Hospital Staff Safety & Duress

Healthcare Staff Safety & Duress

What is a Staff Duress & Safety Solution?

A duress and safety solution is often a key part of workplace violence prevention programs. A staff duress system ensures the safety of healthcare workers in potentially dangerous situations. Discreet yet effective, the system allows staff to quickly alert security personnel during an emergency situation, often pinpointing their location.

Why is a comprehensive program to address workplace violence so important?

According to the Bureau of Labor Statistics, healthcare workers are nearly five times more likely to be assaulted due to workplace violence than all other workers in the private sector combined. And the numbers are rising: A reported 40 percent of healthcare workers experienced an incident of workplace violence in the last two years. In addition, hospitals must now comply with Joint Commission and OSHA regulatory requirements/guidelines and state-by-state legislation designed to mandate the development of workplace violence programs for staff safety in hospitals.

Why have attacks on nurses and other healthcare staff become more frequent?

There are a variety of reasons that an ever-increasing number of healthcare workers have become the target of workplace violence:

• Increasing use of hospitals by the criminal justice system for criminal holds and the care of acutely disturbed, violent individuals
• Increasing number of acute and chronic mentally ill patients for whom adequate inpatient and follow-up care is not available
• Long waits for service and overcrowded waiting rooms
• Availability of medication, particularly opioids, amidst a national opioid crisis
• Increasing presence of substance abusers
• Distraught family members
• Isolated work with patients during examinations or treatment
• A workforce that is predominantly female
• Poorly lit corridors, rooms, parking lots, and other areas
• Lack of staff training and policies for preventing and managing crises with potentially volatile patients
• Understaffing

What staff duress & safety solutions have been employed in hospitals and why did they fail?

There has been an assumption that de-escalation training alone is enough to protect clinical teams from violence, but the data shows that violence has only increased despite training.

For many years, the only alerts available when a situation escalated were hard-wired duress buttons installed on walls for convenient electrical access. They are often placed in areas where the clinical staff can’t access them in an emergency, sometimes in a hallway or at the nurse’s station, which is often too far from the event. Another common spot for a duress button is behind the patient’s head on the wall, which is not accessible when a patient becomes your assailant.

What should be included in a solution for WPV?

A comprehensive workplace violence prevention program is the best way to reduce violence in the workplace. A successful program should include these foundational elements:

• Management commitment and employee participation — In order for a WPV to succeed, management must demonstrate their commitment to the program, communicate that commitment, and document its performance. Workplace violence prevention should be a priority, goals and objectives should be established, and communication between management and employees should be open and without fear of reprisal.
• Worksite assessment/analysis — An initial identification of any hazards should take place, with continual reassessments and formal re-evaluations after incidents, through accident review boards or after-action reviews.
• Hazard prevention and control — Once hazards are identified, controls should be put in place to reduce or eliminate them. These could include alarm and/or staff duress systems, training and posting of security, and adequate staffing.
• Safety and health training — All employees should have education and/or training on hazard recognition and control, including what to do in an emergency.
• Record keeping and evaluation — Hospitals should establish a process for continually monitoring, internally reporting, and investigating all instances of violence and any safety and security incidents involving patients, staff, or others.

What are the components of the Cognosos RTLS staff duress and safety solution?

• Badges designed to be discreet (similar to a typical hospital asset badge) and inconspicuous to an assailant
• Alerts sent with the push of a button on the badge
• A dedicated communication channel that relays the emergency alert quickly
• Integration with hospital emergency codes (Code Gray) to ensure all staff are aware that an incident is in progress
• Continuous location of the person who is at risk while the event is ongoing
• Reporting about the incident response in compliance with the hospital’s workplace violence prevention plan

How critical is location for a staff duress and safety solution?

Having an RTLS that offers room-level accuracy with high confidence is essential when an incident involves more than one location. If an assailant is moving around the hospital—especially if they have a staff member or patient in tow—first responders need to go to their current location, not where they were five minutes ago when a staff duress button was pushed.

What areas should a staff duress and safety solution cover?

• The entire hospital footprint, including patient rooms, offices, closets and storage rooms, restrooms, hallways, and loading docks
• Pathways leading to and around the hospital
• Parking lots and garages

How does the Cognosos staff duress and safety solution work?

• A staff member personally experiences or witnesses an incident of workplace violence.
• The staff member presses a button on their wearable badge to alert the hospital that an incident is in progress.
• A designated department of the hospital receives the alert and initiates an emergency response; a Code Gray emergency code is announced throughout the hospital.
• After the incident is over, Cognosos collects data about the hospital’s response for use in a report according to the workplace violence prevention plan.

How does a staff member activate the duress button?

• Buttons are located on a badge or similar device worn by hospital staff.
• When a staff member witnesses or experiences an incident of workplace violence, they press the button on the badge.
• After the button is pressed, the badge sends a message to the designated hospital department responsible for responding to the incident.

What happens after a staff member activates the duress button?

• The badge will provide a silent, tactile “buzz” when the duress button is pushed, assuring the staff member that help is on the way without alerting or agitating an assailant.
• The badge sends a message through a low-latency communication channel separate from the hospital’s network that prioritizes emergency calls.
• An emergency code announcement (Code Gray) is made over the public address system, informing staff that an incident is in progress.
• During and after the incident, Cognosos collects data from and publishes the information via a dashboard. That information is included in reports the hospital must produce to meet standards (from The Joint Commission, OSHA, and other regulatory and legislative entities) for workplace violence prevention plans.

What are the benefits of a staff duress system?

• Meeting The Joint Commission, OSHA, and other regulators’ workplace violence prevention plan requirements
  • The Joint Commission’s 2022 guidance requires hospitals to establish processes for monitoring, reporting, and investigating all safety and security incidents; deliver ongoing safety and security education and training; and conduct an annual analysis of their workplace violence prevention plan.
  • OSHA guidance requires all hospitals and healthcare facilities have a system-wide workplace violence prevention plan that includes duress buttons, workstation paging systems, or personal alarm devices worn by staff.
• A proactive approach to prevention
  • Although no technology or system can prevent all incidents of workplace violence, a staff duress and safety solution ensures your hospital has resources to help keep incidents from escalating if and when they occur.
• Improved performance by staff
  • The Joint Commission has noted that exposure to workplace violence can lead to psychological distress and stress, which can negatively impact patient care because staff are not 100% focused on their responsibilities.
• Increased job satisfaction
  • Reliable staff duress and safety solutions can facilitate a culture of safety in your hospital, giving your staff peace of mind. They know that if they or their patients are in danger, they can immediately report the incident and there will be a swift emergency response. Their peace of mind extends to the parking lots or garages and pathways they use to arrive at and depart from work.
• Improved recruitment of staff/reduced turnover
  • Healthcare staff want to work at a hospital where they know they’ll be able to do their jobs as safely as possible. The presence of an easy-to-use and effective staff duress and safety solution may be a factor that prospective employees consider when choosing a hospital to work for. The lack of such a solution may be a deciding factor for those considering whether to stay in their current jobs.

What systems does a staff duress and safety solution integrate with?

A staff duress and safety solution should have an API that communicates with other systems, such as the hospital’s public address system (e.g., for emergency announcements) and security systems (e.g., to lock down specific areas to isolate an emergency and alert security staff) to facilitate a multi-tiered incident response.

What is required to comply with agencies that have current and upcoming regulations and guidelines for hospitals?

The Joint Commission created new and revised workplace violence prevention stardards that became effective on January 1, 2022 for all Commission-accredited hospitals and critical access hospitals.

• • The Hospital Manages Safety & Security Risks (EC.02.01.01). The hospital conducts an annual worksite analysis related to its workplace violence prevention program. It takes actions to mitigate or resolve the workplace violence safety and security risks based upon findings from the analysis. A worksite analysis includes a proactive analysis of the worksite, an investigation of the hospital’s workplace violence incidents, and an analysis of how the program’s policies and procedures, training, education, and environmental design reflect best practices and conform to applicable laws and regulations.
  • The Hospital Collects Information to Monitor Conditions in the Environment (EC.04.01.01). The hospital establishes a process(es) for continually monitoring, internally reporting, and investigating the following:
    • Injuries to patients or others within the hospital’s facilities
    • Occupational illnesses and staff injuries
    • Incidents of damage to its property or the property of others
    • Safety and security incidents involving patients, staff, or others within its facilities, including those related to workplace violence
    • Hazardous materials and waste spills and exposures
    • Fire safety management problems, deficiencies, and failures
    • Medical or laboratory equipment management problems, failures, and use errors
    • Utility systems management problems, failures, or use errors

Based on its process(es), the hospital reports and investigates the following: Safety and security incidents involving patients, staff, or others within its facilities, including those related to workplace violence.

• • Staff participate in ongoing education and training (HR.01.05.03). As part of its workplace violence prevention program, the hospital provides training, education, and resources (at time of hire, annually, and whenever changes occur regarding the workplace violence prevention program) to leadership, staff, and licensed practitioners. The hospital determines what aspects of training are appropriate for individuals based on their roles and responsibilities. The training, education, and resources address prevention, recognition, response, and reporting of workplace violence as follows:
    • What constitutes workplace violence
    • Education on the roles and responsibilities of leadership, clinical staff, security personnel, and external law enforcement
    • Training in de-escalation, nonphysical intervention skills, physical intervention techniques, and response to emergency incidents
    • The reporting process for workplace violence incidents

• • Leaders Create & Maintain a Culture of Safety & Quality Throughout the Hospital (LD.03.01.01). The hospital has a workplace violence prevention program led by a designated individual and developed by a multidisciplinary team that includes the following:
    • Policies and procedures to prevent and respond to workplace violence
    • A process to report incidents in order to analyze incidents and trends
    • A process for follow up and support to victims and witnesses affected by workplace violence, including trauma and psychological counseling, if necessary
    • Reporting of workplace violence incidents to the governing body

OSHA has guidelines that healthcare facilities and hospitals can follow to create system-wide WVP program that includes:

• • Panic buttons, workstation paging systems, or personal alarm devices worn by staff
  • Creation and maintenance of a workplace violence prevention plan
  • Employee consultation on and involvement in the workplace violence prevention plan
  • Safe worksite analysis
  • Hazard prevention and control
  • Record keeping
  • Program evaluation

State and federal guidelines and legislation. Several states including California, Connecticut, Illinois, Maryland, Minnesota, New Jersey, Oregon, and Washington have passed laws requiring workplace violence prevention programs for healthcare facilities and hospitals, and many others have legislation in progress.

What happens to facilities that do not have a WPV plan in place?

If a hospital fails to create a workplace violence program, there can be significant penalties involved. The Joint Commission may revoke a hospital’s accreditation, while OSHA has issued fines under its General Duty Clause, which requires employers to provide employees with a place of employment that is “free from recognized hazards that …are likely to cause death or serious physical harm.” The organization has fined several hospitals for failing to protect their employees against workplace violence, including one Pennsylvania hospital that was fined more than $32,000. Additionally, some states have laws that establish penalties for assaults on healthcare workers.

How long does it take to install a staff duress and safety solution?

Implementation time depends on several factors, such as facility size and involvement of hospital IT staff. Because the Cognosos staff duress and safety solution runs on such light infrastructure, however, the time from contract to use is among the shortest on the market.