VIOLENCE IN HEALTH
CARE FACILITIES:
LSBN PRESENTATION
JUZAR ALI ,MD;FRCP;FCCP
Professor of Medicine
LSUHSC
CMO
2
Discussion /Debate originates at

Is there awareness of this problem ? “Not just part of the job” ; Comes under
the wider umbrella of work place safety; more than just “throwing scalpels
around”!!

Is training and technique adequate to address the problem ?

What are the safety and security steps needed ?

Is there a standard process we all have to adopt to address this ?
2011 ANA Health & Safety survey
Level of Risk & Type variable

This is based on patient types, flow and point of care

May be increased in the Trauma /ED/ Intensive care Units/ OR /Surgical area

Different types of problems in Clinics
2004 OSHA report identifies three risks

1. Increased number of Psych patients

2. Rise in police use to hold aggressive individuals

3. Facilities with 24 hour public access
a. Workplace Violence Type 1: Violent acts by criminals,
who have no other
connection with the workplace, but enter to commit
robbery or another crime.
b. Workplace Violence Type 2: Violence directed at
employees by customers,
clients, patients, students, inmates, or any others for
whom an organization
provides services.
Examples: patient-on-staff; visitor-on-staff
c. Workplace Violence Type 3: Violence against
coworkers, supervisors, or
managers by a present or former employee.
Examples: physician-on-nurse; employee-on-employee
d. Workplace Violence Type 4: Violence committed in the
workplace by
someone who doesn’t work there, but has a personal
relationship with an
employee—an abusive spouse or domestic partner.
//ihssf.org/PDF/crimesurvey2014
Results from two important studies on hospital violence were released at the IAHSS conference held in May.
VIOLENCE IN HEALTH CARE FACILITIES:
SOME DATA

JC SE Database : About 256 incidents have occurred since 1995

Marked spike in the last three years : 37% increase

2010 International Association of Health Care Security and Safety survey of
212 hospitals about 2720 assaults of all types

3 % hospitals experienced shooting incidents

59 % of shootings occurred within hospital walls

91 % perpetrators were male

25 % current or former pts

5 % current or previous staff
One year survey of Emergency Room
nurses

97 % perpetrated by patients and relatives

80.6 b% in patients areas

23.2 % in corridors/hallways /elevators 14 % at nurses station

38.2 % against ED nurses at triage levels , while 33 % while restraining or
subduing pts 30 % while performing invasive procedures

Ref: Emergency Nurses Association’s ED Violence surveillance study 2010

2009 JON data: Nurses most frequent targets; 50 % ED nurses encountered
some type of physical abuse and 70 % verbal

The culture of accepting this as “part of the job” and not reporting or having
action taken upon

Debate /confusion: Should I protect the patient or protect myself first ?

“Disruptive behavior committee”

Legal and Ethical implications
The rate of violent crime, assaults and disorderly
conduct incidents at U.S. hospitals in 2013 was
significantly higher compared to the previous year,
according to research released by the IHSS Foundation at
the International Association for Healthcare Security and
Safety (IAHSS) 46th Annual General Membership meeting
held May 18-21 in San Diego.
The violent crime rate per 100 U.S. hospital beds rose
25%, from 2.0 incidents in 2012 to 2.5 incidents last year,
while the assault rate increased from 10.7 to 11.1. The
rate of disorderly conduct incidents experienced the
biggest jump, from 28 per 100 hospital beds in 2012 to
39.2 (40%) last year
In a separate IHSS Foundation study that was also
released at the IAHSS conference, 89% of the hospitals
surveyed had at least one event of workplace violence in
the previous 12 months. The perpetrator was often a
patient (75%) or visitor (9%), and most incidents involved
a threat/verbal abuse (41%) or physical assault (29%). If
the incident involved a physical injury, the injured victim
was almost always a security worker or non-security
hospital staff member, and not the perpetrator. A
weapon was used in only 4% of the incidents, and 7%
resulted in legal action. Less than 1% resulted in
regulatory follow-up
IHSS Foundation at the International Association for
Healthcare Security and Safety (IAHSS) 46th Annual
General Membership meeting held May 18-21 2014
Nearly 500
safety
professionals
who responded
to
MySafetySign's
2015 Health and
Safety Industry
Survey.
Notably, 90% of
respondents
indicated that
their senior
management
considered
safety important
to their
organizations
J Loud
www,mysafety
Sign.com
ACUTE Behavioral Emergency
3 step approach
verbal engagement , collaborate relationship,
de-escalation
 4 main objectives
ensure safety all around;
help the patient manage his/her emotions while
maintaining control
Avoid physical restraints
Avoid coercive interventions


Richmond , Janet , Berlin J et al West Emerg Med 2012 Feb ; 13(1) 17-25 Verbal de-escalation of agitated pt Consensus
statement of American ass for emergency psychiatry Project BETA work group
10 Domains of De-escalation
Fishkind A Calming agitation with words , not drugs: 10 Commandments for safety
)
Current Psych 2002-2011;1(4
SUMMARY

Risk assessment and threat identification

Identify and be aware of triggers /frustration/ medical or social stressors /operational stress wait
time s

Buy in of the awareness at all levels top down

Zero tolerance ( by this the reduction can be 50% )

Steps towards de-escalation … depends upon the threat 90 % problems and issues solved with
engagement and discussion

Communication and all types of communication tools

Police /security/ timeliness

Code silver

Panic buttons/hand held alarms

Monitors/ electronic access stations

Metal detectors and the debate // really necessary , effective ? Controversial ; depends whom you
ask
Thank you , JA