Security | Mac's Safety Space

Testing the bounds of your lockdown arrangements

One of my clients has an access control system that covers all of exterior doors and several interior doors. Security can use an emergency shutdown button if the facility needed to be locked down.

This approach is absolutely [more]

May 19, 2009 | Steve MacArthur | Comments 0

Police chief: Hospital shooting may reflect society’s overall mood

Hi everyone, it’s Scott Wallask. It was very interesting to hear the police chief of Long Beach, CA, wonder out loud whether a double-murder-suicide at Long Beach Memorial Medical Center — and other mass shootings this year — are a sign of the tough economic times.

During the shooting last Thursday [more]

April 20, 2009 | Scott Wallask | Comments 0

Hostage situations aren’t just on the high seas

Hi folks, it’s Scott Wallask online today. The hostage-taking by Somali pirates that played out over the weekend made me harken back to March 2002, when a man took his girlfriend and infant son hostage at Manatee Memorial Hospital in Bradenton, FL. It was one of the few times I can recall covering a legitimate hostage situation in a medical center.

One interesting point that the safety manager at the time noted to me [more]

April 13, 2009 | Scott Wallask | Comments 0

Mac’s MacGyver instinct about behavioral risks

A reader on HCPro’s Patient Safety Talk listserv asked about maintaining safe environments in behavioral health settings.

I mentioned to her that the important thing to keep track of as you assess the environment and identify improvement opportunities is to be sure that you are also identifying mitigation strategies for those improvements you can’t implement right away. [more]

April 02, 2009 | Steve MacArthur | Comments 0

I’m talking blog at our Hospital Safety Center Symposium

Exhalation, exultation — we are but a mere two months away from HCPro’s 3rd Annual Hospital Safety Center Symposium (it’s May 14-15 in Las Vegas), where I’ll be helming a session that focuses on, of all things, this very blog (which, in and of itself, considers all things).

My good friend and partner in rhyme, Scott Wallask, and I have been exhaustively reviewing posts from the past year or so that have generated more than a modicum of interest, either [more]

March 13, 2009 | Steve MacArthur | Comments 0

Do you know CMS’ stance on weapon use in healthcare?

It’s Scott Wallask filling in a bit for Steve Mac this week — as Mac put it to me, “I”m up to my eyeballs in alligators this week.” Knowing Mac’s sense of humor, that comment could probably mean one of many things.

Moving on, one thing I’ve noticed is that security topics get a fair amount of hits on the blog, which prompted me to dig up this reference about CMS’s views on weapon use: [more]

February 24, 2009 | Scott Wallask | Comments 2

New Joint Commission FAQs should prompt a critical review

I want to jump in with a couple of thoughts relative to the increased activity on the The Joint Commission’s Web site in the FAQ section — especially in the EC, emergency management, and life safety sections. There are nine new FAQs available for your viewing pleasure right now. Go check ‘em out (I’ll wait for you to come back).

Back? Good! I think you probably noticed that the topics are scattered across the spectrum. I’m not exactly sure what’s prompted this flurry (it is, after all, winter) of activity, but if you’ll allow me some extrapolation space, it may be that the FAQs have become a venue for moving physical environment compliance into the future. [more]

January 21, 2009 | Steve MacArthur | Comments 0

More about security officers watching patients

If I may continue on the topic of security officers getting pulled into the role of caregivers . . .

Time and again, I have seen security directors bemoaning the positions they find themselves in: patient watches spread all over an ED, multiple patients being assigned to a single officer (because that’s all that is available), and entire shifts of security officers tied up in the ED watching patients. The litany of, at best, untenable situations in which security staffs find themselves continues to grow.

And again, this is not a knock on security officers, who are generally very well-educated and competent in their role as security officers. But they are not educated as caregivers, and I believe that when we are looking at best care for these patients, caregivers are indeed what is needed (and not just sitters).

These patients are in crisis, and this thought of security keeping an eye on them just doesn’t translate into appropriate care. I’ve worked with security staffs over many years of my healthcare career and I can say with all honesty, if I had a family member in crisis, I would want them to be observed by someone competent in the whole range of potential issues, not just “making sure they don’t get up off the bed” or “making sure they don’t get out of the room.”

During those tense moments of crisis, security absolutely should be involved, but once the situation is under control, the patient should be handed off to a caregiver.

December 05, 2008 | Steve MacArthur | Comments 0

When security gets drafted into caregiving mode

Howdy blogspotters!

There was an article in The Boston Globe in November regarding the rise of incidents involving combative patients in Massachusetts emergency rooms that I thought was worth bringing to your attention, primarily (as I see it) because you are either already experiencing this phenomenon or you will be. I don’t think there’s anybody involved in healthcare safety and security who will remain unscathed on this one (a little hyperbolically apocalyptic you might say, but I don’t think so).

Over the course of my career (more years than it’s comfortable to consider), I’ve had the opportunity to observe the arc of patient behaviors in the direction of, shall we say, more aggressive actions. I think there’s been a great deal of societal shifting that’s resulted in this (people with virtually any reserves of patience are becoming a bygone artifact), as well as a diminution of the services provided to those folks who might be considered at greatest risk (from a psychological/medical standpoint).

As with the rise of the various and sundry healthcare plans that end up encouraging (for want of a better word) patients to seek out EDs to manage whatever might be ailing them, the hospital emergency room has become a fulcrum of acuities, symptoms, (sometimes unrealistic) expectations, attitudes, preconceptions, impatience, and so on. It seems that EDs have become much like vacuums in that no matter how big they are, there’s always enough “stuff” to fill them.

In looking at the above-noted article, I cannot help but reflect on what I think is the defining (or perhaps overarching would be le mot juste) question: Are we managing this condition/situation/patient population to the best of our abilities? Or more to the point: Is this what good, quality care is about?

In many instances, the answer is a resounding “no”! The Globe article referenced (and I’m interpolating a bit here) the thought that one of the causative factors is the lower profile of security staff as a function of efforts to be more customer-service oriented, and to be honest, I have a hard time thinking that that is anything but a red herring.

My experience has been (almost uniformly) that security’s ability to respond to crisis situations is almost completely mitigated because they are tasked to take over the management of the “at risk” behavioral health patients (which would also include those addictive personalities).

In hospital after hospital, I see a continuing rise in the use of security officers to “watch” patients. Now I have no quibble for the most part with the need for these patients to be provided some sort of oversight. From a care as well as a liability standpoint, we have no real choice to do otherwise.

What I do continue to take issue with is the use of what is generally a very finite resource (security staff) to function, even if only at a de minimus level, as caregivers.

Handcuffs, pepper foam, and caution

A while back I was conversing with someone at an organization about the use of handcuffs and pepper foam by security officers.

Handcuffs are tricky because of the forensic restraint issue. I don’t know of too many, if any, security forces in my travels who use cuffs that have not received special police designation from the locals. If you’re considering handcuff use, my suggestion would be to canvas some of the other hospitals in your area to see if they’re using cuffs.

As for pepper foam, I know from personal experience at the hospital where I first started working that the local police would never allow security services, contracted or otherwise, to carry pepper foam. Depending on where you’re located, your state or police might require pepper foam carriers to have a firearms identification card issued by an agency. You definitely need to tread very carefully on this one.

December 02, 2008 | Steve MacArthur | Comments 0

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