Case Studies

INTEGRIS Health - Significant Threats: Domestic Violence and Forensic Patients

Oklahoma City, OK

Domestic Violence
In preparation for domestic violence issues in the hospital – whether it directly involves a patient or an employee – INTEGRIS Health has created a Threat Assessment Guide, conducted training on conflict resolution with both clinical and security staff, developed a procedure for Enhanced Security Staffing Threats and created a special parking program for potential victims. Representatives from Human Resources, Nursing, the Women’s Center and Public Safety attended a conference on handling incidents where domestic violence spills over into the work environment.

When domestic violence is an issue for a patient or an employee, the Public Safety Department conducts an assessment of each situation to determine the level of threat, based on a review of the following information: (1) What the threat is, and whether it is specific or implied; (2) The identity and relationship of the target; (3) The suspect’s motivation; (4) The suspect’s ability to carry out the threat; and (5) The suspect’s criminal background or prior behavior.

If the potential threat is determined to be significant enough, precautions and actions are taken to mitigate the threat, including placing an armed officer at the site until the threat is diminished. If the potential victim is an employee, the hospital offers special parking, escorts to and from their car and, if necessary, a temporary transfer to another INTEGRIS facility.

Forensic Patients

Thirty percent of all hospital shootings involve forensic patients in police custody. In preparation, the hospital developed a training session for law enforcement and submitted it to the largest police agency in the metropolitan area. INTEGRIS also is submitting it to the State Law Enforcement Training Academy in hopes it will be incorporated into the Academy’s online training for all officers. The training includes information on the responsibilities of medical staff, security staff and police officers, as well as at shift change and a room safety assessment. The hospital also developed and circulated a training on forensic patients to the clinical staff. Just-in-time training is also provided to all staff caring for forensic patients.

In addition to the trainings, the hospital has modified the policy to empower clinical staff and security officers to address forensic safety concerns. An additional security officer is provided to focus on clinical and environmental safety when an extreme risk is present. Staff has developed a new procedure for sharing information on violent forensic patients with clinical and administrative leadership.

INTEGRIS Health has trained more than 500 staff on violence in the workplace, which includes a focus on domestic situations. They are averaging about 15 assaults on employees per month at their metro facilities, with emergency department patients under the influence of alcohol or drugs posing the most concern. Prior to the training, serious injuries had resulted from the assaults. However, since the system has begun offering the trainings and taking precautionary measures, no significant injuries to staff have occurred.

Lessons Learned
As a result of higher-acuity patients and challenges in staffing in some departments, many employees who are concerned about the issue of violence were not initially able to attend the trainings. To accommodate these employees, Public Safety moved the trainings from the classroom to the hospital departments. The trainings can occur during a shift change or a break – whatever works best for that department. All employees are paid for attending training. In addition, domestic violence and forensic patient violence are covered in the annual training that involves all employees. INTEGRIS Health is committed to maintaining a safe environment for patients, staff and visitors. The Public Safety Department budget has been re-evaluated annually and adjusted accordingly.

Regarding forensic patients in particular, clinical staff needed support and encouragement to report when a patient physically hurt them. Violence against nurses may be the most underreported violence, especially when the nurse has been in the profession for a long time. INTEGRIS Health has zero tolerance for violence against anyone in its facilities, so training all clinical staff to report all incidents has been included as part of the employees’ annual training.

The director of Public Safety for the system is a retired police officer, which helps him relate more easily to the police officers and contract security staff who must sit with forensic patients. At first, these police and security officers from outside the hospital did not understand the need for them to stay awake in the hospital room and keep watch over the forensic patient at all times. Also, police officers did not initially understand that, while the forensic patient is in the hospital, they must treat the patients in accordance with hospital policy while prioritizing safety. It took some additional training for these officers to absorb that the hospital is committed to keeping everybody safe – staff, visitors and patients – no matter what, and that using verbal skills to de-escalate a situation always comes first.

Future Goals
In response to rising domestic violence issues in our society, INTEGRIS Health has just begun working with the Women Centers in the health system to prepare them for Static and Active Situations in their areas. Training involves the following:

Static Situation Responses

  • Clinical staff communications to the dispatch center (full details)
  • Immediate communications between Public Safety and clinical staff
  • Concept of the more shared the information, the safer the environment for all
  • The often volatility of static situation – it can change from Static to Active in an instant

Active Situation Responses

  • Criticality of information to Public Safety dispatcher
  • Concept of “Walk & Talk” communications at the scene
  • Clinical supervisor’s role in protecting/isolating their staff
  • Public Safety’s response to the threat (no police involvement)
  • Public Safety’s response to protect the staff (police involved)
  • Debriefing and review after the threat is over

INTEGRIS Health is continuing to train the public safety officers to have a heightened sense of awareness about domestic violence and forensic patient threats, and to conduct a risk assessment to determine the best course of action to mitigate the threat.

Contact: Bo Boshell
Director of Public Safety and Integrated Support Services
Telephone: 405-919-3775

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