1. SAVEING TEAM MEMBERS FROM WORKPLACE VIOLENCE INJURY
Brown Bag Webinar
University of Virginia Health System
August 27, 2018
Good afternoon and welcome to the 2018 Brown Bag Webinar series. This is a series promoting positive patient safety culture and high reliability. My name is Betsy Archer, Senior Director of Grants & PI. I’m your hostess today on behalf of JW, the VHHA Center for Healthcare Excellence, and the Virginia PSO.

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3. SAVEING TEAM MEMBERS FROM WORKPLACE VIOLENCE INJURy
Ava Speciale, BSN, RN, CCRN
Amy Johnston, MSN, RN, AGCNS-BC
August 27, 2018

4. Objectives
Review the necessary components to create a complete hospital-based workplace violence program
Participants will learn the essential team members to include, goals to set, and actions to take
Focus will be placed on prevention, mitigation, response, and recovery around violence in the healthcare workplace
Suitable for all team members who work in healthcare, with a focus audience of leadership team members interested in creating or expanding a workplace violence prevention program

5. S.A.V.E.: Situational Awareness Violent Events at University of Virginia Health System
Several significant violent events occurred
Situational Awareness Violent Event (SAVE) Task Force was formed in August 2016
Comprised of multi-disciplinary team members
Executive sponsors (Chief Operating Officer and Chief Nursing Officer) facilitated operational alignment of the work
Facilitated by quality performance improvement team members

6. Methodology Preparedness, mitigation, response, recovery
Nine safety improvement strategies were developed and implemented
Strategies centered on preparedness, mitigation, response and recovery using a 30, 60, 90-day timeline
Lean tools such as A3 methodology, frontline staff development of standard work, and visual management systems were utilized
Weekly meetings that included senior leadership occurred to help remove barriers

7. Preparedness
Visual Markers outside Patient Rooms

8. Mitigation Visual Markers for Potential for violent behavior in EMR
Yield (low risk):
Stop (high risk):
Shouting
Profanity
Generalized Threats
Self-Injury
Assault and Battery
Pushing
Punching
Kicking
Pinching
Throwing Objects
Spitting
Biting
Property Destruction
Specific threat to harm
Strong likelihood of repeating

9. Mitigation
Behavioral flag note in emr

10. Mitigation Threat Assessment Threat assessment team assembly:
Hospital security
Police
Unit Manager or Nursing Supervisor
Attending physician (notify but discussion may commence without their presence)
Unit’s Shift Manager
Nurse
Team agrees on a plan to mitigate threats and; operationalizes a plan
If any member of the team has concerns about the plan, they are encouraged to escalate to their chain of command

11. Mitigation Private Security May preclude or follow a threat assessment
Can be requested by Nurse Shift Manager/Charge Nurse at the point-of-care when it is needed
Frontline team members are empowered to request this resource immediately without approval by leadership

12. Response
SAVE Call Script

13. Response Securing Unit Access Doors
Routine Nighttime Restricted Access for all Acute Units ( )
ICU’s and IMU’s access restricted 24/7
Activate restricted access for:
Violent event occurring on a unit
An overhead announcement of a violent event on the same floor, or one floor above or below the unit

14. Response Unit Response to Explosive Violence
RUN Immediately evacuate the area, isolate the incident
HIDE Seek a secure place where you can deny the threatening individual access
FIGHT You may make the personal decision to try to challenge the perpetrator to survive
All units with restricted access capability should lock doors and initiate emergency procedures
*Be alert to potential for entry behind another person’s access; observe doors during closure

15. Recovery
Immediately after an event, a resource support team may contribute by relieving the nurse involved
After Action Review completed after all violent events
Faculty and Employee Assistance Program (FEAP) available to all team members after experiencing a violent event

16. education Situational awareness
Computer based learning and in-person class on SAVE standard work and how to increase situational awareness with overall nursing completion rate of 99.6% (n=1,765)
“Be Safe” Bulletin s
Threat assessment volumes nearly tripled from
Call duration decreased by 5% when activating help through facility emergency operators

18. resources SAVE desktop icon
Icon found on the desktop of all shared computers
Quick, easy access to resources

19. Milestones Achieved

20. Transitioning to a permanent workgroup
Work completed/in progress
Threat assessment initiated in the ED
Private security duty checklist
SAVE Badge trial (alert buttons worn by team members)
24/7 information desk coverage
Flagging of restricted visitors in the EMR with SAVE restriction vs. simple visitor restriction request
Use of computer desktop alert pop-ups for violent events
Visitation management review
Explosive violence and active shooter drills
Developed a 4 hour Workplace Violence Prevention & Response course

21. Learnings Underreporting
Nursing culture towards workplace violence “it’s just part of the job”
Educating new staff and communicating new education to existing team members
Difficulty with compiling and measuring workplace violence data due to underreporting and lack of a standard national benchmark for comparison

22. outcomes

23. outcomes

24. SummarY: program developement
OSHA Guidelines
SAVE Program
Written program for workplace violence prevention; clear goals & objectives
Developed a charter that defines both the scope of the work and clear objectives
Management commitment & employee participation
Workgroup includes Executive sponsorship (COO & CNO), direction from administrative leadership, & is inclusive of interdisciplinary frontline team members
Worksite analysis
Gemba walks performed; learnings gained from like-organizations
Hazard prevention & control
Mitigation standard work, situational awareness education, new building design
Safety & health training
Classes, s, training drills, videos
Record keeping & program evaluation
Annual charter evaluation, weekly review of events, TMI data tracking

25. summary
Engagement and participation is necessary from frontline and leadership team members
Addressing preparedness, mitigation, response, and using lean methodology contributes to efficiency
Team member engagement, reporting of incidents, and continual education is necessary for success
Workplace violence in healthcare persists, necessitating a continual effort to provide a safe environment for patients, visitors, and team members

26. Thank you!
Questions?

27. REFERENCES
Occupational Safety and Health Administration. (2016). Guidelines for preventing workplace violence for healthcare and social service workers. U.S. Department of Labor. Retrieved from