July 11, 2017 | | Comments 0
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Horrors beyond contemplation

It is impossible to capture, or even comment on, the events that transpired at the Bronx-Lebanon Hospital Center in New York at the end of last month with anything less than abject horror. There have been lots of news stories about the various events that contributed to what happened, so I will let you investigate the causative factors on your own. But having checked out the available information, I can’t help but feel almost powerless when it comes to being able to provide any sort of guidance relative to the compliance aspects of preparing for such an event.

I think I can say, without much fear of contradiction, that this is likely to create an additional focal point for TJC surveys this year (so, keeping count, we have ligature risks; management of environmental conditions including temperature, humidity, air pressure relationships; intermediate- and high-level disinfection activities; workplace violence, including active shooter). But I still keep coming back to Sentinel Event Alert #45, “Preventing violence in the health care setting,” and I keep pondering the import of that one word: preventing.

Much as we have discussed in the past with a whole bunch of topics, at what point can we say that we have reduced the risk associated with X, Y and/or Z to the full extent possible? It would be an amazing thing to be able to put in place measures and strategies that could actually prevent something (really anything) bad from happening, but I have yet to encounter many instances in which prevention is actually achieved. Do we work towards that as a goal every moment of every day? Absolutely! But I don’t know how you “prevent” what happened at Bronx-Lebanon.

Until we have sufficiently sophisticated early detection for armed persons, aberrant behavior, etc. (we can’t have metal detectors at the front door of everyone’s home, can’t do a behavioral health assessment at everyone’s front door either), the purpose of looking at this is to ensure that there is an appropriate response, be it de-escalation or run, hide, fight. From what I gather, the response at Bronx-Lebanon was in keeping with appropriate levels of preparedness. As is usually the case with human beings, I suspect that there will be valuable lessons learned in reviewing what happened, but the fact of the matter is that this could have been so, so much worse.

At any rate, we know this is likely to be a focus during survey (information from a survey just this past week indicates a very significant focus on the management of violent events), and I think one of the most important preparation activities is to share information with the healthcare safety community. To that end, I wanted to alert you to an opportunity to do just that: next week, on Thursday, July 20, 2017, HCPro will present a webinar, “Emergency Preparedness for SNFs: How to Plan for, Respond to, and Recover From an Armed Intruder/Active Shooter Event.” While the title indicates a focus on skilled nursing facilities (SNFs), the general concepts are very much applicable to all healthcare environments and, truthfully, couldn’t be more timely.

I’ve worked in healthcare long enough to recall a time when this level of violence occurred in environments other than health care, but I think we have to operate under the thought that it is only a matter of time before our organizations come face-to-face with the reality of 21st Century existence. Although I wish it were otherwise, not focusing on preparing is no longer an option.

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Steve MacArthur About the Author: Steve MacArthur is a safety consultant based in Bridgewater, Mass. He brings more than 30 years of healthcare management and consulting experience to his work with hospitals, physician offices, and ambulatory care facilities across the country. He is the author of HCPro's Hospital Safety Director's Handbook and is contributing editor for Briefings on Hospital Safety. Contact Steve at stevemacsafetyspace@gmail.com.

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