Workplace Safety Increases with Multiple Interventions

Healthcare employees are often trained in workplace safety measures throughout the year, covering everything from fire drills to chemical spills. But sometimes the danger to caregivers can come from the patients themselves.

A 2013 study shows that more than 70% of nurses have experienced some sort of violence from their patients, with emergency department nurses at an even higher number. Some of the nurses surveyed noted they had experienced 50 or more instances of workplace violence during their career.

The American College of Emergency Physicians gathered the following statistics in a 2018 survey about workplace safety:

• 47% of emergency physicians have been physically assaulted at work
• About 7 in 10 emergency physicians say emergency department violence is increasing
• Almost half say hospitals can do more to provide security

While patients’ safety is often on the minds of healthcare leadership, keeping the workplace safe for caregivers should also be a consideration. A large amount of workplace violence goes unreported and studies have shown employees are frustrated with inaction from their leadership when they do report.

Increasing Workplace Security

Lack of workplace safety can cause turnover in healthcare organizations, so reassuring staff that steps are being taken to resolve issues can go a long way toward job satisfaction. A Sept. 21 study found that multicomponent interventions are the best way to help reduce violence in healthcare settings.

Bill Johansen, Senior Director of HR Services for the Cleveland Clinic, shared some of the things his organization does to ensure workplace safety. Their first step – giving caregivers a voice.

“We want our caregivers to know, regardless of how benign or little it may seem to them, that it does have an effect on them and those around them. We want them to speak up and speak out so we can support them on that,” Johansen said.

The organization has installed magnetometers in its emergency departments, and those along with wand scanning by police officers have resulted in the confiscation of thousands of weapons each year, including tasers, mace, knives and guns.

“It’s hard to say who has the intent to use them as a weapon once they're in the hospital. But once we can remove them, it sends a strong message to our team that, particularly in our emergency departments, that we do care about them, and we want to make sure that people are safe,” Johansen said.

The healthcare organization also boosts workplace safety by having an increased police presence in all their emergency departments. 

“We've partnered with local municipalities to have those municipal police in our emergency rooms 24/7, so we employ them as PRN police officers, so between them and our own Cleveland Clinic police, we do have police coverage,” Johansen said.

He added that this provides a police presence for patients and visitors, but also employees and caregivers. However, some studies argue that a police presence can be off-putting for patients or interfere with their care. When implementing such a program, organizations should ensure that patient privacy can be maintained and police officers are not intrusive into medical care.

The organization also provides Welle Training (formerly NAPPI) to its employees, which provides them skills in behavioral safety management. Caregivers who work in security, behavioral health or the emergency department must complete an eight-hour training course. This may be included in their onboarding. A shortened four-hour version is encouraged for other clinical providers.

Johansen noted they have trained more than 1,000 employees in this area.

“We also recently have hired a hospital safety officer, who is specifically designated and stationed on our behavioral health floors. And again, there's a strong presence to our caregivers that we care about them or that we're willing to offer support and provide the resources that are necessary to help prevent any kind of attack or incident that might come up,” Johansen said.

Other steps the organization took to improve workplace safety include drills and training around codes.

Proper Serious Incident Reporting

One of the best ways to help employees feel heard when it comes to workplace safety is to provide them with resources to report violent incidents.

Paul Kuzmickas, Director of Cleveland Clinic’s Ombudsman Department, said the organization uses a Serious Incident Reporting System (SERS) to allow caregivers document any incidents that may have occurred.

“The SERS team created a separate icon, a separate way to report all data for workplace violence events,” he said.

The ombudsman department then follows up with the patients and caregivers to determine the next steps, but having everything in the SERS system is helpful for the large organization. If an incident occurs in one state and then the patient travels to another and needs care, there are records of incidents for the caregivers to look into.

“Any event, no matter how small or serious, we want to document it in our records, and keep track,” Kuzmickas said.

Path to Workplace Violence Prevention

The organization also utilizes safety flags in the EHR. It pops up in the patient’s chart, and the caregiver has to click that they reviewed the summary before proceeding with anything else.

“We've also recently incorporated this for both autistic patients and people with sensory disorders where maybe it's less of a serious safety event that occurred, but we want to alert them that maybe this particular patient gets triggered by flashing lights or when someone touches their shoulder a certain way. And then we give them tips on how to calm and de-escalate this patient,” Kuzmickas said.

Such summaries can note things like sundowning, and what types of toys, games or distractions might work to calm a patient down.

“It really helps to provide guidance and alerts the caregivers to be proactive, to avoid any sort of repeat event in the future, and how to handle and navigate the events so that it happens in a safe way,” Kuzmickas said.

The organization’s ombudsman office has a workplace violence checklist to ensure everything is documented and followed up on to help ensure it does not happen again.

“It's crucial because caregivers see it. They know something's being done to prevent it from happening again in the future, and done to support them,” Kuzmickas said. “And the patients are told and given an opportunity to change their behavior so that we can make it a safer place, both for patients, other patients, and for our caregivers.”

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