OR Manager - June 2018 - 9

Patient safety
These factors, along with the opioid
epidemic, may be fueling an increase in
disruption. " From working with frontline
nurses and hearing their stories, I can
say that they are feeling that there is
more disruption in recent years, " Halm
says. Results from a 2016 survey conducted
by Health Facilities Management
and the American Society for Healthcare
Engineering support that perception:
* 75% of respondents said that maintaining
security had become more
challenging in the past 2 years.
* 78% of responding hospitals conduct
security risks at least annually,
and 97% have workplace violence
policies.
Kevin Carroll,
EdD, FACHE
Statistics specifically related
to disruptive patients
and families are
hard to come by. Kevin
Carroll, EdD, FACHE,
vice president of behavioral
health services at
Unity Point, West Des
Moines, Iowa, notes
that one reason for the uptick may be
that people are now encouraged to report
these types of problems. " We're
just much more open now about the
struggles that departments face, " he
says. " People feel more comfortable reporting
things verbally and through the
computer tracking system we use. "
Most experts say incidents and reporting
of incidences have increased.
Sources of disruption
The Joint Commission's Sentinel Event
Alert summarizes factors associated
with healthcare violence, including:
* altered mental status associated
with dementia, delirium, substance
intoxication, or decompensated
mental illness
* patients in police custody
* being given " bad news " about a diagnosis
*
gang activity
* domestic disputes among patients
or visitors
www.ormanager.com
* presence of firearms or other weapons
*
understaffing, especially during
mealtimes and visiting hours
* lack of organizational policies and
training for security and staff to recognize
and de-escalate hostile and
assaultive behaviors from patients,
clients, visitors, or staff
* long wait times or crowding.
That last factor can be a particular
problem for the OR because of the
number of people waiting for their loved
ones. " People used to bring just one
family member, but now it's often a
large group-as many as 10 people, "
says Kaye Reiter, MSN, RN, NE-BC, vice
president for surgical services and women's
health services at Summa Health
in Akron, Ohio. Reiter attributes part of
the increase to the rise of outpatient
surgery. During the preoperative call,
staff encourage patients to have a limited
number of people accompany them,
but patients don't always do this.
More people can lead to more problems
and more noise. " It can become
like a family reunion, with people even
bringing in pizza because the cafeteria is
far away [from the waiting area], " Reiter
says, adding that negative family dynamics
can also erupt into loud arguments.
Children, unused to sitting still for long
periods of time, can become loud and
disruptive.
An organizational responsibility
The Occupational Safety and Health Administration
(OSHA), the states, the Joint
Commission, and safety associations
have weighed in about the responsibility
of organizations to protect employees.
Franchesca Charney, MS, RN,
CPHQ,
CPHRM,
CPPS,
CPSO,
DFASHRM, director of risk management
for the American Society for Healthcare
Risk Management, says that although
OSHA has no specific standard related
to workplace violence, the General Duty
Clause 5(a)(1) of the Occupational Safety
and Health Act of 1970 states employers
Franchesca
Charney, MS,
RN, CPHRM,
CPHQ,
CPPS, CPSO,
DFASHRM
need to provide employees with a place
of employment that is " free from recognized
hazards that are causing or are
likely to cause death or serious harm. "
According to the OSHA
website, the courts have
interpreted the general
duty clause to mean that
an " employer has a legal
obligation to provide a
workplace free of conditions
or activities that either
the employer or industry
recognizes as hazardous
and that cause,
or are likely to cause,
death or serious physician
harm to employees when there is a
feasible method to abate the hazard. "
Therefore, employers who have experienced
threats or workplace violence,
which certainly would include hospitals
and ASCs, need to, according to OSHA,
" implement a workplace violence prevention
program combined with training, engineering
controls, and administrative
controls. "
OSHA has an injury tracking system
where covered employers must report
incidents. (For more information, see
https://www.osha.gov/injuryreporting/
index.html.) In addition, organizations
can submit workplace violence data to
the National Institute for Occupational
Safety and Health's voluntary Occupational
Health Safety Network and receive
reports customized to their facilities.
OR leaders need to be aware of any
state requirements related to workplace
violence prevention programs. For example,
state laws in Washington, New
York, New Jersey, and Connecticut require
employers to provide workplace
violence education. California's law,
effective April 2018, was the first to
require hospitals to have a comprehensive
plan to protect clinicians from workplace
violence.
Joint Commission standards in
Continued on page 10
OR Manager | June 2018
9
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OR Manager - June 2018

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