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In security we trust, insecurity we fear: Are you up for a challenge?

Last week we started noodling on where things might go from a regulatory/accreditation perspective as the dust “settles” relative to the management of behavioral health patients, ligature risks, etc., as well as the continuing march on infection control targets, items that are certainly on the radar. But there’s one other item that I keep coming back to (in my mind’s eye): Getting our arms around issues relating to workplace violence. While I have no data to support it beyond a general impression based on conversations with various folks, I would venture to say that, if you look at it purely in terms of “room for improvement,” concerns relating to the management of workplace violence has got to be sitting pretty near the top of the “to do” list (I suspect it’s at the top of that list, but if you should happen to either have this one completely under control or there’s something that concerns you more, I’d love to hear about it).

I don’t think (and I’m certainly not in a position to dispute) the numbers are indicative of anything but a pervasive, tough-to-solve issue, particularly in the current healthcare environment. I hear stories about difficulties getting funding for technology solutions, additional staffing to maximize those technology solutions, etc. sometimes forcing us to be reactive as opposed to being able to develop a proactive response. But in looking at the OSHA website as a warmup to penning this particular entry into the Safety Space canon, I noticed that some updated materials have been posted on the OSHA website, including an executive summary for hospital leaders, some examples of best practices, and some information on how you might integrate workplace violence prevention into your organization’s “regular” compliance activities. The addition of these materials, perhaps as a subset of being helpful, tells me that there’s still a fair amount of consideration being given to the subject and we, as an industry, might be well-served to give these materials a look-see. Share that executive summary with your organization’s leaders if you have not already done so; start talking with your organizational risk management and occupational health folks to start working towards elevating this to an organizational priority before the events of the day force you to do so (or to explain to your boss why you didn’t). I’ve worked in healthcare long enough to remember those halcyon days when hospitals were not the hotbed of safety and security risks they are today—until somebody invents a working time machine, we’re not going back there, so we have to focus on future improvement.

And, interestingly enough, I’m not the only one thinking about this stuff; I would encourage you to check out Tim Richards’ blog post. He provides some good food for discussion and perhaps even some early budget planning. There’s a lot of technology out there, some of it (I daresay) could be very useful in protecting folks in a more effective way. This one’s not going away any time soon, and to be honest, I can see this becoming something of a survey focus in the not-too-distant future.

What do you do when everything goes wrong?

In reflecting on the healthcare safety news items of the last 12 months, the one that gives me the most pause is the situation involving missing patient at a hospital in San Francisco last fall, solely because it seems to have been so preventable (and yes, I recognize that hindsight is 20/20), even if I also recognize it could potentially have happened at any medium- to large-sized facility.

I guess the answer to the rhetorical question is that the only thing you can do is learn from what happened and make the necessary improvements to ensure that the chances of recurrence are pretty close to zero (this is in recognition that perfection is often a nice objective, but very tough to pull off). It does appear that a number of failure modes were identified (and shared—that’s a good thing—see the story) and I’m sure there have been changes to procedures that reflect what was learned.

How often do patients go “missing”? I don’t know that we’d ever be able to gain a full sense of how many folks are unattended for any length of time. Patients go out for air (smoky air, maybe), or just want to stretch their legs inside. It’s a very slippery slope to try and control every patient’s every waking moment, at least the ones who are mobile (from a risk management perspective, we probably focus more on the movements of the less mobile patients—falls are a big deal too). I don’t think you can, from a practical standpoint, query every patient you might encounter during rounds, though I suppose you could invoke the customer service “Can I help you find something?” to ease that type of encounter. Ah well, I guess this is likely to remain an issue of some complexity, but if anyone out there in the blogosphere would care to share their thoughts and ideas in this forum, I think there would be a great deal of interest.

You lift me up!?!

As I wander around the countryside visiting hospitals of all shapes and sizes, there are a few common challenges that seem to give just about everyone fits. And probably among the most common of commonalities is the challenge of managing patient lifting and all the inherent risks of that frequently occurring occurrence (that would be a FOO for you in acronym-land).

At any rate, while catching up on some conversations on one of the safety listservs (this particular listserv focuses on colleges and universities, but there are some healthcare folks in the mix as well) and I found reference to a very interesting article on patient lifting.

The most useful thing about the article (and it’s pretty gosh-darn useful) is that it includes a link to a protocol that can be used (very quickly so it seems) to effectively forecast the patient care and financial impact of patient lifting changes. Now I know from my past experiences that it can be really tough to “sell” the C-suite on avoided future expenses based on a little technology investment in the now. I’m not sure where you all are in relation to this as a focus item, but on the off chance that it might be helpful…

Mac’s Safety Space: Managing medical equipment in outpatient mini-clinics

Our hospital operates a number of outpatient mini-clinics in places like grocery stores and we’re trying to figure out how to manage medical equipment being used in those locations. Do we need specific medical equipment management plans for those locations? Also, do we need to include the equipment being used in our annual preventative maintenance program?

Thanks for your question – it’s always good to include medical equipment concerns in the discussion.

As to your question, the answer is: it depends.

If the organization that owns the clinics is operating them under the auspices of its Joint Commission accreditation, then you would need to make a determination as to whether management plans and/or scheduled preventative maintenance activities would be of benefit.

Some folks would write sites like this into their management plan, effectively treating the off-site locations as departments of the hospital. Others, because of the complex range of services provided off-site, would have a management plan dedicated to just the off-sites. When it comes to PM activities, I think you have to look at it from a risk management perspective as opposed to a solely accreditation compliance standpoint. I’m going to guess that most, if not all of the equipment used in these types of settings, would run more towards the low- or no-risk, with maybe the odd scale to calibrate.

But if they have things like AED’s, that might change the dynamic a little based on what model AED’s they have and what the manufacturer recommendations are.

In some ways, I’m probably making it sound more complicated than it really is. If there are enough commonalities in terms of equipment, then managing them monolithically should be just fine (I would document the decision process in the annual evaluation and periodically revisit the decision using the evaluation forum).

Does that make sense? Please let me know if you have any questions or concerns.