Children's Hospitals Today - Summer 2017 - 16

FEATURE / EMPLOYEE SAFETY

to combative patient situations and develop new ways to keep employees safe
while they worked in this unit. Lessons
learned from the first year included:
 A need to better train and educate
staff members on techniques to
keep themselves and patients safe
during times of crisis
 Most employee harm resulted from
employees not having personal
protective equipment (PPE), such
as eye goggles or Kevlar sleeves,
available or not having it on in time
for it to be effective
 Employees were anxious, apprehensive and infrequently using
de-escalation techniques
Many of these injuries and situations
were new to the hospital, and leaders within the organization quickly
learned all employees throughout the
hospital's facilities needed to be prepared for combative patient situations.

Making a culture change
In 2015, Nationwide reported 12 injuries related to combative patients that
resulted in days away from work for
affected employees. As the hospital
started to develop solutions, leadership
knew the culture also had to change.
Many health care workers think being
harmed by a combative patient is an
element of the job.
For example, imagine a 16-year-old
boy has been admitted to your unit for
using "bath salts," psychoactive drugs
containing various amphetamine-like
chemicals. The patient's aggressive
behavior is unpredictable and unwarranted. He may lash out at everyone
in the room, regardless of the person's
relationship to him. Is it okay for the
patient to kick, punch and bite because
he's a patient?
According to OSHA, some employees will put their own safety at risk
to help a patient. To change the culture at Nationwide, employees were

CHILDREN'S HOSPITAL S TODAY Summer 2017

encouraged to better understand that
it's not acceptable to be harmed by
patients-employee safety, even from
patients, is a priority.

From reactive to proactive
With employee harm incidents coming
from sudden, unpredictable acts of aggression, the employee safety team developed creative ways to anticipate and
plan for events to eliminate employee
harm. The hospital had to find ways
to inform all staff members about pa-

Many health care
workers think
being harmed by a
combative patient
is an element of
the job.
tients that had aggressive tendencies
and identify their emotional triggers.
The organization created a Code
Violet banner within the organization's
electronic medical record (EMR) system. A Code Violet is the code employees can call when there is a violent situation with a patient or family member.
Once this code is activated, security
and other crisis staff members respond
to protect the employee from harm
while also ensuring the patient does
not inflict harm upon him or herself.
When a Code Violet is activated, it's
also recorded in the patient's EMR.
This header remains purple in the EMR
and is visible anytime staff members
or providers access the patient's EMR
at on-site or off-site care locations
throughout Ohio. This creates awareness that the patient has been violent
or aggressive in the past and allows

employees to take appropriate safety
measures in the future.
Employees also include this intervention into routine reporting. Each
week, Nationwide's outpatient managers and security personnel receive a report outlining the date and location of
outpatient clinic appointments for any
prior Code Violet patient scheduled in
the next two weeks. Additionally, each
morning, Nationwide's inpatient mangers and security personnel receive a
report that provides the unit number of
any prior Code Violet patients who are
currently inpatient. This identification
helps managers and security team personnel anticipate and address potential
combative patients.

Preparing and practicing
Despite a focus on plans that help prevent incidents, there are times when
unforeseen combative patient situations put team members in reactive
mode. To ensure response teams are
well prepared, the hospital implemented mock Code Violets, which feature
simulated scenarios. These scenarios
help employees practice their reactions
to actual events and test their ability to
execute comprehensive crisis management techniques.
These mock Code Violets are recorded, documented and used as a teaching
tool for staff members and providers
and is part of the hospital's continuous
process of informing and teaching. This
ensures teams prepare, anticipate and
appropriately respond to Code Violets.

Everyone has a part
Similar to patient safety, employee
safety will only be successful if unit
managers
hardwire
accountability into their team's culture. Within
Nationwide's employee safety incident
reporting system, the employee safety
team tracks, trends and reviews incidents of harm to determine whether
the harm could have been prevented.

Table of Contents for the Digital Edition of Children's Hospitals Today - Summer 2017