The September shooting at Johns Hopkins Hospital in Baltimore left some healthcare workers pondering the same question: Are healthcare facilities a safe place to work?
Recently, the Wall Street Journal (WSJ) ran a blog post about which healthcare workers are most likely to be assaulted. The Journal of the American Medical Association published a study and after looking at government statistics, found that the rate of assaults in healthcare facilities is fairly high. Nursing home staff, ICUs, emergency departments, and psych units are amongst the higher risk of assault, the WSJ reported.
Why is the assault rate so high? The study found a few different factors. Physicians are not respected as much, the healthcare industry is more seen as a business, and patients are not always happy with the healthcare system, reported the WSJ.
Is this a trend you are noticing and planning for, or do you think the study focuses too much on big cities? Do you feel safe in your facility? We’d love to hear your thoughts on this.
Steve MacArthur, safety consultant at The Greeley Company, answers a question regarding medical equipment.
Q: What should our medical equipment non-life safety completion percentage monthly thresholds be? I have been using 90%, but was told 95%.
Steve MacArthur: This is kind of a trick question in that, to some degree, both responses can be correct (note the very wishy-washy use of “can” in that last statement). When looking at preventative maintenance compliance rates for non-life-support medical equipment, there are generally two not-quite distinct processes that come into play.
From a Joint Commission perspective, the performance element regarding the maintenance on non-life-support medical equipment (EC.02.04.03 EP #3), you will note that this is a “C” performance element, which ultimately means that the minimum compliance expectation would be a compliance rate of at least 90% (the 90% is specifically identified in the instructions for conducting the annual Periodic Performance Review; during a “real” survey, if you have two instances of non-compliance, then that would result in a Requirement for Improvement (RFI) – an RFI that you can remove from the final report via the clarification process). The 95% number is a vestige of the ancient days of the EC standards, though I believe that as a performance improvement target, 95% is a “better” number than 90%. That said, 90% is still an “A” and a passing grade for Joint Commission compliance.
I’ve been having a lot of discussions lately with clients about whether we should view the Joint Commission standards as a be-all, end-all proposition and I’ve been encouraging folks to look at the TJC standards as a baseline expectation and then identify improvement strategies that establish expectations that go beyond that. As another example of this minimum expectation, I frequently talk about hazard surveillance rounds and whether merely complying with the two per year in patient care areas and one everywhere else is really sufficient to appropriately manage the physical environments in our facilities. To my mind, compliance with regulatory standards is the least we can do, so to speak – but we always strive to be better than that.
The death of two healthcare workers has prompted hospitals to increase safety and security in California hospitals.
An East Bay, CA, assembly-woman, Mary Hayashi, D-Hayward introduced a bill last week, saying it would improve the safety in hospitals, mental health institutions, and correctional medical facilities, reported The Napa Valley Register.
In addition, Napa State Hospital unions have requested safety improvements such as increased police officers and staff having just their first names on ID badges.
The bill, titled Assembly Bill 30, would require hospitals to do the following:
- adopt a violence prevention plan
- report attacks on personnel to law enforcement within 24 hours instead of the current 72 hours
- detail to the state legislature information on acts of violence at the facilities
- require annual safety training sessions for all hospital employees assigned to a psychiatric unit
The bill is expected to come in front of a committee early next year.
On October 23, a psychiatric technician at Napa State Hospital was found dead by a patient. A nurse was attacked on October 25at The Martinez Facility in Contra Costa County, CA, by an inmate who hit her with a lamp. She died three days later Both incidents led to staff and unions coming forward to improve security.
How do you think the proposed security procedures would improve the safety of the staff? Let us know in our comment section.
Here I am back with yet another question for you to ponder, but first, think on this for a moment:
In my rapidly expanding experience (not unlike the Big Bang of yore), I have noticed that the organizations that have “driven” safety out to the far (in Boston, that would be pronounced “fah”) reaches of the environment are the ones that typically manage their surveys with minimal muss and fuss. This is primarily based on having the ability to identify conditions and deficiencies in a much more proactive fashion than merely relying on hazard surveillance rounds. Yes, I know that The Joint Commission (TJC) only requires two visits per annum to patient areas, one visit for everywhere else – but I would consider that a minimum requirement – hey, something else you could evaluate is meeting TJC frequencies enough?
The truth of the matter is this: safety “lives” in every portion of your organization’s environment and, unless you’ve developed a dandy cloning device, you and your staff can’t be everywhere at every moment of the day (though when the fecal matter makes contact with the rotating blades it sure seems like that is the expectation). But you know who’s got eyes everywhere that you’re not – every living, breathing soul working for your hospital.
So the question becomes this – in looking at the results of your hazard surveillance rounds over the past 12 months or so – how many of your “findings” are items that would, or should, nominally have been reported as a function of your work order/work request process (I won’t say system – not everyone has a “system,” but everyone ought to have a process by now). Stuff like stained ceiling tiles, especially those nasty ones that you know have been sitting there for weeks, if not months – you know you’ve seen them, broken electrical receptacle faceplates, gaping holes in the soiled utility rooms from errant trash truck drivers, and the list goes on.
If you can look back and say that those types of things are being captured on a regular basis – bully for you (and if you wanted to share how you made it happen, we’re all ears), but if you can’t say that, you, my friend, have just identified an opportunity.
And now is the time to apply your marketing acumen to the problem. Be silly, give prizes for doing the right thing, don’t be afraid to ask folks to help – and keep asking them. Each of us has a responsibility in this and it’s high time we got everyone to play in the sandbox. So what’s your idea?
With hopes to improve hospital security, Cookeville (TN) Regional Medical Center only allows after hours visitors to use a limited access point to get inside.
The hospital implemented this new type of security on December 7, closing one of the main visitor accesses from 9 p.m. until 5 a.m. Visitors have to enter through the emergency room entrance, reported The Herald Citizen of Cookeville. The cause for the security change came during a safety assessment conducted by the Cookeville Police Department.
CEO Bernie Mattingly said that the hospital sees countless people coming through the door every night. He told The Herald Citizen that violent incidents are becoming more common in hospitals.
“We assess the safety of our building every year, and this year, two officers were involved in that process as well as Chief Bob Terry, he said, “Based on that assessment, this was one of the main things we found we needed to do.”
Mattingly said the new security policy was an important move to protect patients, visitors, and staff members.
Along with the new access point, visitors who come after hours must sign in at the emergency room information desk, reported The Herald Citizen.
What do you think of the hospital’s new security policy? Does your hospital do anything similar to Cookeville Regional? Let us know in our comment section.
Okay, maybe not really wicked, but what’s the point of blogging if one doesn’t occasionally lapse into frantic hyperbole. If I had added “details at 11,” it would be just like watching prime time TV, but I digress.
First some history – back in 2004, CMS weighed in on the increasing use of wheeled computer workstations and other such devices; if you’d like to take a gander at that lovely document, it may be found here.
One of the interesting things in the 2004 memo is the discussion of the whole “in use” concept as a function of clear corridor width, etc. Back then, and you can absolutely assume that there’s been a change, in use was identified as “In use (not left unattended for more than 30 minutes).” This was practically applied to linen carts, medication carts, and janitorial carts, They were not to be “included in the exclusions” regarding placing chairs in front of computer work stations that would decrease clear corridor width. So one could interpret “in use” as having a somewhat more flexible interpretation, because you could have anything in the corridor for 30 minutes and it would be okay.
Fast forward to May 2010, and we have a somewhat different interpretive dance to navigate (at least in terms of the language; I do believe that the more draconian interpretation has been with us for a while, it just appears that everyone is going to get a turn in the barrel). So this year, “in use”, or more accurately “not in use,” has become a little more clear cut. An item is considered “not in use” if it is left unattended or is not moved for more than 30 minutes. You can see the whole magillah at this web link.
So now, as soon as something is unattended (and how much fun is it going to be to navigate that – ouch, ouch, ouch!), it is a citable deficiency. I don’t know about your place, but I know it’s been a very long time since I’ve been to a facility with sufficient alcove space for all this stuff.
This one’s not going away and I suppose you could make the case that CMS is ratcheting things up a bit; which (at least in the short term) means that findings under LS.02.01.20 (Integrity of Egress) will remain in the top five most-cited standards during Joint Commission surveys (there’s got to be a Dick Clark tie-in here – maybe it’s just too early in the day).
HO HO HO!
A new question regarding security is arising in the October 23 murder of a Napa State Hospital nurse.
Donna Gross was checking into the guard station after taking her break when she was murdered by Jess Massey, an inmate patient. Hospital security was questioned after it was found to let patients walk around at their own leisure.
But now a new issue surrounding security had been brought up, which may have prevented the situation, said KGO-TV.
Anna Bock, daughter of Donna Gross, is questioning the security of the hospital. A police source told KGO that he saw Gross press an alarm button she was wearing on her belt, which didn’t work because the alarm does not reach outside of the building.
Bock was told by investigators that after Massey ran back into the building with a torn shirt and flustered demeanor, no one wrote him up, reported KGO.
“I just feel something could have been done and that if there’s anyone out there that can help, so that it doesn’t happen again,” Bock said.
Massey is still awaiting his trial.
Was this an issue with the hospital’s security system or do you think it was just a case of Gross being in the wrong place at the wrong time?
Although Sentinel Event Alert #46 does seem to focus mostly on the clinical aspect of managing this particular risk (which is already included in the standards under the National Patient Safety Goal chapter), now the focus is expanding to account for the potential risks associated with patients that might not be exhibiting more “classic” symptoms and behaviors.
The data supporting this expansion is very compelling and quite adeptly moves towards how we would be managing at-risk patients in general areas and in the absence of those “classic” symptoms and behaviors.
We need to start thinking about how we will begin looking at the management of suicide risks in the “rest” of the physical environment. We’ll certainly be leaving most of the diagnosis piece to the clinical folks, but it’s likely to become increasingly important that the rest of the point of care/point of service folks (EVS, Plant Ops, Security) are informed with a certain awareness of what signs to be mindful of.
It will also fall to the safety folks to be closely scrutinizing the manageable risks in the physical environment and identify strategies for quickly “safing” the immediate patient environment when a determination is made that we’ve got someone at risk.
Should be interesting to see how this unfolds.
Oh wait, wrong poem – let’s try this again:
“The time has come,” the Walrus said, “to talk of many things.”
And one of those things about which we might converse is the annual evaluation of your EOC management plans, unless you happen to be on some variation of the fiscal year, (or as a boss of mine used to say, the physical year) in which case I apologize for not covering this a little earlier.
This year, I’d like to challenge you to take a bit of a step towards more of a performance improvement focus as you close out the EC year. So, in that light, please consider this.
Ask yourself, and those of you folks who’ve had me as a guest will recognize this, looking back over the last 12 months, ‘What did we do to improve the management of risk in the physical environment?’ At this point, you’ll likely come up with a laundry list of things that you’ve done–systems upgrades and the like–and that, as I like to say, is a very good thing.
But as we start to think about where our improvement opportunities might be in the coming 12 months, the question I would ask you is how do we know that what we did last year actually resulted in some improvements? Is there some element that we could measure, some event that will not occur or will recur on a less frequent basis? How do we know we got better and how can we articulate that knowledge in something close to solid, data-based performance?
That said, I’d like to hear from folks as they close out the year. What did you improve and how do you know it was real improvement. And as a special bonus thought: how do you plan on sustaining that improvement?
Ultimately, we want the boo-boos to be the outliers, not the good stuff.
I’d also like to take advantage of my little bully pulpit to wish you and yours a most joyous and bountiful Thanksgiving!
Feeling safe in a hospital is something both patients and staff want during their stay. But in Seattle, a hospital was fined for violating worker safety violations after security guards were left without proper equipment to handle dangerous situations.
Harborview Medical Center was fined $13,200 earlier this month by the state Department of Labor and Industries. The fine was imposed after repeated complaints by the guards concerning both their and the public’s safety, according to an article in the Seattle Post-Intelligencer.
The issue stems back to 2007, when guards at the hospital handed out pamphlets throughout the hospital stating they wanted more training and tools to help manage hazardous situations. However, Harborview insisted that it maintained a safe environment, and on November 16, released a statement regarding the fine.
“Harborview Medical Center places the safety of our patients and staff as the highest priority and commits extensive resources to maintain high standards of safety at all times.”
The state Department of Labor and Industries told Harborview Medical Center that after repeated safety violations, it hadn’t made the effort to execute or develop safety programs, according to Seattle PI.
Highlighted in the citation was proper training given to the guards. Harborview did not make sure that guards were trained properly on identifying explosives in metal detectors or X-ray machines. Physical violence training was an additional concern, the citation stating guards were unsure how to deal with an aggressive person, according to the article.
The state ordered Harborview Medical Center to correct all the violations and problems.
How should this hospital execute training programs for its guards? What security measures does your facility take when it comes to employing guards? Let us know in our comment section.