Study aims to improve handoff process to stem incidence of workplace violence

Violence in the workplace continues to vex the health care industry, putting the safety of health care professionals at risk every day. Surgeons who attend to victims of violent trauma and share bad news with patients and families, and health care professionals who have to face individuals who are intoxicated or who have mental health disorders are well aware of this challenge.

Prevalent problem

The Centers for Disease Control and Prevention defines workplace violence as the act or threat of violence, ranging from verbal abuse to physical assaults directed toward people at work or on duty.¹ Furthermore, the U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) reported that on average, from 2002 to 2013, incidents of workplace violence occurred in health care settings at a rate of more than four times that of private industry.²

In 2016, the Bureau of Labor Statistics reported a total of 16,890 workers were victims of trauma from nonfatal workplace violence.³ Of those workers, 70 percent were employed in health care or social services.³

OSHA updated its “Guidelines for preventing workplace violence for healthcare and social service workers” in 2015.⁴ In the guide, the authors said, “Health care and social service workers face an increased risk of work-related assaults resulting primarily from violent behavior of their patients, clients, and/or residents.”⁴ The following organizational risk factors for workers were cited:⁴

• Lack of facility policies and staff training that address the recognition and management of  escalating hostile and assaultive behaviors from patients, clients, visitors, or staff
• Work that occurs when understaffed, especially during mealtimes and visiting hours
• High worker turnover
• Inadequate security and mental health personnel on site
• Long waits for patients or clients and overcrowded, uncomfortable waiting rooms

With increased attention to workplace violence—as well as ways to improve processes geared toward supporting and keeping care workers safe—a study published in the February 2019 issue of The Joint Commission Journal on Quality and Patient Safety describes how a large academic hospital designed and tested a huddle handoff communication tool to improve its process for addressing the risk of violent patient events.⁵

New tool for successful huddles

In “Using a potentially aggressive/violent patient huddle to improve health care safety,” Larson and colleagues explain how a multidisciplinary quality improvement (QI) team developed a tool called the Potentially Aggressive/Violent Huddle Form, using two iterative Plan-Do-Study-Act (PDSA) cycles.⁵

This QI effort came in response to two patient safety incidents during a two-year period in which a patient became violent at the time of admission to the medical unit from the emergency department (ED).⁵

As part of the communication tool, an ED nurse initiated the huddle process by informing the admitting unit that a patient at risk for violence was being admitted. Then, the admitting care team called the team in the ED to ensure that both teams communicated and participated in the handoff together. The huddle process occurred for 21 transfers in the first PDSA cycle and for 18 transfers in the second.

The results were as follows:

• The ED nurses and care workers from the six medical units reported feeling safe during the transfer process 100 percent of the time during both cycles, compared with a baseline of 54.7 percent.
• From the first to the second cycle, satisfaction with the process in the ED improved to 75 percent from 53.3 percent.

These findings led the study’s authors to conclude that the huddle handoff communication tool and other methods to facilitate the transfer of potentially violent patients have the potential to decrease the number and severity of violent incidents in the workplace.⁵

The Joint Commission recently published a Quick Safety newsletter that focuses on de-escalation techniques in health care. The issue touches on assessment tools to identify aggressive patients, as well as several de-escalation models and ways to defuse aggressive behaviors. The Joint Commission also maintains a web portal for Workplace Violence Prevention Resources for Health Care, including presentations, research and more. Read more about the huddle handoff communication tool in the Journal.

Acknowledgment

The thoughts and opinions expressed in this column are solely those of Dr. Pellegrini and do not necessarily reflect those of The Joint Commission or the American College of Surgeons.

References

1. Centers for Disease Control and Prevention. National Institute for Occupational Safety and Health (NIOSH). Occupational violence. Available at: www.cdc.gov/niosh/topics/violence/default.html. Accessed March 25, 2019.
2. Occupational Safety and Health Administration. Workplace violence in healthcare: Understanding the challenge. December 2015. Available at: www.osha.gov/Publications/OSHA3826.pdf. Accessed March 25, 2019.
3. The Centers for Disease Control and Prevention. National Institute for Occupational Safety and Health (NIOSH). Occupational violence. Fast facts. Available at: www.cdc.gov/niosh/topics/violence/fastfacts.html. Accessed March 25, 2019.
4. Occupational Safety and Health Administration. Guidelines for preventing workplace violence for healthcare and social service workers. Available at: www.osha.gov/Publications/osha3148.pdf. Accessed March 25, 2019.
5. Larson LA, Finley JL, Gross TL, McKay AK, Moenck JM. Using a potentially aggressive/violent patient huddle to improve health care safety. Joint Comm J Qual and Pat Saf. 2019;45(2):74-80.