By Elain Richardson, Regional Chief Nursing Officer, SSM Health Oklahoma
George Benard, Regional Vice President of Emergency Services, SSM Health Oklahoma
Jimmy Durant, Director of Government Affairs, SSM Health Oklahoma
A decade ago, it wasn’t uncommon for a healthcare worker to be assaulted in a month’s work in an emergency or behavioral health department. Today, it happens in almost every shift.
Workplace violence is a national problem that isn’t unique to any one organization or state. However, the state of Oklahoma had always classified violence against a healthcare worker as a misdemeanor, not a felony. Individuals who committed a crime against a healthcare worker were often just ticketed.
With 773 licensed beds, SSM Health is Oklahoma’s largest healthcare campus with a significant behavioral health presence. Attacks had been escalating, and in 2020, staff members were instrumental in changing the legislation to classify aggravated assault as a felony. It was a particularly difficult time to change the law in the wake of the George Floyd protests, but clinicians at SSM Health felt it was important to strengthen the penalties and protect its workers. The goal was not to increase prisoners in Oklahoma’s prison system, but to protect healthcare workers and create more awareness of the problem.
Creating Awareness
One important aspect of SB 1290 was the posting of required signage stating assault on a healthcare worker is a felony in Oklahoma. Awareness is a critical piece, as many instances of violence don’t merit much media coverage unless multiple individuals are attacked. Healthcare workers are becoming more desensitized to violence in their professional settings, and a key goal of this legislation was to bring the necessary stigma to acts of violence against healthcare workers.
Another crucial piece of the legislation was specifying exactly who is included in the definition of medical workers. Per the definition, “medical worker” encompasses everyone working in the healthcare organization, including chaplains and other support staff.
Securing Emergency Department Area
While some staff were working tirelessly at government affairs, others were implementing practical changes within our work environment. One change that garnered compliments from our Joint Commission surveyors was the secure point of entry for behavioral health patients within the emergency department (ED).
This is one of the areas of the hospital that experiences the most violence-related outbursts, as many patients are under the influence of drugs. The area is staffed with licensed counselors and has been successful at managing problems in the acute phase before frustrated patients move to other areas of the hospital.
Another secured area contains patients who have been medically cleared but are awaiting treatment. This glass-enclosed area is strategically placed where hospital security has a physical view of the patient and can respond quickly.
Physical Environment Precautions
SSM Health’s ED is housed in a building that’s less than 10 years old, so a great deal of consideration was taken during the construction process in removing items that could be weaponized. Hand sanitizer foam canisters, for instance, can be used to injure someone, so they were bolted down. SSM’s infection preventionist became quite creative in redesigning our organization’s hand sanitizers so that no parts could be broken off and used for violence.
There’s a certain balance that’s inherent in removing risk while not locking away all supplies necessary for the treatment of patients.
Additionally, what has worked well for SSM Health is assessing the room with a similar thought process as evaluating ligature risk. This “overlap” has led to changes of door handles, hinges, railings and furniture.
Technological Approach
SSM Health’s goal is to review the organization’s entire culture – from the physical environment to staff rounding and everything in between – to determine where the potential for hospital violence can be addressed.
Weekly, we look at interventions and best practices at other healthcare organizations for possible implementation in our health ministry. One such idea was to provide each staff member with a wearable call button device that whistles, similar to a rape whistle. The idea is that potential victims could activate the high-pitched personal alarm – allowing for time to get away or to deescalate the situation.
It’s a challenge to measure success with these initiatives. A decreasing number of potentially violent events seems like a worthy goal, but is complicated by the fact we’re encouraging more reporting. Therefore, while violence against our staff could indeed be decreasing, the increase in reporting, while encouraged, makes it difficult to measure a downward trend of workplace violence. While we don’t know how long this journey will take, we do know the goal: keeping our staff safe.