Create and implement a workplace violence prevention program
Workplace violence prevention programs focus on developing processes and procedures to reduce or eliminate the risk of violence in the workplace. A workplace violence prevention program should have clear goals and objectives for preventing workplace violence and should be incorporated into an organization’s overall safety and health program. You may view the Occupational Safety and Health Administration’s (OSHA) Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers publication to learn more about violence prevention programs.
An effective workplace violence prevention program should include a multifaceted approach.
Environment of Care and Worksite Analysis
A worksite analysis involves a step-by-step assessment of the workplace to find existing or potential hazards that may lead to incidents of workplace violence and should be used to identify measures that may reduce the risk of harm to healthcare workers. A worksite should ensure that local police and fire officials are engaged. Along with law enforcement, the hospital security team and third-party contractors can be part of a risk assessment team.
Security workplace features include secured entry and silent alarm systems, physical barriers (e.g., plexiglass, design of offices, locked doors, and barriers), signage and exit routes, lighting, cameras, mirrors, and weapons detections systems. Opinion and feedback from employee surveys can be used to gain insight into potential security related issues. Previous events and past experiences should also be reviewed and leaned upon as a resource.
Safety and Health Training
Healthcare employees should be trained to raise awareness about workplace violence. They should be provided with the tools needed to identify workplace safety and security hazards and address potential problems before they arise. Training should also include de-escalation strategies and self-defense techniques.
Patient Screening Assessments
Screening assessments to identify and flag patients at risk for violence can create a shared mental model with the team. Additional precautions and support can be implemented for these high risk patients. Patients with a previous history of violence should also be identified and flagged in the system.
Monitoring Systems
Entrance and exit screening of visitors and control of access to high-risk areas are critical for the monitoring process. Weapons detection can include metal detectors, hand wands, manual body palpation, and even Artificial Intelligence (AI). Camera systems can be installed with software that contains automated responses to the shape or heatmapping of firearms or weapons. This artificial intelligence software can even recognize raised voices.
Strategies that report threatened or at-risk caregivers include cameras in the facility and cameras worn on the body. Software can be purchased that collects data from multiple information sources such as cameras, badges, and logins to quickly glean information about what is happening and can provide information to on-site security or emergency services. Some software can be automated to remove human variables in response time or identification of threats. Radiofrequency identification (RFID) technology uses electromagnetic fields to automatically identify and track tags attached to persons or objects to create a real-time location system.
Duress, Panic, or Threat Electronic Notification/ Reporting
All threats and incidents should be tracked in a reporting system. Such a reporting system should include detailed event reports of incidents, security response logs, medical records related to injuries or worker’s compensation reports, and logs of serious occupational injuries.
Real-time location systems (RTLS) are surface bearing, wearable devices/buttons/badges which immediately alert threat and track location. They can be wireless or wired or downloaded as an application to be uploaded to employees’ cell phones.
Robots can increase coverage areas for live camera feeds. This maximizes the use of video streaming, thermal cameras, two-way audio communication, automated messaging, object avoidance, and drone capabilities to avoid and/or minimize security personnel injury.
Policies and Procedures
Organizations should have clearly defined policies and procedures to reduce the risk of workplace violence. Key components of such a policy should address:
- Behavioral expectations for employees & patients (zero tolerance)
- Code of conduct for employees
- Event reporting policies (which should be reviewed and updated regularly)
Terminating a Patient from Clinic
The American Medical Association (AMA) has made resources available to guide a surgeon in appropriately managing the termination of a physician-patient relationship.
Resources
- De-Escalation in Health Care. The Joint Commission Quick Safety. https://www.jointcommission.org/-/media/tjc/documents/resources/workplace-violence/qs_deescalation_1_28_18_final.pdf?db=web&hash=DD556FD4E3E4FA13B64E9A4BF4B5458A. Published January 2019. Accessed February 7, 2023.
- Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers. Occupational Safety and Health Administration. https://www.osha.gov/sites/default/files/publications/osha3148.pdf. Accessed February 7, 2023.
- Reducing Violence Toward Healthcare Workers: The Value of At-Risk Patient Screening. IAHSS Foundation: Evidence Based Healthcare Security Research Series. 2017;17(2). doi:https://iahssf.org/assets/IAHSS-Foundation-At-Risk-Patients.pdf
- Terminating a Patient-Physician Relationship. AMA Code of Medical Ethics. https://code-medical-ethics.ama-assn.org/ethics-opinions/terminating-patient-physician-relationship. Accessed February 7, 2023.