Using Code Words for Violence Prevention
Nationwide Children’s Hospital (NCH) in Columbus, OH, takes a proactive approach to violence, which is especially necessary because the facility treats a high number of young people for behavioral health issues.
The hospital’s response plan for violence uses the name “Code Violet,” notes Dan Yaross, MSM, CPP, CHPA, director of security at NCH. A violent patient will prompt staff to call a Code Violet, and that brings representatives from several different departments to help.
The Code Violet response alerts a security offer, nurses, a member of the hospital’s behavioral health crisis management team, the attending physician, and a pharmacist who can provide sedation if necessary.
“Everyone has a role, and we also have enough people to implement safe holds if necessary,” Yaross explains. “De-escalation is the goal, but if we have to go hands-on, we need a number of people with the right training to do that. There’s a specific procedure for controlling each limb and securing the head so they don’t slam it on the floor, and the people on the response team have that training.”
NCH uses a broad definition of violence or aggression that may require intervention, Yaross says. In addition to physical violence, aggression includes verbal threats or passive-aggressive comments suggesting a threat, yelling, throwing objects, and body language. All NCH employees have been trained to recognize the signs of potential violence and are authorized to call for help.
“Every employee is authorized to activate Code Violet whenever they see the need,” Yaross says. “We don’t restrict that to just certain people like supervisors or someone else with authority.”
For violent persons other than patients, the staff calls a “Code Violet — Security,” which alerts a security officer and, in the evening, the nursing supervisor who is in charge of the hospital at night when administrators are away. These incidents may involve siblings and parents, other visitors, and people who have no business at the hospital but come in off the street and cause a disturbance, Yaross says. The hospital also notifies the social work department after an incident with a non-patient so they can follow up with family members if they were victims, or with unrelated patients or visitors who may have witnessed the violence.
NCH made the program more proactive over the past couple of years after witnessing harm to employees that could have been mitigated if staff had known certain information beforehand, Yaross says. The hospital now documents any Code Violet in its electronic medical record system, and that puts a purple warning banner on the patient’s record. In the notes section, the hospital details the nature of the incident, what triggers to avoid, and anything else that might prevent or de-escalate violence.
Nationwide Children’s Hospital takes a proactive approach to violence, which is especially necessary because the facility treats a high number of young people for behavioral health issues.
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