Enhanced Non-Lethal Security Blog

    Free Virtual Panel 4/30: Reconciling CMS and OSHA Regulations for Dealing with Hospital Violence

    Posted by Paul White on Apr 22, 2015

    In a 2014 survey, almost 80 percent of nurses reported being attacked on the job within the past year. Health-care workers experience the most nonfatal workplace violence compared to other professions by a wide margin. According to data from the Bureau of Labor Statistics, incidents of patients hitting, kicking, scratching, biting, threatening or harassing staff accounting for almost 70 percent of all nonfatal workplace assaults causing days away from work in the U.S.

    I believe that in order to reduce the incidence of patient violence, three things need to happen:

    1. The patient care culture needs to change
    2. Support staff needs to be trained on how to recognize, define and respond appropriately to force in a given situation
    3. The entire community needs to rise to the challenge.

    The patient care culture needs to change. Clinical staff are taught to heal patients at all costs, and they do their jobs well. However, what nursing and technical schools don’t teach staff is how to protect themselves while administering care. As a society, we can create any number of laws designed to safeguard patient care staff. But until the patient care culture shifts, there’s very little we can do to reduce patient violence in hospitals. At Securitas, we spend a lot of time training staff on how to look for the warning signs that a patient is about to become violent, and how to prioritize their own safety above providing patient care “at all costs.”

    Train support staff on the use of force continuum. While seventy percent or more of the hospital security industry is familiar with the use of force continuum, I would venture to guess that only five to ten percent of patient care staff are familiar with it.   Therefore, the majority is prone to respond inappropriately in a given situation, and the line between rendering care and law enforcement actions gets crossed.

    I personally wrote Securitas’ force continuum for dealing with violent patients and emphasize the following points when training support staff.

    1.   Voice. Communication is 90% of every intervention. We spend a lot of time engaging staff on how to communicate with people from a wide variety of cultures. They need to understand how culture impacts their ability to interpret patients’ behavior and to communicate effectively when attempting to help, control or migrate them into a different behavior. A case in point: In many Asian cultures, extended eye contact can be taken as an affront or a challenge to authority. So when dealing with Asian people, don’t immediately assume that a patient’s refusal to look them in the eye is a signal they are lying. It’s possible they’re just being polite.
    2.   Lightly touch. When verbal command fail, the next step in our force continuum is to use light physical touches to “point people in the right direction.” Except when dealing with people from a handful cultures that will not tolerate physical proximity, we train staff to touch the middle of a person’s back, or their arm lightly to assert their authority.
    3.   Physical control. The next step, if the patient does not respond to a light touch, is to move into physically controlling the patient. The intention is to control them, without adding to the patient’s angst or injury, so staff can provide professional care.
    4.   Use a non-lethal device. If physical control is not effective and the patient is kicking, biting or otherwise threatening immediate harm to hospital staff, officers need to use some type of device such as pepper foam to control the patient. This step crosses the line from patient care to the law enforcement realm. Staff cannot use tools to control a patient and then continue to render care. Doing so would be a violation of CMS rules.
    5.   When firearms are used, they must be met with similar lethal force. No one wins in these situations.
    The entire community needs to rise to the challenge. There are numerous products, commercial programs and protocols out there to help the community rise to the challenge of combating patient violence against staff, and I strongly believe that getting everyone on the same page isn’t as daunting or as cost prohibitive as we may think.

    What are your questions or thoughts about training hospital care staff on the use of force continuum?   Please share them here.

    On April 30th at 2 pm ET, I’ll continue this conversation live as part of an all-star panel of security experts that includes Mass General Hospital’s Bonnie Michelman, Universal Protection Service’ Rick Ward and HSS’ Tony York.

    Join us?   You can register for the free panel today.

    Guardian 8 COO Paul Hughes will moderate the discussion.

    Paul White is currently Vice President for the Healthcare Division of Securitas Security Services USA. Paul has over 25 years of experience in the healthcare security and safety field. Paul is also a former board member of the IAHSS San Francisco Bay Area Chapter, a position which he held for three years.

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