to recognize when patients are start- ing to lose control of their emotions, which can lead to physical violence.” She plans to reeducate herself on de- escalation by taking another course, and then present what she learns to her ASC’s staff so they can better recog- nize when a situation is likely going to escalate and how to properly deesca- late that situation.

“Most important in physical vio- lence situations is not to respond with physical force as this usually makes the situation worse,” she says. Rodriguez also plans to work to ensure the issue receives ongoing attention. “Every month during staff meetings,” she says, “we address a particular topic. Responding to patient violence will be one of the topics addressed during a meeting. We will also provide annual online training. Even if we do not have an incident, I want to keep this at the front of my team members’ minds because you never know when one might occur.” Take the time to learn your state’s rules concerning workplace vio- lence, Coppo advises.


for example, instituted new proto- cols from the Occupational Safety and Health Administration concern- ing workplace violence in January 2018.” Those protocols require man- datory training in all employment facilities to help protect against vio- lence, not only against physicians and ancillary personnel, but also against patients or personnel by fam- ily members or third parties. “That means knowing how to antic- ipate a situation, defuse it and contact law enforcement for support, if neces- sary,” Coppo says. “If there is an inci- dent of violence, you want to be able to show that your facility has imple- mented all the required statutory pro- tocols and procedures.”

Assess Occurrences If your ASC experiences an incident of patient violence, set aside time to


To improve your ASC’s prepared- ness for possible patient vio- lence, consider the following:


Education and training provid- ed by local law enforcement

■■ Simulations and drills ■■


Conference seminars and web- inars on workplace violence

Online videos, such as “Run. Hide. Fight.” from the City of Houston

some time. The incident occurred when there was a single staff mem- ber with the patient.” In the interest of staff and patient safety going for- ward, the ASC changed its policy to stipulate that two staff members will always be assigned to patients with any history of aggressive behavior.

Weigh Legal Options

The culture of nursing ingrains that you should do no harm even if harm is done to you.”

— Stephanie Rodriguez, RN Parkway Surgery Center

carefully analyze what happened, Coppo continues. “Start with an ini- tial assessment of what led to the violence. You should first determine whether it was an intentional or sub- conscious act.”

Hold a meeting to talk about the

situation and what could have been done, if anything, to avoid the vio- lence, Rodriguez adds. “Were there warning signs that were missed? Steps that should have been taken to get the attacked employee out of harm’s way? Learn all you can from the experi- ence and identify whether there are changes you can make to policies and procedures to reduce the likelihood of another occurrence.” Following the incident at Foothills

Surgery Center, Tamburo Martini says the ASC revised how it assigns staff to patients. “The patient had a history of some aggressive behavior but we were informed that he had not shown any signs of this behavior in quite

When incidents of intentional patient violence occur, surgery centers will need to determine whether to press charges. That decision might not be easy to make, Rodriguez says. “As a nurse, you are trained to empathize with your patients because they are your patients and you are their care- giver. The culture of nursing ingrains that you should do no harm even if harm is done to you.” That said, this perspective is evolv- ing, she says. “Just because you are a patient does not make it acceptable to treat healthcare professionals in a derog- atory or violent way. I never pressed charges against anyone who attacked me in the hospital. If I was attacked here, I might consider otherwise.” Coppo advises ASCs to strongly consider pressing charges whenever a patient is intentionally violent toward staff or physicians. “The law is the law. There are laws against assault, battery and even just threats. There is no justification for personnel to be exposed to a hostile work environ- ment created by patients.” Tamburo Martini agrees. “Bar-

ring any extenuating circumstances, I would pursue punitive measures against a violent patient the same as I would if I experienced such an inci- dent outside of the ASC. As far as liti- gation, we have a very litigious society and litigation does nothing other than hurt someone financially. But we must make it clear that combative behavior is never acceptable.”


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