Mitigating Workplace Violence at Ambulatory Care Sites
Healthcare organizations often overlook the security needs of freestanding clinics and offices. These best practices will help you address the risks.
Freestanding healthcare clinics have their fair share of security issues. Fortunately, there are many best practices designed to keep clinicians and patients safe.
Clinicians Have Options When Dealing With Drug Seekers
Physicians and other practitioners authorized to write prescriptions are also provided with education on how to manage aggressive drug seekers who threaten, verbally infer or non-verbally express a willingness to harm clinicians if their demands are not met.
Many practitioners believe their only options are to refuse so they protect their license, which means they are taking the risk of being harmed, or to write an unnecessary prescription, which violates their professional ethics. However, practitioners do have another option.
In working with our county district attorney, we learned that if a practitioner reasonably believes he or she will be harmed if he or she does not comply with a drug seeker’s request, the practitioner may issue the script and then call the police to report that they were criminally coerced. If a specific verbal threat was made, it is a rather simple matter of reporting to the police what was said by the patient. If the threat was inferred or communicated non-verbally, the practitioner needs to describe any threatening non-verbal gestures or cues given by the patient, and the situation that created the safety concern (e.g. alone with patient, patient’s size, gender, fitness, etc.).
Police refer to this as the “totality of the circumstances,” which helps to justify a chosen course of action taken by a person who was criminally coerced. The practitioner needs to document the incident as soon as possible to capture important details that may be quickly forgotten. The documentation is even more credible if it is included in the patient’s medical record.
Charges do not have to be pressed if the practitioner is satisfied with police contacting the patient. The patient is unlikely to repeat the behavior at the same location after being contacted by the police, even if they are not arrested. This solves the issue of developing a reputation for being a place to get drugs on the street and avoids having the practitioner place him or herself at risk or compromise his or her professional standing.
Consider the Use of Safe Rooms and Securing-In-Place
Secure-in-place locations and safe rooms should be designed proportionately to the risk. Out-of-control assaultive persons are an everyday risk, but the risk of an active shooter is far less common. Depending on a specific risk/benefit analysis, an organization may elect to create rooms that can resist bullet penetration or protect against severe weather.
In any case, all freestanding locations should have a room where staff can flee from a physically assaultive person. These rooms can also be used to flee from armed persons if staff are trained where to position themselves to minimize the possibility of being struck by a bullet. At a minimum, basic secure-in-place locations should be lockable from the inside, resistant to being forced open (solid wood or metal door in a metal frame), have hinge pins protected against removal, have no exterior windows or limited visibility/access from the outside and be equipped with a telephone or alarm mechanism to summon for help.
There already may be ideal spaces that c
ould serve as ready-made safe rooms. Radiology imaging rooms are a good example because they have lead-lined walls and doors that are naturally resistant to bullet penetration. Additionally, these rooms usually have a phone and no outside windows.
To help staff identify safe rooms and secure-in-place locations during high stress situations, St. Luke’s has developed a wall-mounted sign modeled after the types used to help staff locate fire alarm pull stations and fire extinguishers at a distance down a corridor. These signs display our corporate logo on a yellow background, but don’t have wording that tips off the uninitiated as to their meaning. Employees are trained to look for these signs, and the signs also help to serve as a continual reminder where to secure in place during a dangerous situation.
Panic Buttons Can Be Cost Effective
Panic buttons are another item to discuss in some detail. Internet protocol (IP) addressable systems that generate computer screen “pop-up” alarm messages to remote PC workstations from front line locations are cost effective alternatives to hardwired panic alarms. The cost of having to install and pay central station monitoring fees for many individual alarm systems is avoidable by using one IP-based software solution.
It is important to note, however, that if an intrusion alarm system is currently in place, only a minor installation cost would be charged to add a panic alarm to an existing system, and this is preferred over an IP solution. Hardwired panic alarm systems tend to be more reliable; whereas IP-based systems have more potential for failure due to technological complexity. Monthly testing and equipping of multiple computer workstations as a redundancy helps to increase operational reliability of IP systems. As always, investments in security technology need to be proportional to the risk.
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