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De-escalation/Workplace Violence

De-escalation/Workplace Violence. The Swedish Perspective… Stacia Gloman, CHSP Safety Officer for Swedish First Hill, Issaquah, and Metropolitan Park. Why De-escalation Training is a must.

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De-escalation/Workplace Violence

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  1. De-escalation/Workplace Violence The Swedish Perspective… Stacia Gloman, CHSP Safety Officer for Swedish First Hill, Issaquah, and Metropolitan Park

  2. 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.

  3. 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

  4. 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.

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

  6. De-escalation at Swedish Past • Swedish has tried toimplement 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 tomaintain competency of trainers • Unable to provide time for trainers to train (mandatory= pay staff) • Unable to get buy-in from Senior Leaders

  7. 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.

  8. For Example • Scenarios……

  9. 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 work…constantly re-evaluating based on needs

  10. 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

  11. 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.

  12. 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.

  13. Reinforcing… • Who’s Safety is #1? • Who’s Safety is #2? • Who’s Safety is #3? Yours Co-workers Patients

  14. Our Numbers Since Starting Training

  15. 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

  16. Reporting Structure • Campus Safety Committee • Corporate Environment of Care Committee • Quality Management Committee • Board Quality Committee

  17. 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

  18. Questions???

  19. THANK YOU!Be Safe! Stacia Gloman, CHSP Stacia.Gloman@swedish.org 206-386-2915 Samuel and Stacia

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