Here’s a checklist to prevent violence
Remove environmental factors in your ED that may provoke those with violent tendencies, urges Tracy G. Sanson, MD, FACEP, assistant medical director for the department of emergency medicine at Brandon (FL) Regional Medical Center. She recommends using the following checklist to prevent violence:
- Have greeters direct patients and family members.
- Give realistic expectations, and keep patients informed about delays.
- Provide consultants with specialized equipment, a quiet place to dictate, centralization of charts, and necessary paperwork.
- Have policies for dealing with patients in police custody, psychiatric patients for medical clearance, weapons and traffic in the ED, controlled access to the ED and hospital, police and security responsibilities, and response time to calls for help.
- Review incident reports to look for trends of involvement by ED personnel, then provide counseling and education.
- Provide a welcoming, calming surrounding.
- Reduce irritating background noise.
- Have clean waiting rooms and bathrooms.
- Have telephones and vending machines.
- Ensure parents control their children in the waiting room and the examination rooms. Consider a children-only room or volunteer "sitter" program.
- Install security lighting and protective barriers.
- Improve surveillance and your ability to monitor offensive behavior by positioning trained personnel in the waiting room and installing monitored security cameras.
- Develop safe money-handling procedures, such as having a locked safe box at the checkout desk and posting signage about the amount of cash on hand.
- Have trained and experienced staff.
- Increase staff at peak and night periods to reduce stress and delays and help meet realistic deadlines.
- Address adequate outside lighting.
- Examine and address employee isolation factors, such as staff who are isolated from the rest of the ED at registration or triage. Ensure they have a mechanism to immediately summon help, such as a silent duress button, and arrange escorts to parking lots.
- Provide security personnel.
- Request increased police patrol in the area.
- Post laws against assault, stalking, or other violent acts. Obtain copies of these from your hospital’s legal counsel.
- Post signs addressing on-site cash or narcotic availability.
- Control access to the ED by installing security cameras at all doors to monitor and deter "tag-along" entrances, installing locks requiring a swipe of an ID card, and having visitors obtain a pass and sign in with security.
- Review management strategy for layoffs and disciplinary actions to ensure the employee has had access to counseling services, confidential employee assistance programs, and community programs to assist in their transition.
- Ensure access to employee assistance program or other counseling program.
- Develop a policy regarding restraining orders. (For more information on restraint, see ED Nursing, October 2000 and December 2000.)
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