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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]

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]

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]

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]

Training for gun incidents, from the latest Briefings on Hospital Safety

Hi folks, it’s Scott Wallask logging on today. Given that most hospitals aren’t using metal detectors at the entrance, it’s not a surprise that some visitors enter the facility carrying guns.

In the p. 1 story of our March issue of Briefings on Hospital Safety [more]

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]

Emergency management scoring grace period ends January 1

Hi folks, it’s Scott Wallask checking in today. Steve Mac is on vacation this week (well deserved after I heard about the amount of miles he logged in the air in the last couple of months).

I wanted to remind you that a Joint Commission grace period–during which certain emergency management citations wouldn’t count against your hospital’s accreditation status–is ending as of January 1.

Because the new 2009 emergency management chapter renumbers the previous standards, double-check these provisions, all of which fell under the grace period in 2008:

  • EM.01.01.01, EP 8-Documenting an inventory of assets and resources
  • EM.02.02.03, EP 6-Monitoring quantities of assets and resources
  • EM.02.01.01, EP 3-Meeting the 96-hour provision
  • EM.02.02.01, EP 7-Communicating with vendors of essential supplies and services
  • EM.02.02.03, EP 5-Sharing of assets and resources with healthcare facilities outside of the community
  • EM.02.02.03, EP 9-Transporting patients, medications, equipment, and staff members to alternate care sites
  • EM.02.02.05, EP 3-Coordinating security activities with outside agencies
  • EM.02.02.05, EP 4-Managing hazardous materials and wastes
  • EM.02.02.07, EP 7-Training staff members about their roles in emergency response
  • EM.02.02.07, EP 8-Communicating with licensed independent practitioners about their roles in emergency response
  • EM.02.02.09, EP 5-Determining alternative supplies of fuel for building operations or essential transport activities
  • EM.02.02.11, EP 6-Managing mental health needs of patients
  • EM.02.02.11, EP 7-Managing mortuary services
  • EM.02.02.11, EP 8-Documenting and tracking clinical information

Emergency management will be a big part of our 3rd Annual Hospital Safety Center Symposium in May, so I encourage you to check out the full agenda.

A brief thought about nurse calls

I generally try to discourage folks from having nurse call buttons in areas of public access because it can become a risk management nightmare. With a nurse call in a public spot, you’ve established an expectation that someone will respond when it’s pushed, etc.

The same thinking applies for areas that are closed during portions of the day, but are not secured. In such cases, if someone wanders in, uses a restroom, has some sort of event which prompts them to activate the nurse call, and then no one responds, you’re may be looking at a lovely lawsuit.

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.

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.
More on this next time . . .