2023 14th Annual NUBE Conference

Without question, emergency departments around the world have been witnessing an increased number of workplace violence incidents. It is known that these incidents lead to physical injury, psychological injury, decreased work performance, and increased turnover rate amongst staff. Current “best practice” interventions found in the literature include high level/high cost system interventions such as de-escalation training, environmental safety assessments, use of safety duress badges, increased security presence, and flagging of patient charts in the electronic medical record (EMR). However, there remains a gap in the literature about how to mitigate workplace violence in a proactive, timely, and effective manner at a departmental level. We have developed a process that has led to quick improvements to increase safety, but also, one which we believe can be easily duplicated in other departments, to yield similar positive results. To be proactive in mitigating workplace violence, real time knowledge is critical. At our level 1 trauma emergency department in the Midwest, a group of interdisciplinary team members have developed a “just in time” WPV quality review process. Our intervention utilizes a collaborative approach, bringing together emergency department physicians, behavioral health experts, and emergency department nursing management to review every event which occurs each month in our ED in a mini-“root cause analysis”. Each event is fed into a database with pre-designed questions based on the literature regarding risks for WPV and intradepartmental processes. Once each discipline reviews the case, all recommendations are formatted into a 2 page document which includes basic information about the event, patient care/context/team factors that can provide opportunities for increased safety/education, “take away” education that can be immediately given back to staff, and administrative actions which may be needed. Once these events are summarized by the interdisciplinary team, this information and knowledge is disseminated to all emergency department staff through emails, huddles, staff meetings, resident meetings, and quality newsletters. Like any quality event, we believe it is important to dive deep into each specific incidence of violence to focus on the why as not every event has the same root cause. The triggers and response to a patient with autism versus a patient with schizophrenia versus an intoxicated patient are different. While these 3 groups are at risk for violent behavior, the proper approach and care differ; our intervention not only helps to narrow the root causes down, while being nimble enough that we can make quick changes or longer policy changes based specifically on our department’s needs. Our rapid-fire presentation will describe the creation of this intervention, the criteria we use to assess each event, some of the data we have been able to collect and monitor because we now use a standardized approach, and examples of some of the action changes which have been implemented since this process was started.

Learning Objectives:

1. Learners will be introduced to a framework to review violent events that can be immediately implemented in their own work settings.
2. Learners will be provided with an overview of high-risk factors which contribute to workplace violence events.
3. Learners will be introduced to simple “action items” which have been implemented to help prevent workplace violence.