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 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 A rate of 8.3 assaults per 10,000 workers vs. 2 per 10,000 in the private industry.

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

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.

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

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

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.

For Example Scenarios……

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

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

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.

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.

Reinforcing… Who’s Safety is #1? Who’s Safety is #2? Who’s Safety is #3?

Our Numbers Since Starting Training

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

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

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

Questions???

THANK YOU! Be Safe! Stacia Gloman, CHSP