Hospital Security News
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VOLUME II NUMBER III September,
2004
"Hospital
Security News" is SAI’s quarterly newsletter dedicated to helping
hospitals identify and manage their security risks, recognize organizational
strengths and weaknesses in physical protection and improve the personal
security of patients, staff and individuals that use their facilities. This edition features an article on violence
in the Emergency Department.
To receive a free copy of Hospital Security News, please write to: newsletter@saione.com. If you would like to contribute your personal
experiences, please write to Pam Carter, RN,
Is Violence Overtaking Your ED?
by Jeff Aldridge, CPP
The
Over a hundred and fifty panic stricken
people flee an emergency room as a 29 year old mentally disturbed man shoots a
policeman and security officer after grabbing the policeman’s gun. One witnesses compared the incident to “The
Shoot-out at the OK Corral”.
A deranged assailant storms a university
medical center emergency room killing a doctor and visitor from the blast of
his shot gun.
A 42 year old man with a history of mental
illness shoots and kills a nurse and medical technician and seriously injuries
two others in a
In another case a 40 year old man opens fire
with a semiautomatic pistol critically injuring three doctors in a triage area
of the emergency department at
As a result
of this incident and the continuing escalation of violence in the health care
setting, California Legislators passed legislation requiring all hospitals, as
of
Causative Factors
Numerous studies have been undertaken to
identify causative factors into this perplexing phenomena. There are many contributing factors that
place health care workers at an increased risk to death and serious injury on
the job. Factors which may precipitate
violence in the emergency room setting may include, but are not limited to the
following:
▪ Patients
with acute alcohol or drug intoxication
▪ Acutely
disturbed mental patients
▪ Open
access to the patient care area
▪ Tension
filled atmosphere
▪ Patients
waiting too long for treatment
▪ Patients
receiving the wrong treatment
▪ Agitated
or distraught patient or visitors
▪ Bizarre
behavior (screaming, yelling, or use of profanity)
▪ Patients
or visitors that communicate a threat to staff or others
▪ Patients
that have been involved in or are a victim of a violent act
▪ Gang and
Domestic related violence
A patient’s history of violent behavior is
one of the best predictors of future violent behavior. Even though this information is not always
available, it is important for health care providers to identify any past history
of violence if possible. Additional
indicators may include individuals seeking revenge, distraught family members,
social deviants and persons who feel threatened and desperate.
The prevalence of handguns in our society
and the propensity for their use may be the single largest root cause of
serious injury and death to health care providers. Voluminous documentation shows that, not only
do patients, visitors, and family members carry guns into the health care
setting they also have a propensity to use them. One study, Wasserberger et al.
(1989) reported that 25% of major trauma patients treated in the emergency room
carried weapons. There has, most
certainly, been an increase in this phenomena in the past ten years. One of my client hospitals no only experienced
an increase in assaults on staff in their emergency department but also an
increase in unauthorized weapons brought into the emergency department. A walk-through metal detector was installed
after a risk assessment was conducted of the emergency department. After a thirty day screening period security
was able to confiscate 30 hand guns, 105 knives, and a meat cleaver that was
concealed by a 70 year old female patient in the back of her Blue Jeans. Another study, Goetz et al.
(1991) found that 17.3 % of psychiatric patients searched carried weapons.
Staffing patterns can also be a major
contributing factor to incidence of violence.
Shortages of staff and a reduction of properly trained employees can
increase violence in the health care setting.
In the emergency department setting gun
threats do not always come from the outside.
In many cases choosing the use of armed officers can present its own
potential risk. On more than one
occasion police and security officers have been shot with their own weapon when
the assailant gained control of their gun during a struggle. Training is an essential part of providing
armed officers for the protection of health care workers. Gun retention is an essential part of that
training. Only Level 3 and Level 4
security holsters should be used by hospital police and security officers.
Government Intervention
Several states are attempting to address
violence against health care workers by imposing heavy criminal penalties on
those who would do harm to them.
The U.S. Department of Labor’s
Occupational Safety and Health Administration has released “Guidelines for
Preventing Workplace Violence for Health Care and Social Service Workers” and
made them available to the healthcare industry.
The guidelines are currently advisory in nature and have not yet become
law.
The content is intended to provide
employers with guidance in developing a safe and healthful workplace violence
prevention program. These guidelines
address only the violence inflicted by patients or clients against health care
workers. Enforcement will be applied by
the use of OSHA’s “General Duty Clause” (OSH Act 5 (a) which states employers
have a general duty to provide their employees with a workplace free from
recognized hazards likely to cause death or serious physical harm. Employers can be cited under the “General
Duty Clause” if there is a recognized hazard of workplace violence and nothing
is done to prevent or correct the hazard.
OSHA will not cite employers who have effectively implemented
recommended guidelines. OSHA’s goal is
to hopefully eliminate or reduce worker exposure to conditions that lead to
death or serious injury from violence by seeing that effective security
programs and work practices are implemented.
This concern by the Department of Labor
for the safety of health care workers goes beyond the emergency department
setting. All types of medical facilities
that provide patient care to the public will be monitored by OSHA. This includes psychiatric facilities,
correctional clinics, hospital clinics, out-patient facilities, home healthcare
providers, community service workers, extended care facilities, and physician
offices.
An
effective safety and security program, according to the OSHA guidelines should
include the following:
A. Worksite
Analysis
B. Hazard
Prevention and Control
C. Education
and Training
D. Recordkeeping
and Evaluation
The purpose of the worksite analysis is to
recognize, identify, and correct security hazards. Hazard Prevention and Control addresses the
written program and physical security.
Education
and Training may include, but is not limited to the following:
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* Training employees on the
management of assaultive behavior |
* How to recognize security hazards |
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* Incident reporting |
* Potential risk of illness and injuries from
assault |
|
* Use of corrective measures |
* Restraint application |
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* Progressive behavior control methods |
* The need for availability of assistance |
Record keeping and evaluation
addresses:
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* Recording of violent incidents |
* Verbal attacks or aggressive behavior
incidents |
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* Safety committee minutes |
* training records |
|
* OSHA 200 log |
|
The evaluation process describes how to
conduct a periodic assessment of
accomplishments, progress made, and future needs. This can be accomplished through the review
of reports, safety committee minutes, and interviews with employees.
Written program elements may
include, but are not limited to:
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* Recognizing high risk behavior |
* Managing hostile or verbally threatening
people |
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* Reporting assaultive behavior |
* Visitor control |
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* Staffing |
* Post incident response |
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* Identifying training issues |
|
Physical security issues to
consider may include:
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* General design of the facility |
* Lighting |
|
* Nursing station enclosure |
* Bullet resistant glass |
|
* Seclusion/holding areas |
* Access control |
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* CCTV |
* Metal detectors |
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* Photo Imagining |
* Panic alarms |
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* Admission Clerk protection |
|
Hospital employees are frequently placed
in positions of significant risk because the population is largely female, the
work is performed 24 hours a day, and the employees enter and exit the facility
at all times of the day and night.
Should an incident occur, it will usually be alleged that the hospital
knew, or should have known of the risks on its premises, and that it has an
obligation to make its premises reasonably safe. When hospitals don’t…they are sued.
Crime has penetrated into the healthcare
setting at an alarming rate. Assaults on
medical personnel are becoming increasingly frequent and severe. Following the September 11th
attack on
The items listed in this article reflect
just a few of the many elements a health care provider may be required to
implement to have a successful violence prevention program. Health care administrators must demonstrate a
commitment to providing the necessary resources and funding to ensure that
their employees have a safe work environment free from violence. If past history is any indication of the
future, we can be certain that violence in the health care setting is with us
now and will be with us for some time to come.
Security Assessments International will
be glad to evaluate your existing security and risk management activities and
offer our recommendations to assist you in the protection of your facilities
assets within an acceptable time frame at a reasonable cost.
References:
FBI Uniform Crime Report – 2003
Scot Hill, MF & Jorge Petit, MD, The Violent Patient, Emergency Medicine Clinics of North America, Vol.
18, No. 2, May 2000
Health care
security: the emergency room view on violence, National Library of Medicine, J Healthc Prot Manage. 1997
Summer;13(2):31-6.
“Emergency Department Violence” - The
Schumacher Group – QI/RM Newsletter, September, 2002
On-line resources
Emergency Room Violence –
legislation (
Problem: A survey of over 100
at least once during the prior year.
AB 508 requires all hospitals to conduct a security and safety assessment plan
to protect personnel, patients and visitors. All hospitals are required to
report any assault or battery to local law enforcement within 72 hours. All
hospital employees assigned to the emergency department will receive training
on how to handle emergency room violence. AB 508, Chapter 936, Statutes of 1993
Vulnerability Assessment
http://www.saione.com/hsservices_vulnerability.htm
Future Newsletter Topics
Hospital Liability “When
to hire a Security Expert”
Components of a “Self-Assessment”
Educating Employees
and Staff
How to
select an infant security system
State-of-the-art
protection for Emergency Departments
Violence
in the workplace
Access
control / lockdown
Parking
deck and parking lot lighting
Disclaimer
Advice given in this "Newsletter" is general in nature, and
subscribers (readers of this material) should consult with professional counsel
for specific legal, ethical, or clinical advice.
The
information provided in the SAI Newsletters is for educational purposes
only and should not be considered 'legal' advice. Websites listed
are for reference only and are provided for subscribers (readers of the
material) to have an opportunity to read the original documents in total.
Please consult your legal counsel or Compliance Officer for clarification of
laws and rules related to your State when applicable.
SAI
is not affiliated with the Joint Commission on Accreditation of Healthcare Organizations.
SAI - ©April, 2004
