1. Protecting the Nursing Workforce through an Aggression Prevention Team and Behavior Alert Response
Deb Fabert RN MSN BC
Joe Anderson MBA
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2. Disclosure of Conflict of Interest
Both presenters are consultants with Crisis Prevention Institute (CPI)
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3. Objectives
Understand the components of an all-encompassing organizational response to threatening behavior
Discuss the strategic development and implementation of a team response to threatening or violent behavior.
Define how a similar aggression prevention process could be used at the participant’s place of work
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4. Indiana University Health Statewide System & Academic Health Center
17 hospitals and health centers, partners, affiliates and joint venture operations
Academic Health Center
Methodist Hospital
100,000+ annual ED patients
Level 1 Trauma Center
30,000+ annual inpatient admissions
747 beds
100+ Behavioral Health beds (63 in program)
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5. Sentinel Alert Event – The Joint Commission – Issue 59, April 17,2018
Burning Platform
The American Nurse Association has petitioned OSHA to require mandatory comprehensive programs to prevent workplace violence
Sentinel Alert Event – The Joint Commission – Issue 59, April 17,2018
Healthcare workers are victims of the highest numbers of workplace assaults
20% of patients admitted to acute psychiatric wards act violently against staff
Only 30% of nurses report workplace violence
Prevalence of violence is high but number of police-reported incidents are low
High percentage of assaults against nurses (76% of all assaults at AHC)
Altered mental status is most common perpetrator trait (64% of assaults against nurses classified as non-intentional)
De-escalation training by itself is ineffective in reducing acts of violence
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6. They spoke and we listened!
Call for Action
Nurses/Support Staff were experiencing increased assaultive behaviors, violence and were fearful at work as evidenced by declining engagement scores
They spoke and we listened!
Organization Cares about the Employee Safety
2012
4.05
2014
3.84
2015
3.39
2016
4.16
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7. Who Gets Assaulted? Nurses
Assaults against nurses
Assaults against others
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8. Zero Tolerance of
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9. Strategic Plan for Improvement
Inter-professional team included clinical and non-clinical services
Goal
Caregivers need to feel safe and supported while giving care to patients
Current state analyzed and ideal state included a rapid response team that responded to the threat of violence
Aggressive Prevention Team
The Behavior Alert was developed for imminent danger situations
Evaluation process for effectiveness
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10. Comprehensive Security and Safety Responses
Training for Active Shooter is widespread though incidents are low in healthcare (2.5%) Experts recommend all hazards approach
AHC Police Department
Parking Lot Shift Change
Crisis Prevention Institute (CPI)
Domestic Violence Committee
Panic Alarms – Personal Desktop
Hard-wired Panic Alarms
Dr. Armstrong Page/Response
Visitation Policy - Enforcement
24/7 Law Enforcement Presence
AHC Workplace Violence Workgroup
Daily Operations Safety Report
APT/Behavioral Alert Response
Active Shooter training
Threat Response Protocol
Hot Spot List
24/7 Metal Detection
“No Weapons” Signs at All Entrances
No Information Patients
“Are You Safe?
Access to Hospital Entrances – Control
Internal Access Controls
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11. Maslow’s Hierarchy of Needs
If just ONE of the basic needs are met, the chance of a violent outburst drops by 50%.
If TWO of the basic needs are met, the chance of a violent outburst drops by 70%.
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12. Social Triage / Violence Risk Factors
History of Violence
Mental Health Disorders
Social Stressors
Relationship
Legal Action
Financial Loss
Physical and Metabolic
Head injury
Addiction
Dementia
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13. Type of Violence - Affective
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14. Tiered Approach to Safety
Prevention
Early recognition of grievance
Meet the patient’s needs
De-escalation techniques
Response
Aggression Prevention Team – APT -Escalating conduct
Behavior Alert Response - BA - Imminent threat of physical violence
Recovery
Critical Incident Response Team – CIRT
Employee Assistance Program for individual counseling - EAP
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15. A Positive Trend
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16. De-escalation Training - Prevention
Instruction on non-violent de-escalation techniques
Currently have ten instructors at the AHC
All APT-BA responders trained
Goal 24/7 coverage of trained staff available
Training module required for bedside patient care staff
Now available for all team members
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17. APT Process - Response Aggression Prevention Team – APT
Before Violence Occurs (Breach)
Anyone can activate by calling Security
Maximum 10-minute arrival
Pre Huddle
Social Worker/Chaplain de-escalate and support staff
Security is present for show of force as needed
If necessary a Care Contract is initiated to set boundaries
Associate Administrator may provide support
Post Huddle
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18. Majority of Assaults - Non Intentional
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19. Behavior Alert Response
Violence is Occurring (Attack)
Anyone can activate by calling the Operator
Announced overhead
Security
PCD
Behavioral Health Staff Access
House Orderly
Physician
Psychiatrist
Pharmacist
Chaplain/ Social Work
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21. IUH APT and Nursing Assaults
At IUH APT responses increased, 12% reduction in assaults ‘16 to ‘17 April study by CDC found violent injuries to nurses had almost doubled Higher % of assaults now being reported Each APT response is an opportunity to improve staff safety
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22. Sustainability
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23. APT/BA compared to Violent Restraint use
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24. APT/BA compared to Staff Assaults with injury
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25. Critical Incident Response Team - Recovery
Responders certified in Critical Incident Stress Management
Immediate intervention
Staff have access to resource 24/7
Intervention and follow-up key to emotional healing
Debriefs Conducted
Number of Participants in Debrief
2014 29
313
2015 36
536
2016 20
250
2017 52
796
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26. Roll Out Available to present to all teams
Over 70 presentations to teams in the AHC
Open forums – panel discussions
Behavior Alert Drills
Presenting at national conferences
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27. APT/BA Decision Tree
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