Health care violence: protect your health

Image: Cassio Lynm, © American Medical Association
Image: Cassio Lynm, © American Medical Association

Health care professionals dedicate their careers to the well being of others. To do so, they are frequently put in adverse or potentially dangerous situations. Unfortunately, violence against health care workers has steadily increased over the past several years and has been considered a public health epidemic. That’s why emergency preparedness in a hospital setting is an important topic emerging nationwide and something all health care providers need to be actively aware of.

An emergency in the health care setting can take a variety of forms, including outside threats as well as patients who are aggressive or experiencing severe cognitive impairment. A recent podcast of “This American Life” featured an intriguing example of the latter. It told the story of Alan Pean, a highly paranoid and delusional manic depressive individual who was experiencing an extreme manic episode and drove himself to the hospital to seek refuge and medical attention. He mistakenly crashed his vehicle into the side of the hospital and spent time in the emergency department and was eventually admitted for treatment of the motor vehicle accident.

During his stay, Alan was very aggressive. On a regular day, he was aware of his manic depressive behavior; during moments of mental clarity at the hospital, he tried to alert medical staff that he was having a manic episode. Furthermore, Alan’s father, an internal medicine physician, who was also aware of his son’s tendencies, spoke with the nurse and attending physician to request a psychiatric evaluation. However, although Alan’s charts also included several notes from a variety of providers about his manic depression and that he was incoherent and delusional, was acting very irrationally and stated he was having a manic episode, the concerns were dismissed.

A point arose when Alan became particularly aggressive. Because of hospital policies, the local police department was called for security. Due to the rise in violence against health care workers and the fact that some facilities are unable to provide private security forces, more and more police officers are involved with hospital security. Unfortunately, officers may not be familiar with standard hospital procedures or how to effectively deal with a mentally ill individual, both of which were the case in Alan’s situation. Upon arrival, the police entered Alan’s hospital room without supervision by medical staff, closed the door and then moments later Alan was shot during an altercation.

Health care providers see demented and combative patients on a daily basis. In Alan’s situation, the blame may be pointed to lack of training for the police officers that were involved. However, the situation could also have been avoided had the health care providers addressed the various notes in Alan’s chart and taken seriously the request for a psychiatric evaluation. Upon completion of an evaluation, it is likely that Alan would have been moved to the care of a psychiatric unit with training and experience in handling cognitively impaired patients.

This sort of scenario was the topic of a recent workshop hosted by Des Moines University Continuing Medical Education in collaboration with Mercy Medical Center and the Des Moines Police Department. Below are some key takeaways from the workshop; use them to protect yourself and your facility while providing the most optimal care possible in an emergency situation.

  • Be aware of your surroundings and what is going on within your clinic.
  • Within the patient’s room, place yourself between the patient and the door, giving you the option to escape should the situation turn violent.
  • Know your facility and have a plan if something were to happen in a variety of locations.
  • Understand body language and anticipate outcomes in order to effectively mitigate violence.
  • If you see or hear something, be sure you report it. Fully document all occurrences and bring a second person into the room if possible in order to support documentation.
  • Participate in emergency management drills and trainings that are offered in your workplace.
  • Prior to resorting to physical restraint, utilize a “stand-by” option by placing a security guard outside of the aggressive patient’s room in order to discourage violence against medical staff.
  • Consider moving to plain language emergency alerts rather than using code-based alerts. This takes out the guess work involved and allows other staff, patients and visitors to also be aware of their surroundings and any potentially dangerous situations.
  • Consider staff trainings on topics such as management of aggressive behavior and verbal defense and influence in order to increase effectiveness in emergency and violence mitigation.

There is a great need to collaborate and educate each other to reduce this violent trend and mitigate the consequences of aggression and other related emergencies in the medical field. As health care providers, we can work to ensure our clinics and hospitals have clear guidelines and tactics for dealing with confused and aggressive patients; and that these guidelines are enforced and shared with all involved.

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