General Consideration about Safety in
      Emergency Department




                     Montinee Sangtian, MD
          ...
Common safety and health topics:
Emergency Department (ED) Module




                             http://www.osha.gov
Workplace Violence Facts

 70% of all workplace violence incidents do not get
  reported.
 2637 nonfatal assaults on hos...
The highest frequency of violent attacks

emergency   department
psychiatric ward
waiting rooms
geriatric units.
Violent in ED

   A 1988, 127 U.S. teaching hospitals ( > 40,000 visits/yr)

           •    32% reported at least one ve...
ER : Potential Hazard
Are your ED at risk?

• emergency department > 50,000 per year
• and an average waiting time>2 hours
• were significantly ...
Resident Life

 1994 , 461 emergency medicine residents
     62% were concerned about their personal
      safety while ...
Well, we work in the high risk area of violent.
   How should we prepare for the situation…..???
Ummm…………

 However, only 40% of hospitals surveyed
  provided formal nursing education on violent.

 The survey found th...
Security in Emergency Department
PREPARING THE EMERGENCY DEPARTMENT
             TO PREVENT VIOLENCE


 Only 21.4% control access to the emergency
  depar...
War or ED ?

 Weapons carriage in ED : 4% to 8%
 5.4 weapons a day using a metal detector.
 26.7% of major trauma patie...
Should assume :




 all violent patients are armed (until proved)
especially those presenting with major trauma.




  Or...
What is EP’s role in violent?

Emergency physician should…
 control the patient and the situation
 diagnose and treat re...
ECombative patients : Organic or Functional ?
FIND ME
Predictors of Violence Patients

   Positive Predictor             Not Reliable

 Male                     Ethnicity
 P...
PREPARING THE EMERGENCY DEPARTMENT
TO PREVENT VIOLENCE
PREPARING THE EMERGENCY DEPARTMENT
          TO PREVENT VIOLENCE


 Security Personnel
 Patient Searches (Early recognit...
Prevention

              • To control the factors in the
 Primary        environment that encourage the
                d...
Prevention : Primary prevention

 To control the factors in the environment that
  encourage the development of frustrati...
Secondary prevention

 involves response to pre-violent agitation and
  aggression.

• Early recognition of high-risk pat...
De-escalation Technique

1.   Simple Listening
2.   Active Listening
3.   Acknowledgement
4.   Allow Silence
5.   Agreeing...
• Give clear, brief, assertive instructions
• Explain your purpose or intention
• Negotiate options
• Avoid threats
• Move...
•   De-escalation is a very difficult and humbling skill.
•   You cannot be unsure of your own pride or self-esteem.
•   Y...
NEVER THREATEN
unless you are prepared to take the next step !



Once you have made a threat, or given an ultimatum,
you ...
Tertiary prevention

 To limitation of the actual act of violence itself once
  it has occurred.

 Physical and chemical...
Restrain and Seclusion
     The Joint Commission on Accreditation of Health Care Organizations (JCAHO)


1.    The impleme...
American College of Emergency Physicians. Emergency physicians’ patient care
       responsibilities outside of the emerge...
The violent patient suffered as well !

 13% of hospitals reporting injuring patients

  while restraining them, includin...
Prevention Strategies that Work

• Metal Detectors installed in a Detroit Hospital
  prevented the entry of 33 handguns, 1...
KEY CONCEPTS

 Emergency department staff should be trained to
  recognize the early signs of impending violent behavior
...
References and Further Reading

• ACEP Policy Statement : 2009 Policy Compendium
• Joint commission on accreditation of he...
Case Studies
Deadly shootings at US army base




                                                        Major Nidal Malik Hasan,
    ...
Workplace Violence
Workplace Violence
Workplace Violence
Workplace Violence
Workplace Violence
Workplace Violence
Workplace Violence
Workplace Violence
Workplace Violence
Workplace Violence
Workplace Violence
Workplace Violence
Workplace Violence
Workplace Violence
Workplace Violence
Workplace Violence
Workplace Violence
Workplace Violence
Workplace Violence
Upcoming SlideShare
Loading in...5
×

Workplace Violence

8,860

Published on

Published in: Health & Medicine
1 Comment
1 Like
Statistics
Notes
  • Congratulations on your slideshow very interesting ! Great work... beautifully presented ! ! Thank you for sharing. I allowed myself to add it to 'GREAT CAUSES and JUST CAUSES' Slideshare group . Feel free to join us. Thank you in advance for your participation and sharing your 'favorites'. .. With friendship from France. Bernard
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
No Downloads
Views
Total Views
8,860
On Slideshare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
95
Comments
1
Likes
1
Embeds 0
No embeds

No notes for slide

Workplace Violence

  1. 1. General Consideration about Safety in Emergency Department Montinee Sangtian, MD Emergency Physician Rajavithi Hospital
  2. 2. Common safety and health topics: Emergency Department (ED) Module http://www.osha.gov
  3. 3. Workplace Violence Facts  70% of all workplace violence incidents do not get reported.  2637 nonfatal assaults on hospital workers (1999) (8.3 assaults per 10,000 workers) • Government employees have a higher rate of violence than private sector employees • Women are over 8 times more likely to be victims of Workplace Violence than men National Institute for Occupational Safety and Health : Violence: Occupational Hazards in Hospitals
  4. 4. The highest frequency of violent attacks emergency department psychiatric ward waiting rooms geriatric units.
  5. 5. Violent in ED  A 1988, 127 U.S. teaching hospitals ( > 40,000 visits/yr) • 32% reported at least one verbal threat daily • 18% reported at least one threat with a weapon daily • 25% reported restraining at least one patient daily • 7% had experienced a violent death in the ED. • 80% had a staff member injured by violence. Lavoie FW, Carter GL, Danzl DF, Berg RL: Emergency department violence in United States teaching hospital. Ann Emerg Med1988;17:1227
  6. 6. ER : Potential Hazard
  7. 7. Are your ED at risk? • emergency department > 50,000 per year • and an average waiting time>2 hours • were significantly associated with increased incidence of violence.
  8. 8. Resident Life  1994 , 461 emergency medicine residents  62% were concerned about their personal safety while working in the emergency department  50% thought that security measures in their hospitals were inadequate.  1999, survey of psychiatry residents  36% had been physically assaulted in residency.
  9. 9. Well, we work in the high risk area of violent. How should we prepare for the situation…..???
  10. 10. Ummm…………  However, only 40% of hospitals surveyed provided formal nursing education on violent.  The survey found that 24- hour security was in place at only 23% of emergency departments.
  11. 11. Security in Emergency Department
  12. 12. PREPARING THE EMERGENCY DEPARTMENT TO PREVENT VIOLENCE  Only 21.4% control access to the emergency department during high-risk hours
  13. 13. War or ED ?  Weapons carriage in ED : 4% to 8%  5.4 weapons a day using a metal detector.  26.7% of major trauma patients were armed with lethal weapons. Ordog GJ: Weapons carriage among major trauma victims in the emergency department. Acad Emerg Med1995;2:109
  14. 14. Should assume : all violent patients are armed (until proved) especially those presenting with major trauma. Ordog GJ: Weapons carriage among major trauma victims in the emergency department. Acad Emerg Med1995;2:109
  15. 15. What is EP’s role in violent? Emergency physician should…  control the patient and the situation  diagnose and treat reversible causes of violence  protect the patient and staff from harm  Scene Safety  Preservation of Evidence and Documentation  Reporting  Duty to warn Third Parties
  16. 16. ECombative patients : Organic or Functional ?
  17. 17. FIND ME
  18. 18. Predictors of Violence Patients Positive Predictor Not Reliable  Male  Ethnicity  Prior history of  Diagnosis violence.  Age  Drug or Alcohol abuse  Marital status  Education
  19. 19. PREPARING THE EMERGENCY DEPARTMENT TO PREVENT VIOLENCE
  20. 20. PREPARING THE EMERGENCY DEPARTMENT TO PREVENT VIOLENCE  Security Personnel  Patient Searches (Early recognition)  Alarm Systems (Direct to local police)  Limited Access to the Emergency Department  Controlling flow into the emergency department  Use of a Designated Room  Prevention
  21. 21. Prevention • To control the factors in the Primary environment that encourage the development of frustration and Prevention aggression. Secondary • involves response to pre-violent agitation and aggression. Prevention Tertiary • To limitation of the actual act of violence itself once it has occurred Prevention
  22. 22. Prevention : Primary prevention  To control the factors in the environment that encourage the development of frustration and aggression.  Attempts to shorten waiting times .  Pleasant waiting room environment.  The presence of surveillance cameras and a visible security force also act as deterrents (although their implementation is a form of tertiary prevention).
  23. 23. Secondary prevention  involves response to pre-violent agitation and aggression. • Early recognition of high-risk patients • Managing Aggression • Communication • Non-verbal communication • Defusion strategies • De-escalation techniques and skills
  24. 24. De-escalation Technique 1. Simple Listening 2. Active Listening 3. Acknowledgement 4. Allow Silence 5. Agreeing 6. Apologizing 7. Inviting Criticism 8. Develop a Plan WHEN NOTHING WORKS : Explain what will happen next if the angry person does not follow the instruction you offer.
  25. 25. • Give clear, brief, assertive instructions • Explain your purpose or intention • Negotiate options • Avoid threats • Move towards a “safer place” (i.e. avoid being trapped in a corner) • Ensure your non-verbal communication is non-threatening • Allow greater body space than normal • Appear calm, self controlled, and confident without being dismissive or over-bearing
  26. 26. • De-escalation is a very difficult and humbling skill. • You cannot be unsure of your own pride or self-esteem. • You must be able to control your own anger. • You must be able to see the bigger picture. • You must be willing to practice what you’ve learned.
  27. 27. NEVER THREATEN unless you are prepared to take the next step ! Once you have made a threat, or given an ultimatum, you have ceased all Negotiations and put yourself in a potential win-lose situation.
  28. 28. Tertiary prevention  To limitation of the actual act of violence itself once it has occurred.  Physical and chemical restraints are used, and security and police intervention are often needed.  Emergency department protocols.  Security measures.
  29. 29. Restrain and Seclusion The Joint Commission on Accreditation of Health Care Organizations (JCAHO) 1. The implementation of restraint or seclusion is limited to emergencies where imminent risk of harm exists to patient or others. 2. Staff is trained and competent to apply restraint safely. 3. Staff is trained to minimize the use of restraint. 4. Patients in restraints are regularly evaluated and monitored. 5. Orders for restraint use are provided by licensed practitioners and are time limited. 6. Medical records document that the use of restraint or seclusion is consistent with organizational policy.
  30. 30. American College of Emergency Physicians. Emergency physicians’ patient care responsibilities outside of the emergency department [policy statement]; Approved September 1999. Ann Emerg Med 2000;35:209
  31. 31. The violent patient suffered as well !  13% of hospitals reporting injuring patients while restraining them, including one strangulation death.  Litigation was pending in 16% of surveyed emergency departments because of restraint of patients.
  32. 32. Prevention Strategies that Work • Metal Detectors installed in a Detroit Hospital prevented the entry of 33 handguns, 1,324 knives, and 97 macetype sprays in 6 months • A system of restricting movement of visitors in a NYC hospital using identification badges and passes limiting visitors reduced violent crime by 65% in 18 months
  33. 33. KEY CONCEPTS  Emergency department staff should be trained to recognize the early signs of impending violent behavior and to implement appropriate de escalating techniques.  Every emergency department should have a formal plan of action to deal with violent patients.  Violent patients should be evaluated for possible medical and psychiatric conditions An ounce of prevention is worth a pound of cure.
  34. 34. References and Further Reading • ACEP Policy Statement : 2009 Policy Compendium • Joint commission on accreditation of healthcare organization (JCAHO) Standard 2009 • Rosen’s emergency medicine, 6th ed, ch.189 • Emergency Psychiatry: Principles and Practice, By Rachel Lipson Glick, Jon S Berlin, Avrim Fishkind • Managing violent and aggression : a manual for nurses and health care workers, Tom Mason, Mark Chandley • Security in the Health Care Environment. By David H. Sells, Jr.; published by Aspen Publishers, Inc. • Guidelines for Preventing Workplace Violence for Health Care & Social Service Work : www.ohca.gov • www.crisisprevention.com
  35. 35. Case Studies
  36. 36. Deadly shootings at US army base Major Nidal Malik Hasan, Psychiatrist A US Army major has opened fire on fellow soldiers at the Fort Hood military base in Texas, killing 13 people and injuring 30, officials say. http://news.bbc.co.uk/2/hi/americas/8345713.stm
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×