CO- ENA Safe Work Environment updates

October 10, 2013 Heather Finch RN, BSN, CEN Billie Ratliff, LCSW Shawna Zautcke, RN, CEN

• Who we are

Intro

• Objectives – – Highlights from the ENA Safe Work Env. Intensive held June 2013 How we relate or incorporate info – – Workplace Violenceand the work done at Memorial-UCH (ED WPV-Task Force) Identify current legislative status/future initiatives (Sharon Sperry)

THANK YOU!

3 ENA Connections, August, 2013

Highlights

Presented 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 Bedside

• Strong Teamwork – Improve outcomes, patient satisfaction, staff satisfaction, reduce liability, reduce errors – TeamSTEPPS™ – Communication Tools • IPASSTHEBATON • • SBAR POLO

Team Safety & Conflict 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 & 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 Safety

• “Most errors result from complexity of healthcare system and not individual recklessness or incompetence” Create safer systems Manage “at risk” behavior Strategies at Memorial include Red baskets Two patient identifiers High risk medications checked by 2 RN’s Pediatric medications checked by 2 RN’s (Susan Paparella, RN, MSN)

The Healthy Nurse

• Compassion Fatigue • Healthy work environment • Human Error • Just Culture • Transformational Leadership (ENA Topic Brief, February2013)

Risk 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 Nurses Risk 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 Journey Dept – Central, CU4, North ED Basic staff makeup/ basic organizational structure

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ED WPV Task Force

Introduction

• 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).

Statistics

 Nurses are 3 times more likely to experience violence than any other professional group  Healthcare 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…

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

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The Big Picture

Purpose

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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

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Drilling down…

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

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Plan…

• • • Pre-Survey (22 line-item survey monkey) Education – 90 day – Define, Zero tolerance/support, Reporting process, addressing barriers, – Huddles, email, CBT Post- Survey

Timeline

March

Present to leadership Finalize survey Resiliency QI survey? (Jody)

May

WPV survey Identify interventions

April

IRB approval Interventions cont’d (preliminary brainstorming) August (end) Repeat survey and assessment

June -Aug September Implement

Analyze data

interventions

Oct/Nov Heather’s oral/written defense

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Additional 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 Info

Survey

Respondents Define WPV –verbal Define WPV- Physical Define WPV-Bullying/har Exp Verbal in past 3 mo

Pre- June

96 85% 98% 76% 75% Unreported Exp Phys in past 3 mo Unreported 39% Not sure if Zero toler policy 25% Is leadership commited?

53% 34% 65%

Post-Sep

106 92% 99% 84% 68% Data still pending 19% Data still pending 12% 87%

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Reporting data

• • Still pending….

Anecdotally…..reporting incidents via our internal quality reporting system increased.

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Next Steps…

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

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Legislation

A word from Sharon…

Future intiatives

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Questions?

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