As a result of Appalachian Regional Healthcare System seeing a rise in workplace violence in health care settings, it conducted its own safety study and created a committee charged with generating preventative measures.
According to the Occupational Safety and Health Administration, approximately 75 percent of nearly 25,000 workplace assaults reported annually occurred in health care and social service settings. OSHA defines workplace violence as “violent acts, including physical assaults and threats of assault, directed toward persons at work or on duty.” It goes on to explain that others who study the subject would include threats, verbal abuse, hostility and harassment in the category as well.
Possible sources of workplace violence in hospitals, nursing homes and other health care settings could potentially be patients, visitors, intruders or coworkers, according to OSHA.
“Workplace violence in health care settings is indeed on the rise,” said Rob Hudspeth, the senior vice president for system advancement at ARHS. “It’s not just a trend nationally. Unfortunately, we are seeing it right here in our hospitals and clinical settings.”
In 2018, ARHS experienced 20 reported assaults when physical injuries were associated. Most of the injuries were minor — such as contusions and scratches — and did not require additional medical treatment, according to Hudspeth. There were three assault incidents on staff that were considered significant, though. These incidents were reported at Watauga Medical Center and Charles A. Cannon Jr. Memorial Hospital.
“When patients are not feeling well, they — or their family members — may have a heightened sense of emotion and are sometimes willing to act upon it,” Hudspeth said.
According to Hudspeth, the most common characteristic among those who initiate violence in a hospital is an altered mental status that could be associated with dementia, delirium, substance intoxication or decompensated mental illness.
“Our hospitals often serve as the safety net for patients with opioid abuse and/or complex behavioral health issues,” Hudspeth said. “These patients are typically very fragile, and providing care and safety for them occasionally puts our staff in unsafe situations.”
Chuck Mantooth, the ARHS president and CEO, said that compassion, kindness and humanity are the cornerstones of health care.
“Of course, experiencing those feelings is difficult for our providers, when someone is physically assaulting them,” Mantooth said. “So we’ll need to make every effort to ensure that we promote a culture of healing in our facilities. No patient or employee should fear for their safety. We just cannot tolerate violence in our care settings.”
In November 2018, ARHS — which consists of two hospitals, 13 medical practices and a rehabilitation facility — commissioned an independent safety study.
The safety study provided valuable insight into the areas of ARHS’s strengths and the where it needs to improve, Hudspeth said. He did not think it would have be responsible, though, to share specific information from the study as to not compromise the safety of patients, visitors and employees.
Hudspeth said he did want to assure the public that the solution to workplace violence would be ongoing and multi-faceted with training, staffing, physical improvements, partnerships and an increase in cultural awareness of the unacceptable nature of violence in health care settings. He added that he had read an excerpt from OSHA which stated, “No universal strategy exists to prevent violence. The risk factors vary from facility to facility and unit to unit within a facility.”
Murray Hawkinson, clinical site director at Daymark Recovery Services, said that Daymark conducted an internal study four to five years ago about this topic. He said he has not seen an uptick or trend of workplace violence at Daymark, and could only recall one to two incidents at Daymark in the last several years. He mentioned that he could remember one Daymark client who had visited the provider and shattered glass by slamming a door — but no one was injured — and one employee who had been hit in the face when he tried to stop a client from leaving.
In the case of a workplace violent incident, Hawkinson said Daymark staff are trained on deescalation techniques and have some staff with training on conducting physical restraints on a violent person. The facility also has camera monitoring and can lock down through electronically controlled doors if a threat is detected, Hawkinson said.
Hawkinson emphasized that people should not be afraid of those with mental illness, and that the group of people with mental illness as a whole tends to have lower rates of violence and aggression.
“The stigma makes it hard for people to seek treatment who need it,” Hawkinson said. “That’s an unfair burden, and it creates additional pressure for folks who are dealing with mental illness in the first place.”
Following the study at ARHS, a leadership development meeting was held on Jan. 8, when workplace violence was cited among the most important topics facing the organization, Hudspeth said. The leaders in attendance were given the opportunity to discuss experiences in their respective departments, any fear and anxiety that some may feel and the difficulty of showing care and compassion to a patient who is hostile or abusive, Hudspeth said.
“One of our emergency department nurse leaders stood in front of 82 employees and described what it feels like to be unexpectedly punched in the face while trying to provide care for a patient,” Hudspeth said.
As a result of the study, ARHS established a Workplace Violence Committee in January that is responsible for developing a workplace violence prevention program by evaluating changes to policies and procedures, environment and facilities, technology, education and training, staffing and legal response, according to Hudspeth.
The committee is comprised of a multidisciplinary team of physicians, nurses, hospital police, safety officers, behavioral health leaders, emergency department leadership as well as people from offices in human resources, corporate communications, public relations, facilities management, finance and corporate administrators.
Currently when an emergency takes place, Hudspeth said ARHS works with multiple local and state agencies on violent scenarios such as active shooter training or patient elopement. He added that the system has processes that go into effect when a patient, family member or visitor becomes disruptive or violent.
The group took the recommendations from the study and began implementing them; it started with the formation of a threat assessment team, according to Hudspeth. He added that ARHS is committed to providing a safe environment for patients and staff.
For more information from OSHA about workplace violence, visit www.osha.gov/Publications/OSHA3826.pdf.