24/7 'lockdown' helps ease staff's concerns
Safety, privacy are reason for magnetic locks
In response to concerns voiced by staff members about their own safety and that of their patients, and a desire for greater patient privacy, the treatment area of the ED at Central Vermont Medical Center (CVH) in Berlin has, in essence, been put on a full-time modified "lockdown."
Family and friends still can enter the patient treatment area, but only if they are buzzed in by staff or one of the staff swipes his or her badge in front of one of the ED's six doors that are secured by magnetic locks 24/7. The waiting area still is open to the public.
Many EDs have gone to locked doors, but industry experts say such moves are undermined by inconsistent policies concerning when the doors may be open. That is not the case at CVH.
"The doors are locked all the time," says Phil Brown, DO, the department's medical director, who notes there are only two exceptions. If an internal fire alarm goes off, the doors unlock. Also, if, for example, a demented patient tries to get out and pushes on a fire exit bar and holds it, it will open after 20 seconds. However, an alarm will sound, alerting the staff that someone is trying to leave.
A staff request
That change was staff-driven.
Brown says, "Vermont has probably been fortunate in that there has been a delay in how crime and difficult patients have impacted the ED, but over the last few years there has been an increase in the frequency of patients who had to be confined within the ED and the need to keep the wrong people out. The staff were feeling unsafe about those patients who had to be confined because, as a psych receiving hospital, we had depressed and suicidal patients who would elope."
Confused and demented patients also were a concern, says Derek Kouwenhoven, BSN, the ED's nurse manager. Kouwenhoven adds that previously, patient privacy was not possible, with patients potentially exposed to violent or disruptive behavior by other patients or lying on beds in hallways. In the past, Brown explains, psych patients on occasion did elope from the triage area into other parts of the hospital. "Prior to this, there was no way to control flow in and out of the ED, and they certainly could have entered patient treatment rooms or disturbed patients in the hallways," he notes.
As administration was well aware of these concerns, says Brown, "not much of a sales pitch needed to be made." In fact, he says, the locks were paid for by the hospital even though the money had not been budgeted. The system involves products from three manufacturers. The badges and readers, called the "Interflex" system, were provided by Synergy Software Systems of Dubai. The door openers were from Stanley Associates in Arlington, VA. The locking mechanisms were from Schlage Locknetics in Forestville, CT. The entire system cost in excess of $30,000.
Access is restricted
Under the new system, only staff members with badges can freely access the treatment area. In order for family members to enter the area, a staff member must "swipe" them in with their security badges.
"The badges are for staff only, although that expands into EMS and a limited number of swipe cards per transporting ambulance team," says Kouwenhoven. In addition, the charge nurse has access to a button at her station that allows her to "buzz" in people. There is no other way for unauthorized individuals to enter or exit the department, notes Brown.
To prepare patients and family members for this change, the hospital's communications department issued news releases to the local press so that it could be publicized ahead of the transition, which took place a few months ago.
"We try to be as user-friendly as possible to patients and family who want to come and go," says Brown. "Commonly, the biggest problem is anticipating that a family member might want to leave." In addition, he says, there is signage posted in the department informing patients and family that they need someone to badge them in or out.
"Patients are still a bit mystified about it," Brown concedes. "We have signage on all the doors that I think is fairly clear, but the more I look at the patients, I'm not sure they read them."
The staff, however, went through an orientation program before the locks were installed, part of which involved dealing with patients and family members. "We have a registration person up front — a greeter, if you will — who does quick registration," Brown explains. "They are also supposed to talk about the system and how family members and friends will be allowed to be brought in."
The education process is ongoing, Brown emphasizes. "If I go in and see a patient and they have a whole cadre of family members there, I let them know we are here to help them," he says. "I tell them to inform the charge nurse if they want to come and go, and they will be glad to help them."
That process will be even easier in the future, as the charge nurse will be given a remote control device from Stanley to open and close the door, so she no longer will have to be at her station to buzz people in and out. Kouwenhoven says, "This will also help when we have stretchers coming through the door. Before, we would have to have done it manually."
Resources
For more information on badges and readers, contact:
- Synergy Software Systems, P.O. Box 7780, 303 Al Khaleej Building, Karama, Dubai, United Arab Emirates. Phone: 00971 04 3374282. Fax: 00971 04 3379885. Web: www.synergy-software.com/default.htm.
For more information on remote door openers, contact:
- Stanley Associates, 3101 Wilson Blvd., Suite 700, Arlington, VA 22201. Phone: (703) 684-1125 Fax: (703) 683-0039. E-mail: [email protected]. Web: www.stanleyassociates.com.
For more information on locking mechanisms, contact:
- Schlage Locknetics, Ingersoll Rand Security Technologies, Schlage Electronic Security, 575 Birch St., Forestville, CT 06010. Phone: (866) 322-1237. Fax: (866) 322-1233. E-mail: [email protected]. Web: www.locknetics.com.
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