1. S AFETY AT THE A&E D EPARTMENT – C URRENT SITUATION AND THE WAY FORWARD Paul Calleja - Msc (Manchester) Nurs, Bsc (Hons) Nurs, Dip Nurs. E-mail: aleviola@maltanet.net paul.d.calleja@gov.mt

2. O VERVIEW Introduction The Current situation The Way forward Conclusion

3. I NTRODUCTION Working Environment at A&E Noisy and crowded areas

4. I NTRODUCTION Working Environment at A&E Long waiting times

5. I NTRODUCTION Working Environment at A&E Sudden stressful situation for the patients and relatives

6. I NTRODUCTION Working Environment at A&E Fear of the unknown

7. I NTRODUCTION Working Environment at A&E High amount of patients.

8. I NTRODUCTION Working Environment at A&E Pre-hospital

9. I NTRODUCTION

13. P OSSIBLE H AZARDS IN A&E Traffic Crime Violence Aggression Crowds Electrical Hazards Fire Hazardous Material Unstable Objects Alcohol Drugs Sharp Objects Animals Environmental Conditions Special Rescue Situations Airborne and Blood borne pathogens Ionising radiation Chemical Workplace layout and design

14. P OSSIBLE H AZARDS IN A&E Traffic Crime Violence Aggression Crowds Electrical Hazards Fire Hazardous Material Unstable Objects Alcohol Drugs Sharp Objects Animals Environmental Conditions Special Rescue Situations Airborne and Blood borne pathogens Ionising radiation Chemical Workplace layout and design

15. D EFINITION Workplace violence can be defined as an act of aggression, physical assault, emotional or verbal abuse, bullying or threatening behavior that occurs in a work setting and causes physical or emotional harm. Emergency Nurses’ Association 2010

16. D EFINITION Workplace violence can be defined as an act of aggression, physical assault, emotional or verbal abuse, bullying or threatening behavior that occurs in a work setting and causes physical or emotional harm. Emergency Nurses’ Association 2010

17. D EFINITION Workplace violence can be defined as an act of aggression, physical assault, emotional or verbal abuse, bullying or threatening behavior that occurs in a work setting and causes physical or emotional harm. Emergency Nurses’ Association 2010

18. D EFINITION Workplace violence can be defined as an act of aggression, physical assault, emotional or verbal abuse, bullying or threatening behavior that occurs in a work setting and causes physical or emotional harm. Emergency Nurses’ Association 2010

19. D EFINITION Workplace violence can be defined as an act of aggression, physical assault, emotional or verbal abuse, bullying or threatening behavior that occurs in a work setting and causes physical or emotional harm. Emergency Nurses’ Association 2010

20. D EFINITION Workplace violence can be defined as an act of aggression, physical assault, emotional or verbal abuse, bullying or threatening behavior that occurs in a work setting and causes physical or emotional harm. Emergency Nurses’ Association 2010

21. D EFINITION Workplace violence can be defined as an act of aggression, physical assault, emotional or verbal abuse, bullying or threatening behavior that occurs in a work setting and causes physical or emotional harm. Emergency Nurses’ Association 2010

22. W HO CAN CAUSE WORKPLACE VIOLENCE & AGGRESSION ? Relatives Patients Nurses Doctors Managers Carers Cleaners Police Security

23. L ITERATURE & S TATISTICS A&E Department has the highest rates of assault incidents amongst all group of nurses – May& Grubb 2002. IN USA 50% of emergency nurses experience some kind of abuse. Between 60-80% do not report it. Triage, restraining a patient and performing an invasive procedures. Male nurse reports violence more than female nurse – ENA 2010

24. L ITERATURE & S TATISTICS In Malta

25. C URRENT S ITUATION

27. NO violence prevention programs. Low staffing levels.

28. C URRENT S ITUATION NO effective staff training in recognizing and coping with potentially dangerous patients.

29. C URRENT S ITUATION Inadequate security Cannot handle patients or relatives Cannot open the doors Not trained Everyone can be security When problems arises call police!!!! Police

30. C URRENT S ITUATION No education to the general public Very long waiting times

31. C URRENT S ITUATION Hospital layout – triage, close circuit, alarm button.

32. C URRENT S ITUATION There is a lack of institutional reporting policies; that is, the employee doesn't know HOW to report it. Some employees have a perception that assaults are part of the job.

33. C URRENT S ITUATION Some employees don't believe that reporting will benefit them or correct the situation. There are concerns that assaults by patients and visitors may be viewed as a result of poor performance or negligence of the employee.

34. T HE WAY FORWARD

35. The best way to minimize workplace violence is to plan and implement a prevention program. Emergency Nurse should play an integral part in this planning and implementation.

36. T HE W AY F ORWARD The plan should include: Environmental designs to provide a safe work place e.g. panic alarms, cameras etc. Ensure safe staffing patterns Adequate security measures Trainings to ALL workers to recognize and manage potential assaults.

37. T HE W AY F ORWARD Clear and consistent procedures should be in place to report violent incidents to their employer without fear of reprisal with adequate follow-up. Legislation that mandates and regulates safety standards and controls for workplace violence prevention should be strengthened and supported.

38. T HE W AY F ORWARD Zero tolerance policy for workplace violence should be in place

39. T HE W AY F ORWARD A professional debriefing and medical care for employees exposed to workplace violence with the option of obtaining further counselling. The security should be trained and equipped in order to handle all kind of situations

40. T HE W AY F ORWARD Stronger penalties for the people who conduct violence and/or aggression against any health care workers.

41. T HE W AY F ORWARD Educating the public about how the Emergency Department works TV Campaign against violence and aggression to the staff in A&E.

42. T HE W AY F ORWARD Emergency nurses should be involved in research that increases understanding of workplace violence to identify effective measures and strategies needed to prevent and mitigate violent incidents.

43. C ONCLUSION

44. Do not wait until it is too late Act NOW Act as a Changing Agent What can YOU do more? Everything is in YOUR Hands

45. T HANK Y OU