Across UCHealth – a nonprofit system that includes 15 acute care hospitals in Colorado with affiliate sites in Wyoming and Nebraska – workplace violence prevention isn’t one person’s or one department’s problem to solve. Its Workplace Violence Prevention Program relies on a “triadic approach” of nurse, physician and security leaders to empower all staff to be prepared to prevent, respond to and review WPV incidents.
“Each discipline brings something to the team,” said emergency nurse Renee Schoenbeck, BSN, BA, RN, CEN, the program’s director, who noted the approach developed organically through the work itself.“
Nursing, physician and security leaders repeatedly found themselves solving the same complex problems from different vantage points and realized the strongest solutions came when all three perspectives were at the table,” Schoenbeck said.
The program includes use of the Broset Violence Checklist to identify risks early and the Stay Safe Huddles that bring the interdisciplinary team together around at-risk patients. All staff receive some form of de-escalation training. Mock escalation drills are conducted in high-risk areas or as needed, and de-escalation and weapons detection scenarios are embedded into some of the mock traumas and mock codes.
UCHealth Director of Security Operations Adam Smith, MSCJ, CPP, CHPA, said their triadic approach helped them understand one another’s roles. The physicians and nurses have the day-to-day view of patients and their medical needs, the ED in action and workflow, while the security team brings its unique understanding of concerns such as contraband, threat assessments, scene safety and collaboration with law enforcement.
“When a nurse or security asks a question, there is no longer an assumption that they are critiquing the response or overstepping their roles but are seen as a coworker seeking clarity and offering suggestions to try to make the situation better,” said UCHealth Security Smith said. “This partnership allowed our teams to finally come together as one team versus different camps.”
When incidents do happen, a comprehensive review process looks at clinical and security response, communications, the environment, procedures and policies. Reporting identifies emerging trends and tracks the completion of risk screenings, staff injuries and type of incidents.
Mike Mitchell, MD, MBA, FACEP, the physician lead for the program, has witnessed the way ED teams anticipate risks and identify measures to take before a situation becomes violent. He recalled a recent Stay Safe Huddle among the provider, security, nurse and behavioral health staff to plan for a patient with a known history of escalating during discharge.
“When the patient became verbally escalated and resisted direction during the discharge process, the team remained aligned and carried out the plan without having to determine responsibilities in the moment, and the patient ultimately left the property without injury or further incident,” Mitchell said. “Several years ago, a similar situation might have resulted in staff waiting until the behavior escalated and then turning to security to manage it.”
Added Schoenbeck, “Staff have absolutely reported a better relationship with security and have a better understanding of their roles and responsibilities. The communication is stronger between the teams, and staff report feeling safe, having the tools needed to respond to WPV, and having the necessary education.”
No Silence on ED Violence 