CO- ENACO- ENA Safe Work Environment updates Safe Work Environment updates

October 10, 2013October 10, 2013

Heather Finch RN, BSN, CEN

Billie Ratliff, LCSW

Shawna Zautcke, RN, CEN

IntroIntro

• Who we are• Objectives

– Highlights from the ENA Safe Work Env. Intensive held- June 2013

– How we relate or incorporate info

– Workplace Violence and the work done at Memorial-UCH (ED WPV-Task Force)

– Identify current legislative status/future initiatives (Sharon Sperry)

THANK YOU!THANK YOU!

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ENA Connections, August, 2013

HighlightsHighlights

Presented TopicsPresented Topics

How to manage difficult patients– T.A.C.T. Therapeutic Alternatives in

Crisis Training• Helpful to decrease restraint use in ED• Stresses descalation and behavior

awareness

– Informative to know other programs are available

– Memorial uses CPI

(Mona Kelley, MSN, RN)

Team Safety at the BedsideTeam Safety at the Bedside

• Strong Teamwork– Improve outcomes, patient satisfaction,

staff satisfaction, reduce liability, reduce errors

– TeamSTEPPS™– Communication Tools

• IPASSTHEBATON• SBAR• POLO

Team Safety & Conflict Team Safety & Conflict Resolution Resolution

• Develop safe environment where staff feel comfortable to question safety issues– DESC Script

• D-Describe the specific resolution• E-Express your concerns about action• S-Suggest other alternative• C-Consequences should be stated

– CUS • I am concerned• I am uncomfortable• This is a Safety Issue

Team Safety & CoachingTeam Safety & Coaching

• Defined – A process that enables learning and development to occur and thus performance to improve

• Goals– Help ensure the team has what they

need to be successful• Skills, Knowledge, Opportunities,

Capabilities• Positive, real time feedback, sets them up

for success(Deena Brecher, MSN,RN,APRN,ACSN-BC,CEN,CPEN)

Medication SafetyMedication Safety

• “Most errors result from complexity of healthcare system and not individual recklessness or incompetence”Create safer systemsManage “at risk” behavior

Strategies at Memorial includeRed basketsTwo patient identifiersHigh risk medications checked by 2 RN’sPediatric medications checked by 2 RN’s

(Susan Paparella, RN, MSN)

The Healthy NurseThe Healthy Nurse

• Compassion Fatigue

• Healthy work environment

• Human Error

• Just Culture

• Transformational Leadership(ENA Topic Brief, February2013)

Risk AnalysisRisk Analysis

• Reviewed Methods of Risk Analysis

– Proactive Risk Assessment (PRA)– Root Cause Analysis (RCA)– Apparent Cause Analysis (ACA)

(Kathy Szumanski, MSN,RN,NE-BC)

Liability Risks of Emergency Liability Risks of Emergency NursesNurses

Risk Control StrategiesRisk Control Strategies• Scope of Practice• Documentation• Communication

• Increased monitoring for patients– Administered pain meds– Psychiatric crisis– Return within 24, 48, 72 hrs

Our Story…Our Story…

• Our Journey• Dept – Central, CU4, North ED• Basic staff makeup/ basic

organizational structure

ED WPV Task ForceED WPV Task Force

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IntroductionIntroduction• Definition

– “Any act of aggression , physical assault, emotional or verbal abuse, coercive or verbal abuse, coercive or threatening behavior that occurs in a work setting and causes physical or emotional harm.” (ENA, 2010, Emergency Nurses Association position statement).

StatisticsStatisticsNurses are 3 times more likely to experience

violence than any other professional groupHealthcare workers are more likely to be

attacked at work than police officers or prison guards (NIOSH, 2002)

Healthcare workers suffer 4 times more non-fatal assaults than the private sector (US Dept of Labor Statistics, 2001)

Estimated that 70% of violent events in health workplace are underreported (Luck, Jackson, and Usher, 2007)

Who we are…Who we are…

Interdisciplinary team includes:

Employee Health, Safety, Security, ED Central (RN and Tech), ED North (RN), Behavior Health, ED Team Lead, CNS, FNE, ED physician champion, Risk & Quality/Regulary –support

The Big PictureThe Big Picture

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PurposePurpose • Mission of ED Workplace Violence Task Force 

– Support overall employee health and well-being with a focus on workplace violence Prevention, Recognition, Response, Reporting and Recovery

 •  WPV FOCUS FOR 2013 - TYPE II

– **Patient to Staff – Staff to Staff– Visitors to Staff

Drilling down…Drilling down…

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Goals…Goals…

• ST GOAL – improve WPV incident/injury reporting in the EDs (rationale – need accurate reporting data in order to develop effective interventions).

• LT Goal – use improved reporting data to develop effective interventions aimed at helping staff be better prepared to prevent, manage and respond to WPV as well as reducing WPV

Plan…Plan…

• Pre-Survey (22 line-item survey monkey)

• Education – 90 day– Define, Zero tolerance/support,

Reporting process, addressing barriers, – Huddles, email, CBT

• Post- Survey

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TimelineTimeline

Additional InterventionsAdditional Interventions• Following up on reports…• Communication with police re:

reporting• Safety Alerts• Data trending to include incidents

not just injury– Consolidating data….

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Preliminary Survey InfoPreliminary Survey InfoSurvey Pre- June Post-Sep

Respondents 96 106

Define WPV –verbal 85% 92%

Define WPV- Physical 98% 99%

Define WPV-Bullying/har

76% 84%

Exp Verbal in past 3 mo

75% 68%

Unreported 53% Data still pending

Exp Phys in past 3 mo

34% 19%

Unreported 39% Data still pending

Not sure if Zero toler policy

25% 12%

Is leadership commited?

65% 87%26

Reporting dataReporting data

• Still pending….• Anecdotally…..reporting incidents

via our internal quality reporting system increased.

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Next Steps…Next Steps…

• Resiliency• Lateral violence• Trend reporting• Modify reporting form• Expand work to other units

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A word from Sharon…A word from Sharon…

Legislation Future intiatives

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Questions?Questions?

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