As a hospital patient or visitor demonstrates escalating frustration or agitation, there may be a narrow, closing window to defuse the situation before violence ensues. At South Nassau Communities Hospital (SNCH) in Oceanside, NY, it’s time to call “Code Grey.”

Maureen McGovern, RN, CPHRM, director of risk management and patient safety officer at SNCH, also uses a specially trained team that responds to reports of a patient or other person exhibiting signs of potentially violent behavior. When healthcare workers recognize signs of agitation and a buildup toward violence, they call a “Code Grey” on the hospital intercom system. Employees with special training in de-escalating behavior and containment of violent subjects respond.

“All employees are trained in recognizing potential workplace violence and the availability of the Code Grey team,” McGovern says. “The team is called out most often for situations that do not result in violence, but we’re OK with that. There is no penalty for calling the Code Grey team.”

“Speak in a calm, clear voice”

Also, the presence of the Code Grey team often defuses a person who otherwise might have become violent, McGovern explains. A nurse may call the team for a disruptive patient who refuses to take medications, for example, and seeing the team there and ready to intervene might make the patient think twice about lashing out.

All nurse managers are trained for the Code Grey team, along with nursing supervisors, and many are certified in crisis intervention through the Crisis Prevention Institute in Milwaukee. Some members of the hospital’s security department also are certified in crisis intervention.

“They have been trained on what might trigger the situation to become violent and what techniques to utilize to calm the patient and avoid violence,” McGovern says. “For instance, they are trained to always speak in a calm, clear voice, always be polite, be aware of their own body language, listen to the person, and show confidence and compassion. They learn what the patient’s complaint is and restate it to ensure they understand, apologize if appropriate, and give the person options for how to resolve the situation.”

The team members also calmly but firmly outline the limits of what can be done to address the person’s concerns. At SNCH, the Grey Team is usually called out between 20 and 30 times per month.

Understanding what typically prompts a patient to threaten violence or act violently is important, McGovern says. In healthcare, the motivation might be pain, alcohol or drug withdrawal; a reaction to a medication; disregard of the person’s personal space; slow response to the patient’s needs; delirium and dementia; or a number of other causes.

Every Code Grey call is debriefed to determine how the process worked in defusing or containing the violence, and any injuries are studied closely to see if improvements in the process would reduce them. Very few Code Grey calls result in injuries, McGovern says.