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COVER STORY


Treating Violent Patients


Adequate preparation and response required BY ROBERT KURTZ


S


tephanie Rodriguez, RN, has been punched, kicked and bitten. All these incidents occurred while she was working in the medical intensive care unit and emergency department at a hos- pital. While Rodriguez does not antici- pate similar experiences at Parkway Surgery Center in Myrtle Beach, South Carolina, where she oversees quality improvement, compliance and infection control, she is not taking any chances. “Our patients come to our ASC prepared for their experience with us,” Rodriguez says. “All their questions are answered before they walk in the door and they often have family with them for support. In most instances, the worst that will happen is a patient will become verbally abusive, perhaps because they may need to wait lon- ger than planned, but rarely will an incident become physical.” “Rarely,”


however, is not ”never,” so she cannot afford to be unprepared.


The threat of patient-related vio-


lence is an unfortunate reality that all healthcare providers—regardless of setting—must prepare for and confront pursuant to established violence-pre- vention protocols and procedures, says Carlo Coppo, a partner with the law firm of Nossaman LLP practicing in the firm’s Carlsbad, California, branch. One ASC that has firsthand expe- rience with a violent patient is Foot- hills Surgery Center in Boulder, Col- orado. In late 2017, a patient struck a charge nurse, says Lori Tamburo Mar- tini, CASC, director of operations for the ASC. Important to note, she says, is that not all patient violence is the same. “There are essentially two differ- ent types of incidents that can occur and should be distinguished from one another,” Tamburo Martini says. “You


14 ASC FOCUS OCTOBER 2019 | ascfocus.org


can have a patient who is committing an intentional act of violence. That is inexcusable. Then you can have those patients who may have a medication- driven reaction, such as confusion when coming out of anesthesia, or have a physical or mental condition, as was the case with our incident, that contrib- utes to an accidental violent act.”


Shine the Spotlight Considering her past experiences with patient violence, she wants to raise awareness of the issue with her team, says Rodriguez, who joined Park- way Surgery Center in January 2019. While the surgery center’s handbook addresses workplace violence, includ- ing patient violence, she is planning to devote more time and resources to preparing the ASC’s staff for possible incidences of violence. “Years ago, I took a de-escalation


course,” she says. “What I learned is that to reduce the likelihood of a vio- lent patient incident, you must be able


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