The RL6 event reporting system is a versatile tool that all MelroseWakefield Healthcare employees can and should use not only to improve the quality and safety of patient care, but also to improve safety in the workplace. Sheila Giovannini, JD, risk manager, said, “Reporting adverse events and near-misses related to patient safety and the safety of our workforce brings opportunities for improvements and interventions to light.” Giovannini notes that workplace safety is defined more broadly than some employees may realize. Obvious safety issues to report include events such as needle stick injuries. But what about the agitated patient whose escalating behavior threatens a caregiver’s safety? “No one should be subjected to a physically or emotionally hostile environment or feel they need to suffer in silence,” said Giovannini. “In addition to calling a Code White to get help, employees who experience events like these need to submit RL6 reports so we are aware and can continue to implement strategies to reduce further incidents. We want employees to feel empowered, to support them and to let them know that resources are available to them.” All RL6 reports are reviewed daily and shared with appropriate managers for timely follow up. In addition, data collected through RL6 is analyzed to identify trends, monitor the effectiveness of interventions and plan next steps in the improvement process. “We rely on voluntary reporting,” Giovannini said. “The system is a way for people to feel comfortable raising any and all concerns – to have their voices heard. All employees have an important role in keeping patients, themselves and their colleagues safe from physical and emotional harm, and ongoing reporting is what drives positive change.” Ongoing safety reporting drives positive change for patients and caregivers Safety Counts ! Vol. 7, No. 4 July/August 2018 A newsletter highlighting safety at MelroseWakefield Healthcare Do you have a safety story to share? The SafetyCounts team wants to hear from you. Email us at [email protected]. Workplace violence initiatives align with The Joint Commission recommendations The Joint Commission publishes sentinel event alerts that “identify specific types of sentinel and adverse events and high-risk conditions, describes their common underlying causes, and recommends steps to reduce risks and prevent future occurrences.” The most recent alert addresses workplace violence in healthcare settings. “The term sentinel event is most often heard in reference to unanticipated events that result in serious harm to patients,” said Jessica Cummings, JD, risk manager. “Equally important are events that harm our employees.” In the alert, TJC suggests these steps: • Clearly define workplace violence and put systems in place that enable staff to report it, including verbal abuse. • Capture, track and trend all reports of workplace violence – including verbal abuse and attempted assaults when no harm occurred. • Provide appropriate follow-up and support to victims, witnesses, and others affected by workplace violence, including psychological counseling and trauma-informed care if necessary. • Review each case of workplace violence to determine contributing factors. • Analyze data related to workplace violence and worksite conditions to determine priority situations for intervention. • Develop quality improvement initiatives to reduce incidents of workplace violence. • Train all staff, including security, in de-escalation, self-defense and response to emergency codes. • Evaluate workplace violence reduction initiatives. MelroseWakefield Healthcare has already incorporated each of these suggested actions into its safety culture. “Our goal is always zero harm to patients,” Cummings said.“RL6 helps us capture, track and trend events; evaluate and follow up on individual incidents; measure the success of our improvement initiatives; and identify new needs.” MelroseWakefield Healthcare embraces a culture of respect and safety for all. These signs are posted throughout the organization to remind staff and visitors of our commitment to a safe environment.
Transcript
The RL6 event reportingsystem is a versatile tool thatall MelroseWakefieldHealthcare employees can andshould use not only to improvethe quality and safety ofpatient care, but also toimprove safety in theworkplace. Sheila Giovannini, JD, riskmanager, said, “Reporting adverse eventsand near-misses related to patient safetyand the safety of our workforce bringsopportunities for improvements andinterventions to light.”Giovannini notes that workplace safety
is defined more broadly than someemployees may realize. Obvious safety
issues to report includeevents such as needlestick injuries. But whatabout the agitated patientwhose escalating behaviorthreatens a caregiver’ssafety? “No one should besubjected to a physically
or emotionally hostile environment or feelthey need to suffer in silence,” saidGiovannini. “In addition to calling a CodeWhite to get help, employees whoexperience events like these need to submitRL6 reports so we are aware and cancontinue to implement strategies to reducefurther incidents. We want employees tofeel empowered, to support them and to let
them know that resources are available to them.”All RL6 reports are reviewed daily and
shared with appropriate managers fortimely follow up. In addition, data collectedthrough RL6 is analyzed to identify trends,monitor the effectiveness of interventionsand plan next steps in the improvementprocess. “We rely on voluntary reporting,”Giovannini said. “The system is a way forpeople to feel comfortable raising any andall concerns – to have their voices heard. Allemployees have an important role inkeeping patients, themselves and theircolleagues safe from physical andemotional harm, and ongoing reporting iswhat drives positive change.”
Ongoing safety reporting drives positive change for patients and caregivers
SafetyCounts!Vol. 7, No. 4 July/August 2018 A newsletter highlighting safety at MelroseWakefield Healthcare
Do you have a safety story to share?The SafetyCounts team wants to hear from you.
Workplace violence initiatives align with The Joint Commission recommendationsThe Joint Commission publishes sentinel event alerts that “identifyspecific types of sentinel and adverse events and high-riskconditions, describes their common underlying causes, andrecommends steps to reduce risks and prevent future occurrences.”The most recent alert addresses workplace violence in healthcaresettings. “The term sentinel event is most often heard in reference tounanticipated events that result in serious harm to patients,” saidJessica Cummings, JD, risk manager. “Equally important are eventsthat harm our employees.” In the alert, TJC suggests these steps: • Clearly define workplace violence and put systems in place thatenable staff to report it, including verbal abuse.• Capture, track and trend all reports of workplace violence –including verbal abuse and attempted assaults when no harmoccurred.• Provide appropriate follow-up and support to victims, witnesses,and others affected by workplace violence, including psychologicalcounseling and trauma-informed care if necessary.• Review each case of workplace violence to determinecontributing factors.• Analyze data related to workplace violence and worksiteconditions to determine priority situations for intervention.• Develop quality improvement initiatives to reduce incidents of
workplace violence.• Train all staff, includingsecurity, in de-escalation,self-defense andresponse to emergencycodes.• Evaluate workplaceviolence reductioninitiatives.MelroseWakefield
Healthcare has alreadyincorporated each ofthese suggested actionsinto its safety culture.“Our goal is always zeroharm to patients,”Cummings said.“RL6helps us capture, trackand trend events; evaluate and follow up on individual incidents;measure the success of our improvement initiatives; and identifynew needs.”
MelroseWakefield Healthcare embraces aculture of respect and safety for all. Thesesigns are posted throughout the organizationto remind staff and visitors of ourcommitment to a safe environment.
Home care setting poses unique personal safety challenges
Preventing and responding to escalating situationsMelroseWakefield Healthcare has a variety ofinitiatives and resources in place to keepemployees safe from harm, train employees tohandle potentially volatile situations, and supportemployees before, during and after episodes ofworkplace violence.“Employees in high-risk areas such as
Behavioral Health, the Emergency Departmentand Security complete Crisis Prevention Institutenonviolent crisis intervention training on anannual basis,” said Carol Plotkin, LICSW, executivedirector of Behavioral Health. “The course focuseson prevention and teaches proven strategies forsafely diffusing anxious, hostile or violentbehavior at the earliest possible stage.” The Code White team responds when a
hospital employee experiences an escalatingsituation and needs assistance. Managers fromany department may also request workplacesafety and de-escalation training in their areas. Allemployees also receive annual education inenvironmental risks to help keep them safe, suchas avoiding isolated areas, following parkingsafety protocols, and limiting access to potentialworkplace weapons such as scissors, heavy
paperweights, stethoscopes and neckties.Security will also provide personal alarms andaccompany employees to their vehicles onrequest. Response Violet, also covered in annualeducation, provides short- and long-termresources and support for employees whoexperience workplace violence.“Triggers of escalating behavior include
generalized fear of the hospital environment,getting bad news, physical or psychological pain,substance use and mental health challenges,”Plotkin said. “Any noticeable change in a person’sbehavior may be a sign of escalation.” Warningsigns include pacing, fidgeting, speaking tooloudly or too softly, or using profanity orthreatening language.Basic de-escalation techniques include
speaking in a calm, quiet tone of voice;approaching the person from the side rather thanthe front; and avoiding medical jargon. “We oftentalk too much and promise too much whensomeone is upset,” Plotkin said. “Myrecommendations are to talk less, listen more,stay compassionate and seek assistance fromother staff if needed.”
(Lto R) Danny Navarro and Rick Alford demonstrate self-defense techniques during thecourse designed for Hallmark Health VNA and Hospice staff.
By sheer definition of their roles, Hallmark Health Visiting Nurse Association and Hospicecaregivers have a constantly changing workplace. “Going into people’s homes poses a uniqueset of potential personal safety issues,” said Cindy Lyons, BSN, RN, director of clinical servicesfor Hallmark Health VNA and Hospice. “Although not prevalent, workplace violence is amongthose issues, so staff are trained – through orientation, in-services, NetLearning and othermeans – on an ongoing basis to identify, address and report situations that threaten theirphysical or emotional well-being.”Providing up to 400 visits on any given day, VNA and Hospice staff are trained to look for red
flags such as background yelling during a phone call, family dissention during a visit, a patientor family member exhibiting volatile behaviors, signs of illicit drug use, or the presence of aweapon or an aggressive pet in the home. “Sometimes we have to re-establish boundariesaround acceptable behaviors,” said Lyons. “Creating and implementing a behavior contract – adocument signed by both parties that outlines our expectations and the patient’sresponsibilities – is one of the tools we use to address safety issues.” All clinicians are alsotaught to keep their keys and their phones on their person at all times and, if they don’t feel safeduring a visit, to leave their equipment behind, say they need something from the car and leavethe home. Eighty percent of the VNA and Hospice staff also completed a voluntary self-defense
course designed by Lyons, her son and the owner of Defensive Edge Martial Arts Academy inWakefield. “The course taught practical skills including de-escalation techniques and conflictmanagement, how to approach agitated patients while avoiding being bitten or kicked, how to get out of different types of holds, and more,” said Lyons. “It was a great addition to ourexisting training.”
Get on board! Speak up when you see an opportunity to improve the
safety of patients, visitors and staff by submitting an RL6 report orspeaking to your manager.
SafetyCounts is published by the Culture of Safety Committee. Copy is reviewedand approved by committee members. MelroseWakefield Healthcare includes MelroseWakefield Hospital and Lawrence Memorial Hospital of Medford.
“Triggers of escalatingbehavior include generalizedfear of the hospitalenvironment, getting badnews, physical orpsychological pain, substanceuse and mental healthchallenges. Any noticeablechange in a person’s behaviormay be a sign of escalation.”
Carol Plotkin, LICSWExecutive Director, BehavioralHealth
