1. S.A.F.E.R. Initiative Update
CMHA Annual Meeting – Fall 2017
November 29 – December 1, 2017
Michael R. Dunaway
5 Pillars
Safety Programs
Approaches to Safe Care
Facts to Inform Decisions
Education
Regulatory Reform
TASK FORCE AND LISTENING TOUR

2. Behavioral Health 96-Hour Holds
Patient Encounters
Law Enforcement
Behavioral Health 96-Hour Holds
Immigration Status
Narcotics/
Firearms
Warrants/
Blood Draws
Violence/
Assaults
Patient Rights
Staff Responsibility and Rights
GOAL: Assess
Fire arms, pending legislation, opportunity for awareness/education
Narcotics/HIPAA
Warrants/EMTALA
Search – possessions – narcotics/weapons
EMTALA HIPPA
Opioid Use
Demographics
Prioritizing the issues
Behavioral health/substance abuse patients
Weapons
Narcotics
Law enforcement executing warrants
Law enforcement drop offs
Violent patient encounters
Policy awareness
EMTALA
HIPAA

3. Listening Tour: Demographics
Eight sessions between August and October
225 participants
Community: 60 percent rural
Hospital size: equal distribution
Organizational structure: equal distribution
Position by function: 75 percent operational

4. Identified Threats in Ranked Order
Behavioral health patient boarding in non- psychiatric facilities (more prevalent in rural settings)
Violent patient encounters
Law enforcement drop-offs that create holding and/or elopement concerns
Search and confiscation of narcotics
Search and confiscation of weapons
Law enforcement presence to execute warrants of patients/visitors on site
During the fall, staff listened to members recount frequent, alarming examples of workplace violence.  
To develop long-term actions, staff conducted a listening tour of members to deepen understanding of workplace violence. Eight specific MHA member groups representing 225 physicians, executive leadership, clinical, human resources, security and front-line staff participated in the listening tour. Based on the quantitative and qualitative responses, the following have been identified as the greatest identified threats in ranked order.
behavioral health patient boarding in non-psychiatric facilities (more prevalent in rural settings)
violent patient encounters (more prevalent in urban and metropolitan areas)
law enforcement drop-offs that create holding and/or elopement concerns
Boarding of behavioral health/substance abuse patients in non psychiatric facilities
Law enforcement drop-offs that create holding and or elopement concerns
Violent patient encounters (not resulting from one of the above triggers)

5. Environmental Scan
50 percent (66 hospitals) reported internal violence in their top three risks on hazard vulnerability analysis
65 percent (84 hospitals) employ security workforce as hospital personnel
28 percent (36 hospitals) provided dedicated security in the ED 24/7
36 percent (47 hospitals) have armed security officers
40 percent (24) firearm
48 percent (29) TASER
31 percent (19) pepper spray
42 percent (26) baton
86 percent (111 hospitals) don’t use metal detectors

6. Task Force Recommendations
Synthesize concerns surrounding violence, criminal behavior, behavioral health and interactions with law enforcement to provide hospital policy makers and front-line staff with education, training and technical tools to manage complex and stressful situations in a safe, legally compliant manner

7. Immediate Jeopardy – All Citations
Source: Centers for Medicare & Medicaid, 1Q2015-2Q2017

8. Immediate Jeopardy — Psychiatric
Source: Centers for Medicare & Medicaid, 1Q2015-2Q2017

9. Proposed Approach Advocacy – Immediate and Long-term - Federal - State
Program Development – Long-term
- Criteria to evaluate safety programs
- Policy repository - Resources to integrate and empower security personnel
- Data collection for benchmarking of de-escalation programs
Education – Long-term
- Webinars
- Presentations to targeted groups
- On-demand education for front-line staff
Collaboration – Long-term
- Regional meetings with law enforcement for shared education
- Engage with statewide public safety leaders
- Multi-disciplinary summit
Document Respository: Healthcare Services Group’s legal staff will participate on the task force and serve as legal review to identify exemplar policies for a repository of best practices. Create document repository of vetted security-related policies for member adoption (Partner: HSG) – winter 2018

10. Advocacy Federal officials Call with the American Hospital Association
Letter to HHS leadership
CMS communication
Call with the American Hospital Association
State officials
Letter to Governor Greitens
Physician letter campaign
Meeting with Dr. Williams
Missouri recommendations
Advocate for increased access to mental health services
Governor or representative to convene law enforcement, emergency medical services and health care
Collaborative approach
Joint education
Continued opioid reduction initiatives
Balanced survey approach

11. Michael R. Dunaway Kansas City Metropolitan Healthcare Council 2017 CMHA Annual Meeting