Post on 09-Jul-2020
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Protecting the Workforce Through an
Aggression Prevention TeamDeb Fabert RN MSN BC
Joe Anderson MBA
Copyright IU Health
Disclosure of Conflict of Interest
Both presenters are consultants with Crisis Prevention Institute (CPI)
Learning Objectives
– Recognize the need for a standard organizational response to threatening or violent behavior
– Discuss how Maslow's Hierarchy of Needs and the Pathway to Violence can be utilized for early identification and recognition of impending violence
– Define how a similar violence prevention program could be implemented at the participant’s place of work
Indiana University Health
Statewide System & Academic Health Center
Academic Health CenterMethodist Hospital
• 100,000+ annual ED patients
• Level 1 Trauma Center
• 30,000+ annual inpatient admissions
• 747 beds
• 100+ Behavioral Health beds (63 in program)
Statewide System17 hospitals and health centers, partners,
affiliates and joint venture operations
Burning Platform
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• The ANA petitioned OSHA to require comprehensive workplace violence prevention programs
• Sentinel Alert Event – The Joint Commission – Issue 59, April 17,2018
• The AHA estimates 429 million in medical care, staffing, indemnity, and other costs resulted from violence against hospital employees in 2016.
Who Gets Assaulted? Nurses
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0
5
10
15
20
25
30
35
40
45
912
20
1013
1014 13
2623
12
33
21
26
13
35
20
10
1512
2224
Other
Assaults
Assaults Nurses
Strategic Plan for Improvement
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• Inter-professional team included clinical and non-clinical services
• Goal
o 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
o Aggressive Prevention Team
o The Behavior Alert was developed for imminent danger situations
• Evaluation process for effectiveness
Comprehensive Security and Safety Responses
Access• External/Internal
Systems/Technology• Video Rounding
• Panic Alarms
Personnel Resources• Hired/Contracted
• Law Enforcement
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Training for Active Shooter is widespread though incidents are low
in healthcare (2.5%) Experts recommend all hazards approach
Policy
• Visitation
• No Information Patients
Training
• Nonviolent De-escalation
• Active Shooter
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%.
Maslow, A. H. (1970a). Motivation and personality. New York: Harper
& Row.
VanMale, L.M. (2016) Keeping our workers safe.
Washington DC: VA Office of Patient Care Services
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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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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
Type of Violence - Affective
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A Positive Trend
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2
4
6
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10
12
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Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Assaults
2014
0
5
10
15
20
25
30
Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec
APT Calls
2014
Methodist Riley University
De-escalation Training - Prevention
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• 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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APT Process - Response
Aggression Prevention Team – APT
Before Violence Occurs (Breach)• Anyone can activate by calling Security
• Maximum 5-minute arrival
• Pre Huddle
• Social Worker – Team lead and de-escalation
• 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
• Post Huddle
Majority of Assaults - Non Intentional
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5
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30
35
6
11
17
7 8
36 7
1715
8
26
9
16
8
34
16
47 7
16
20
Intentional Assaults on Nurses
Non-Intent Nurses
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BA Process - Response
Behavioral Alert– BA
Violence is Imminent or Occurring (Attack)
• Anyone can activate by calling operator
• Treated as code announced overhead
• No Pre Huddle
• Security renders scene safe
• Social Worker - de-escalates
• Chaplain supports staff
• Clinical assessment and interventions
• Associate Administrator may provide support
• Post Huddle
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Debrief Form
IUH APT and Nursing Assaults
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APT responses increased, assaults declined
• CDC study found violent injuries to nurses had almost doubled
• Higher % of assaults now being reported
• APT responses are opportunities to resolve patient grievances
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50
100
150
200
250
Q1-16 Q2-16 Q3-16 Q4-16 Q1-17 Q2-17 Q3-17 Q4-17 Q1-18 Q2-18 Q3-18 Q4-18 Q1-19
APTResponses
Intentional Assaults on Nurses Linear (APTResponses)
Q2-19
Sustainability
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0
50
100
150
200
250
Q1-14 Q2-14 Q3-14 Q4-14 Q1-15 Q2-15 Q3-15 Q4-15 Q1-16 Q2-16 Q3-16 Q4-16 Q1-17 Q2-17 Q3-17 Q4-17 Q1-18 Q2-18 Q3-18 Q4-18 Q1-19 Q2-19
APT
Responses
Assaults Nurses Intentional Assaults on Nurses
APT compared to Violent Restraint Use
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0
5
10
15
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35
40
45
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Sum of APT/BA
Sum of Violent
Restraint Used
APT Compared Staff Assaults with Injury
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0
5
10
15
20
25
30
35
40
45
50
Sum of APT/BA
Number of assaults with
injury on staff (Combative
Patient Injuries)
Workers Comp Incident Rates
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AHC
Incident Rates Due to Workplace Violence
2018 National Rate Indiana Rate
Recordable Cases 16
Recordable Incident Rate (IR) 0.16 0.57 0.59
Days Away Cases 4
Lost Time Incident Rate (LTR) 0.04
Restricted/Transferred Cases 12
Days Away Restricted Time Rate (DART) 0.12 0.22 0.21
Number of Days Away from Work 62
Severity Rate 0.62
Critical Incident Response Team - Recovery
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• 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 41 499
2017 52 796
2018 39 636
Questions
Contact:
Joe Anderson, janderson9@iuhealth.org
Deb Fabert, dfabert@iuhealth.org
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