will identify and respond to situations that compromise the safe environment utilizing the education they are provided. If appropriate, additional intervention will be provided by appropriate staff dependent on the level of severity. LOUISVILLE.EDU
    • 10. General Guidelines • Be nonjudgmental • Model effective interventions (such as distraction), when appropriate • Try to have conversations with caregivers out of earshot of others (including the children) so caregivers aren’t embarrassed into being confrontational • Thank parents for respecting our policies LOUISVILLE.EDU
    • 11. Interruption Can be used to “de-escalate” a situation in which caregivers begin to raise their voices, curse, or show other signs of stress and inappropriate behaviors that occur prior to physical discipline LOUISVILLE.EDU
    • 12. Your calm, sympathetic, physical presence is probably the most effective response. You will need to have a variety of lead-ins that you can comfortably use, depending on the situation specifics. (use your own language to convey one or more of the example messages) LOUISVILLE.EDU
    • 13. • Scripting Examples • “Can I help you with something?” • “Would you like me to take your child to get a book or sticker” • “You’ve been waiting for awhile. Let me see when you can expect a doctor to see you” • “Most 2-year-olds can’t sit still/behave for long periods. Would it help if I found something for him to play with?” • “Do you have family here supporting you?” LOUISVILLE.EDU
    • 14. Scenario #1 You are a nurse working in a pediatric clinic. You observe a caregiver yelling at her 2 year and 3 year old children while in the patient’s room. •What do you do? LOUISVILLE.EDU
    • 15. Discussion LOUISVILLE.EDU
    • 16. • Calmly ask if the caregiver needs any assistance. • Acknowledge how frustrating it is to wait a long time with two young children. • Offer to see how long until the patient will be seen. • Offer something for the children to do to keep them busy—books, movies, count stickers, snacks. • Always consider stresses the family may be underneed to get kids off bus, need to get to another appointment (court), other family members may be ill etc. LOUISVILLE.EDU
    • 17. • Let the physician seeing the patient know the family is stressed and starting to get disruptive. • Doctors and nurses should respond immediately to disruptive behavior to help de-escalate situations. • It may take a few times before you are comfortable with this. • Consult a social worker if available and appropriate LOUISVILLE.EDU
    • 18. • Situations may occur when a child/adult is hit or physically disciplined and you may need to relay that the clinic is a “No Hit Zone”. LOUISVILLE.EDU
    • 19. • “For the safety and protection of everyone in our clinic we participate in a “No Hit Zone”. I am obligated to say something. What can I do to help you or your family?” • “You may have seen our posters in your room/waiting room. This clinic is a “No Hit Zone”. We ask that you refrain from hitting and keep conversations quiet/private out of courtesy to the other patients and families.” LOUISVILLE.EDU
    • 20. Scenario #2 • You are walking down the clinic hallway, a mother yells at her child, yanks him by the arm and hits him several times. He is a patient waiting to be seen. • What do you do? LOUISVILLE.EDU
    • 21. Discussion LOUISVILLE.EDU
    • 22. • Intervene and notify the mother that the clinic is a “No Hit Zone”. • Offer assistance. • Let the team taking care of the patient (physician and nurses) know about the incident. • Provide documentation of the incident in the patient’s chart. LOUISVILLE.EDU
    • 23. • What if the mother states “it is my right to discipline my child” ? • What do you do? LOUISVILLE.EDU
    • 24. Discussion LOUISVILLE.EDU
    • 25. Response “I am not trying to step into your role as a parent but this facility is a “No Hit Zone”. We do not allow hitting of any kind. This is for the safety of everyone in our facility.” LOUISVILLE.EDU
    • 26. Sympathize with the frustrations and stresses the parents may be experiencing. Acknowledge that you respect their role as a parent/caregiver. LOUISVILLE.EDU
    • 27. Scenario #3 • You are sitting in your office and hear crying coming from the bathroom two doors down. You continue to listen and identify that it is a child and their caregiver in the bathroom. The child is crying and you hear what sounds to be the caregiver hitting the child and verbally scolding them for misbehaving. • What do you do? LOUISVILLE.EDU
    • 28. Discussion LOUISVILLE.EDU
    • 29. • You look around your office and find a new toy. You go to the bathroom and knock. You ask the caregiver if everything is ok. The caregiver opens the door. You observe that the child is around 3 years old. The caregiver appears to be angry and worked up. The child is still crying. You bend down to the child and ask if she would like a toy. You then tell the caregiver that the facility is a “No Hit Zone”. You ask if there is anything you can get the caregiver. You then report the incident to the nurse and the medical team that will be seeing the child. • If you get no response from your knock, request that the caregiver open the door. LOUISVILLE.EDU
    • 30. • After reporting the incident to the medical team, you returned to check on the welfare on the child. You observe the caregiver hitting the child repeatedly as she pulls her toward the bathroom. You observe the child crying and screaming. • What do you do? LOUISVILLE.EDU
    • 31. Discussion LOUISVILLE.EDU
    • 32. • Intervene with the caregiver and child again and explain that this clinic is a “No Hit Zone”. Make a Social Worker referral and again notify the medical team who will be seeing the child. • Depending on how you feel about the first intervention and the severity of the current situation you may want to contact security and child protective services. LOUISVILLE.EDU
    • 33. • If a person becomes angry consider calling security. Don’t make threats. If indicated by the situation, notify Child/Adult Protective Service • Be aware of adults that go to private places to spank their children. • Do not put yourself in a dangerous situation. Contact security when appropriate. LOUISVILLE.EDU
    • 34. LOUISVILLE.EDU
    • 35. LOUISVILLE.EDU
    • 36. Roll Out LOUISVILLE.EDU
    • 37. Continuation of Program • Refill of brochures, repair of signage • Education of new staff • Other languages LOUISVILLE.EDU
    • 38. Acknowledgements Erin Frazier Kosair Children’s Hospital Deonya Muhammad University of Louisville Department of Jamie Issis Pediatrics Tara Cockerel Rainbow Babies and Children’s Hospital Therese Sirles Riley Children’s Hospital Melissa Currie Anne Eldridge Steve Wright Michelle Robey Steve Menaugh Members of the Kosair Children’s Hospital Child Abuse Task Force LOUISVILLE.EDU

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