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December 9, 2019

'The scar is in your head': How Scripps Health is responding to rising health care violence

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    Workplace violence on average is four times more common in health care settings than in private industry as a whole, according to the Occupational Safety and Health Administration (OSHA)—and many hospitals are working to ensure their staff are prepared to deal with instances of violence, Heidi de Marco reports for Kaiser Health News.

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    The problem of workplace violence in health care

    Last year, Mary Prehoden, a nurse supervisor at Scripps Mercy Hospital San Diego, was attacked by a schizophrenic patient who was not taking medication to help manage his condition. The patient lunged at Prehoden, threw her to the ground, punched her, kicked her, and bit her hard enough to break the skin and ultimately leave a scar on her chest.

    "Even if I didn't have a scar, the scar is in your head," Prehoden said. "That stays with you for the rest of your life."

    Prehoden isn't alone, de Marco reports. A 2018 poll from the American College of Emergency Physicians of about 3,500 ED doctors found that almost 70% of respondents said violence in the ED has increased in the past five years.

    According to data from OSHA, about 80% of serious violent incidents reported in the health care workplace are caused by patients, while co-workers and students caused 6% of the incidents, de Marco reports.

    In California, hospitals are required to report the number and types of attacks that occur. In the state's first full report, 365 hospitals reported 9,436 violent incidents in the 12-month period ending on Sept. 30, 2018, de Marco reports. In a third of the reported cases, staff were punched or slapped, while 7% of the cases involved staff being bitten.

    For instance, Ryan Sommer, head of security at Scripps Memorial Hospital Encinitas, said violent incidents "happe[n] daily," with staff members "get[ting] punched, scratched, spit on, [and] yelled at." Sommer said the number of violent incidents at Scripps hospitals have been increasing—and the injuries that stem from those incidents are becoming more severe.

    But even though violence in health care settings has increased in recent years, the episodes still can take workers by surprise. "I don't know that you ever expect to have to defend yourself at your workplace," Prehoden said, adding, "It's not anything you're prepared for."

    How hospitals are responding

    In light of the issue, some hospitals are taking steps to try to curb instances of violence and help ensure workers are prepared to handle violent situations if they arise.

    For example, Scripps Mercy has implemented a variety of changes to help protect its employees, including a "rapid response" team consisting of staff members who attempt to defuse situations that could turn violent. Scripps also implemented a behavioral screening tool to help identify patients who might be more prone toward violence. Such patients are required to wear a green wristband, and a green peace sign is placed on their doors to alert staff, de Marco reports.

    In addition, all Scripps hospitals have security guards who wear stab-proof vests and are armed with stun guns, according to Janice Collins, a spokesperson for Scripps Health. The guards are permitted to use the stun guns only when they believe doing so is necessary to protect someone's life, de Marco reports.

    Other hospitals throughout California are implementing similar procedures to help reduce violence in the workplace, according to Gail Blanchard-Saiger, VP of labor and employment for the California Hospital Association. For instance, in addition to de-escalation and self-defense training, some hospitals have installed panic buttons, metal detectors, and security cameras, and have increased use of security dogs and police.

    For her part, Prehoden has attended de-escalation training and now serves on a rapid response team focused on defusing potentially violent situations in the workplace. Still, Prehoden says she continues to feel slightly on edge.

    "This cannot be the new face of nursing," Prehoden said. "We can't afford to lose our staff because somebody decides not to take his medication" (de Marco, Kaiser Health News, 12/6).

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