EP15EO

 

Culture of Safety EP15EO

 

1. Provide one example, with supporting evidence, of an improved workplace safety outcome for nurses, specific to violence (e.g., physical, psychological violence, threats of incivility) toward nurses in the workplace.

• Provide a copy pf the organization’s safety strategy.
• Nurse specific outcome data must be submitted in the form of a graph with a data table.

 

 

Example: Decreased Incidence of Physical Abuse Toward Nurses

The healthcare profession has become one of the most dangerous environments in regard to workplace violence. According to the Bureau of Labor Statistics, workers in the healthcare sector experience workplace violence-related injuries at an estimated incidence rate of 8.2 per 10,000 full-time workers. This is over four times higher than in the private sector. Identifying the root cause of violence toward healthcare workers and developing strategies to prevent violence are meaningful tools to address this issue.

 

Greenwich Hospital Safety Strategy
Greenwich Hospital, as a delivery network in the Yale New Haven Health System (YNNHS), adopted a Just Culture model as a safety strategy to support a safe environment for patients and employees. By adopting a Just Culture, “Yale New Haven Health System will strive to be at the forefront of safety leadership in this country and ultimately achieving our goal of zero harm to any patient or employee.”

 

In 2016, YNHHS established the Workplace Violence (WPV) Prevention Program. The goal of Greenwich Hospital’s WPV Prevention Program is to ensure and maintain an environment for employees, patients and visitors that is safe from threats, acts of violence and aggression, and any behaviors intended to create fear. The adoption of the Just Culture aligns with the WPV Prevention Program goals. (Evidence EP15EO-1, YNHHS Just Culture Just Culture Safety Strategic Plan 2019) (Evidence EP15EO-2, YNHHS WPV Prevention Workplace Aggression and Violence Prevention Policy)

 

In July 2019, Susan Burke, RN, COHN/CM Employee Safety Specialist, took the initiative to form a Work Place Violence (WPV) Committee at Greenwich Hospital (GH) and became the committee chair. After discussing goals and proposed interventions with senior leaders Anna Cerra, DNP, MSN, MSHA, RN, SVP Patient Care Services/Chief Nursing Officer, and Spike Lipschutz, MD, SVP Medical Services, Chief Medical Officer, Burke was given complete support for the initiative. Burke requested that a physician co-chair the WPV Committee with her, and Chris Davison, MD, Director of Emergency Department (ED), volunteered to do so.

 

Burke established baseline data to measure the current state and to be able to demonstrate the impact of the WPV Committee. In July 2019, there were three occurrences of physical abuse toward nurses, resulting in a rate of 0.6. This is measured as the number of events of physical abuse of nurses entered in the RLS reporting system divided by the total number of nurses employed at GH.

 

Goal statement
Decrease the rate of physical abuse toward nurses.

 

Participants

 

Work Place Violence Committee
Name/Credentials	Discipline	Title/Role	Department
Susan Burke, RN, COHN/CM	Nursing	Employee Safety Specialist	Occupational Health
Shelby Smith, BSN, RN	Nursing	Nurse Manager	Emergency Department
Anna Cerra, DNP, MSN, MSHA, RN	Nursing	SVP Patient Care Services/Chief Nursing Officer	Administration
Spike Lipschutz, MD	Medicine	Chief Medical Officer	Administration
Anne Marie Mcgrory, BSN, RN	Nursing	Director	ED, MSICU
Priscilla Sterne, DNP, RN, NEA-BC	Nursing	Director	Nursing Programs/Magnet
Helen Brugger, BSN, RN	Nursing	Clinical Resource Nurse, Clinical Nurse, Chair Quality & Safety Professional Governance	Long Ridge Medical Center
Dawn Schupp, RN, CCRN	Nursing	Clinical Coordinator, Clinical Nurse	Intermediate Care
Lisa Micelli, MSN, RN	Nursing	Bed Board Coordinator	Case Management
Barbara Leafe, MSN, RN, NE-BC	Nursing	Director	Medicine, GI, Women & Children
Erika Tubridy, BSN, RN	Nursing	Nurse Manager	Medicine, GI,
Peggy Lennon, MSN, RN, NEA-BC	Nursing	Director	Surgical Services
Kristina Capretti, MSN, RN, ONS	Nursing	Director	Oncology
Pat Basciano, BSN, RN, MNN	Nursing	Nurse Manager	Women & Children
Rose McElwain, BSN, RN	Nursing	Nurse Manager	Heart & Vascular
Helen Kimmons, BSN, RN, CAPA	Nursing	Nurse Manager	ASU, PACU
Mark Larobina	Security	Director	Security
Clarke Foster	IT	IT Specialist	IT
Kristin Browne, MSW	Social Work	Coordinator	Social Work
Jessie Riemer, MSN, RN, CPHQ	Nursing	Nurse Manager	Performance Management
Loretta Jacobs, MSN, RNC	Nursing	Education Specialist	Education
Anne Swallow, DNP, RN	Nursing	Director	Education
Chris Davison, MD	Medicine	Director	Emergency Department
Gladys Luz, BSN, RN	Nursing	Administrative Coordinator	Nursing
Barbara Flanagan, MSN, RN, CNL	Nursing	Education Specialist	Education
Carol Ann Doherty, BSN, RN	Nursing	Nurse Manager	Surgery
Sheila Finn, BSN, RN	Nursing	Clinical Coordinator, Clinical Nurse	Surgery
Angela Melwani	Human Resources	HR Specialist	Human Resources
Marcie Van Gieson	Human Resources	Manager	Human Resources
Maureen Revel, BSN, RN	Nursing	Patient Safety Nurse	Women & Children
Tom Milucci, DPT	Physical Therapy	Director	Physical Therapy

 

Description of the Intervention
August 2019
The Greenwich Hospital WPV Committee established a goal to reduce workplace violence through education, increased reporting, organizational support and other specified interventions. To demonstrate leadership support for this important new WPV initiative, the committee communicated to nurses and all staff members about its formation through daily huddles and at other committee meetings.

 

The committee identified strategies to decrease workplace violence and physical abuse and, based on these strategies, they targeted specific interventions that could be implemented quickly and have a significant impact on reducing incidents of physical abuse toward nurses and other staff members. These interventions included:

• Redesigning the Security Team to ensure CPI and de-escalation specialists would be stationed in the ED 24/7 to help mitigate and prevent escalating behaviors.
• The use of ED security specialists in the ED then enabled more security presence on other units and areas of the hospital. Security guards began more active rounding throughout the hospital.
• Posting YNHHS-approved signage in the ED reading, “YNHH is a healing environment. Aggressive behavior is not permitted on these premises.” The plan for posting signage throughout the entire GH premises will be finalized in early 2020.
• The committee reviewed the Clinical Institute Withdrawal Assessment for Alcohol (CIWA) tool and the relation between ethyl alcohol withdrawal and WPV. The committee identified a lack of consistent use of the CIWA protocol as one area of concern. To address this, Archer reinforced the use of the protocol with all GH physicians. Nurses were also educated by managers on the appropriate evaluation of a patient in withdrawal and the specific interventions per the CIWA protocol.
• The committee established the practice of a debrief after each WPV event, to include the employee and manager. The purpose of the debrief is to uncover any barriers or gaps that may have led to the event and any opportunities for improvement. In addition to the debrief, all employees who experience WPV incidents are referred to the Employee Assistance Program (EAP) and given an opportunity for peer to peer counseling

 

The above interventions were implemented by the end of August 2019.

 

Outcomes

The Work Place Violence Committee, in alignment with GH safety strategies, implemented interventions that decreased the rate of physical abuse toward nurses from 0.6 in July 2019 to 0.0 in September 2019, 0.0 in October 2019 and 0.2 in November 2019.

 

(Evidence EP15EO-3, Greenwich Hospital Rate of Physical Abuse Toward Nurses)