While hospitals across the country are acting to protect staff and patients from violence, state hospital associations are getting involved, too. For example, the Washington State Hospital Association (WSHA) is updating its “Preventing Healthcare Workplace Violence Toolkit” that it developed in 2017 in conjunction with the Alaska State Hospital & Nursing Home Association. (Read more about the toolkit at: https://bit.ly/2ETooj5.) The toolkit includes best practices, steps, and resources to help member institutions address the problem, but it also is part of a larger effort to assess the effectiveness of the various recommended approaches.

“To date, we have 85 member hospitals that are actively participating with us on this work,” explains Ian Corbridge, MPH, RN, a director at the WSHA who works on the safety and quality team as well as government affairs. “They are actively integrating the interventions within their systems, and they are providing quality metrics back to us at WSHA so that we can monitor progress and change over time.”

Corbridge adds that WSHA’s intention is to make meaningful modifications to the toolkit to ensure the resources and recommendations remain relevant and applicable to new issues and emerging trends facing hospital leaders and workers.

In addition to the toolkit, WSHA has created a new position of safety officer. This person is charged with working with member hospitals on reducing worker harm and ensuring employees are aware of the workplace violence toolkit and best practices for keeping healthcare workers safe. This work is targeted to smaller, critical access hospitals in the state, according to Corbridge.

“It is a great opportunity for us to make sure we are out in communities working closely with our members on behalf of the association,” he says.

One of the messages that the association has received from some of the smaller, rural hospitals is that they lack the tools and resources to provide de-escalation training to all the staff who could benefit from this type of instruction. Consequently, WSHA in the process of making such training available to member institutions at a lower cost.

“Members will be able to come here to WSHA to get the training, and some of it will involve the train-the-trainer model,” Corbridge explains. “The new safety officer will also be going out to our member hospitals and offering the training as well.”

Corbridge notes that roughly half of the 108 member institutions in WSHA are in rural areas.

“We have a very high number of smaller, critical access hospitals in the state ... so we are talking about a large number of member institutions that will directly benefit from this work,” he observes.

How to address the issue of active assailants is vexing for hospitals, Corbridge acknowledges. “Unlike other institutions where you may be able to have very strict policies or physical barriers, hospitals need to take pains to be an open place for community members to come,” he says. “We need to make sure we are there for our communities and have that open presence.”

However, some member institutions, especially in urban areas, have established a strong security presence, with some facilities using metal detectors at hospital access points, such as the ED. Typically, such measures are informed by data and events that have occurred at these facilities, Corbridge says.

“Member hospitals do have codes in place to make sure staff members know if an event is taking place, who needs to respond, and what type of response needs to take place,” he says. “Members are training staff per their individual policies and plans at their institutions for those codes.”

To assist hospitals and their employees in this work, the WSHA is partnering with an IT vendor to develop an electronic platform capable of providing notifications to providers if a patient has shown aggression in the past. “We are trying to make sure we are sharing information that may be relevant to the care team and their actions going forward,” Corbridge explains. “That is an opportunity for us to de-escalate situations before they lead to potentially an aggressive event.”