DeescalationWorkplace Violence

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De-escalation/Workplace Violence

• The Swedish Perspective
• Stacia Gloman, CHSP
• Safety Officer for Swedish First Hill, Issaquah,
  and Metropolitan Park

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Why De-escalation Training is a must

• A recent study showed that one in five nurses
  experienced more than one type of violence in a
  five-shift period.
• Data indicates that hospital workers are at a
  high risk for experiencing violence in the
  workplace.
• According to the Bureau of Labor Statistics,
  2,637 nonfatal assaults on hospital workers
  occurred in 1999.
• A rate of 8.3 assaults per 10,000 workers vs. 2
  per 10,000 in the private industry.

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Tipping Point for Swedish

• Typical morning in the ED
• Patient had been discharged from the ED the night
  before came back in pain. Staff thought possible
  drug seeker
• Patient was being very verbally abusive to
  registration staff charge nurse looked at
  security officer and said Deal with It
• Security dealt with it
• Very public display of moving the patient out of
  the ED with on-lookers and staff

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A Bad Situation

• Perception is reality.
• There was a lack of communication between the ED
  staff and Security.
• Lack of expectations between hospital and
  patient.
• Lack of understanding between each others duties
  and expectations.

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Customer Service

• Administration, Managers, Charge RNs, and Patient
  Relations
• Take the HEAT
• Hear them out
• Emphasize
• Apologize
• Take action

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De-escalation at Swedish

• Past
• Swedish has tried to implement most, if not all,
  of the major de-escalation programs.
• CPI (Crisis Prevention Institute)
• MOAB (Management of Aggressive Behavior)
• Unable to customize these programs to allow for
  time constraints and risk management issues
• Unable to maintain competency of trainers
• Unable to provide time for trainers to train
  (mandatory pay staff)
• Unable to get buy-in from Senior Leaders

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De-escalation at Swedish

• Present
• Trainers with law enforcement background created
  a program based off of Verbal Judo by Dr.
  George Thompson (Insight)
• Approximately 300 staff were trained system-wide
• 4 hour training
• 1 ½ hours of didactic training
• 2 ½ hours of mock scene training
• Key success was getting the different departments
  to interact and create the scenarios that were
  worked through.

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For Example

• Scenarios

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De-escalation at Swedish

• Future
• All new staff will receive education in
  de-escalation and restraining patients in new
  employee education (NEO)
• Will back-fill the NEO with current staff to make
  sure that everyone who comes or will come in
  contact with a patient knows how to de-escalate
  and restrain when necessary
• The plan is to meld a couple of the approaches to
  create a swedishized de-escalation program
• Continuous workconstantly re-evaluating based on
  needs

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De-escalation Made Easy

• 5 Easy Steps
• Ask
• Explain
• Options (2, one good and one bad)
• Confirm Choice
• ask Is there anything I can do to earn your
  cooperation
• also a tip off to co-workers that we are close
  to going hands on
• Act

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Dealing with Insults

• Strip Phrase
• A two-part response to insults
• Part 1- Acknowledge the insult
• Part 2- Refocus get them back on task
• Example
• (Patient) You are an evil nurse
• (Nurse) I understand you are upset but we still
  need to get your blood drawn.
• By acknowledging, we strip the insult of the
  power by ignoring, the patient will keep hurling
  insults.

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Goals of our New Employee Education

• Discuss (verbal, non-verbal, and physical)
  techniques to provide for the care, welfare,
  safety, and security of ALL involved in a crisis
  situation.
• Identify behavior levels that contribute to the
  development of a crisis and choose an appropriate
  staff intervention for each level.
• Identify useful nonverbal techniques which can
  help to prevent acting-out behavior.
• Use verbal techniques to de-escalate behavior.
• Identify resources to utilize in crisis
  situation.
• Demonstrate correct application of restraints.

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Reinforcing

• Whos Safety is 1?
• Whos Safety is 2?
• Whos Safety is 3?

Yours
Co-workers
Patients
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Our Numbers Since Starting Training
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Structure for Success

• Monthly Workplace Violence Prevention Team
• Safety
• Security
• HR
• Restraints Committee Chair
• Discuss monthly events and statistical trends
• Action plans
• Evaluation and follow-up
• RCW Documentation

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Reporting Structure

• Campus Safety Committee
• Corporate Environment of Care Committee
• Quality Management Committee
• Board Quality Committee

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Supporting Policies/Procedures

• Complex Behavior Management
• Behavior Agreement Form
• Discharging Patient
• Using Medical Officer of the Day if needed
• Workplace Violence Prevention
• Dismissing a Visitor
• Dismissing an Outpatient Actual or Potential
  Patient
• Leaving Against Medical Advice
• Search and Seizure
• Security Standby
• Forensics- Patient Guarding
• Chain of Custody

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Questions???
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THANK YOU!Be Safe!

• Stacia Gloman, CHSP
• Stacia.Gloman_at_swedish.org
• 206-386-2915

Samuel and Stacia