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Hospital killing focuses security concerns

Medical facilities nationwide are faced with maintaining security in face of several violent incidents

By JEFF AMY
Staff Reporter

From The Mobile Register - January 16, 2005 - Hospitals, being places that help people get better, traditionally haven't given much thought to stopping others from coming in to do harm.

But Friday's killing of Janice Marie Hollis at the University of South Alabama Medical Center was another example of the steady trickle of violent incidents that hospitals nationwide have confronted.

USA officials said after Hollis' death that they would re-evaluate security measures. But Jeff Aldridge, a hospital security consultant, said it's unusual for patients to be attacked in their rooms. Violent incidents, he said, happen most often in hospital emergency rooms.

"Hospitals do everything they can to protect the security of their patients, but hospitals are public places," said Rosemary Blackmon, a spokeswoman for the Alabama Hospital Association.

So, unless USA wants to fortify the hospital, there may not be much that officials can do to prevent similar incidents in the future. And pulling up the welcome mat at a hospital is likely to scare some patients and drive away others, said Aldridge, whose firm is based in Durham, N.C.

"Historically, hospitals have been reluctant to harden their target and put in a lot of security," Aldridge said.

On Friday, Janice Hollis, 62, was shot and stabbed multiple times, and her son, 30-year-old Tyrone Hollis, was arrested shortly after, police said. Tyrone Hollis is being held in Mobile County Metro Jail on a murder charge.

Police found a gun and knife in a stormwater drain in the vicinity of Mobile and Cotton streets, near to where Hollis was arrested and not far from the hospital, police spokesman Cpl. Marcus Young said Saturday.

Family members described Hollis as mentally unstable, and USA officials said Friday's killing shouldn't be seen as an indictment of hospital security.

"The public understands that domestic violence can happen anywhere," USA spokesman Bob Lowry said. "Whether it's here, whether it's another hospital, it can happen anywhere."

University officials acknowledge that USAMC, one of the school's three hospitals, is considered by many Mobilians as a caregiver for the poor and uninsured only, ultimately driving away paying patients and hurting the hospital's finances.

But another hospital killing happened Aug. 18. at Thomas Hospital in one of the area's most affluent communities, Fairhope.

There, 80-year-old Robert Duck shot his wife Maureen Duck in the head and then turned the same pistol on himself. Hospital workers didn't hear the shots, and a nurse discovered the pair when making a routine check.

Both Ducks, Loxley residents, died later that day. The couple's four children said they believed their father was motivated by a desire to end their mother's pain. Maureen Duck, though not terminally ill, had suffered pain including two major hip surgeries.

To some degree, violence in hospitals is a reflection of violence in society, Blackmon said. Because so many people carry around guns and knives, it's not unusual for the weapons to end up in hospitals.

For example, violence carried over to a hospital waiting room at Rush Foundation Hospital in Meridian, Miss., earlier this month. A man shot his wife in the leg on the morning of Jan. 9 and then shot himself in the head.

Later the same morning, police were called to the hospital's intensive care waiting room, where the man's son had been shot multiple times by one of the wife's relatives. The son died from his wounds.

The Joint Commission on Accreditation of Healthcare Organizations, which tries to ensure that hospitals, nursing homes and other facilities meet basic standards, requires hospitals to have a security plan. And USAMC, Thomas and Rush all had precautions in place at the time of their killings, including security guards and surveillance cameras.

But officials may have not anticipated violence in the places where it did happen. Trouble spots at the typical hospital are the emergency room and the psychiatric ward.

Aldridge said emergency departments are danger-prone because people there may have arrived as a result of domestic disputes or may be under the influence of alcohol or drugs. He also said the general stress of an emergency room may breed violence.

At the Meridian hospital, for example, the emergency room has metal detectors. That's one preventive measure that Aldridge often advises when recommending security measures.

A hospital in a small Minnesota city, screening for weapons in an emergency room only at night, found as many as 1,400 knives in a year. A Columbus, Ohio, hospital reported finding 4,000 suspicious metal objects a year at its ER metal detector.

Blackmon, the hospital association spokeswoman, said a few large Alabama hospitals, including DCH Regional Medical Center in Tuscaloosa, have emergency room metal detectors.

But metal detectors have disadvantages. They cost money, plus a hospital has to pay employees to man them. Those expenses can be unattractive when the alternative might be spending money on a machine that will bring in more patient dollars, Aldridge said.

Maybe more importantly, metal detectors don't exactly say, "Welcome." Though ubiquitous at airports, courthouses and other government buildings, they send a bad message for a health care institution: You may not be safe here.

Lowry said he didn't know whether USA had considered metal detectors in the past but said they would likely be examined as part of USAMC's security review. "Certainly all possible measures will be discussed," he said.

There are other things USA might consider. Tyrone Hollis, like other USAMC visitors, didn't have to register. Some hospitals require visitors to sign in.

Aldridge also says some of the responsibility lies with patients and their families, to warn hospital authorities if someone threatening might come in.

No matter what, though, he agrees that there are limits to what security can do. "It's almost impossible to prevent some things from happening," Aldridge said.


Patient claims to have bomb in emergency room

By Alexandra Fenwick
Journal staff writer
January 24, 2005 - A bomb scare at the Jersey City Medical Center early yesterday morning prompted an evacuation of the hospital's emergency room waiting area, hospital spokesman Bill Dauster said.

The waiting area was evacuated at about 2 a.m., after a woman told hospital security personnel that her bag had a bomb in it, Dauster said. Jersey City police were called, but before they arrived, staff had determined there was no bomb, he said. A man who was with the woman left before police arrived, Dauster said. The woman was admitted to the hospital and was still there last night, Dauster said, though he would not disclose her medical condition due to patient confidentiality.

Jersey City Police Capt. Jon Tooke said reports of suspicious objects have increased since the Sept. 11 terrorist attacks. However, even though no bomb was found, he praised hospital security personnel for taking appropriate precautions.

"We remind everyone, particularly private security personnel because they're our eyes and ears, to be very aware of things like unattended property," Tooke said. "There wasn't the level of concern before 9/11, it wasn't something people thought about a lot. But events around the world have raised awareness and have dramatically increased the level of cooperation that we enjoy now with private security."

Tooke says the proper protocol to follow if you discover a suspicious package is to call the police, clear the area and refrain from touching the package.

Unidentified man found injured

Police are asking for the public's help in identifying a seriously injured man who was brought into the Jersey City Medical Center early yesterday morning.

The man was found on Communipaw Avenue at about 2 a.m. and brought to the hospital with serious head injuries, apparently from a beating, JCMC spokesman Bill Dauster said.

The unidentified patient then underwent a neurological procedure and remains in critical condition, Dauster said.

The patient is described as a man of slight build and of average height, possibly in his late 60s, with a mole near his left eye.

Anyone with information is asked to call the hospital at (201) 915-2300.

- Alexandra Fenwick


Security, Stat!

By Marianne Klaas, R.N.

ED Safety requires cooperation between departments

Emergency departments in the post-9/11 world have found themselves becoming security posts, especially after campus lockdown hours. This new defense strategy in a world of weapons of mass destruction forces security staff and ED personnel to be experts in terrorism surveillance, mitigation and response.

The ED in this new environment requires health care security officers to function as a team with ED staff in heightened support of patient and staff safety, as well as quality care.

Core competencies
Most state relicensure surveys and hospitals accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) must be able to demonstrate a competent workforce that supports efforts of safety within the environment of care.

Hospital security officers, like the clinical staff, must be ready to prove, explain and demonstrate such competencies. What might these include?

First, there are basic skills, such as knowing the codes and how one's department should respond. These support the hospital emergency incident command system (HEICS), whether formally activated with HEICS vests and command posts, or informally activated for day-to-day emergent responses.

There are also the common patient response activities, such as violence prevention or patient/visitor/staff threat
response. This usually entails de-escalation techniques and/or up to full takedown and restraint application.

Additionally, security officers are enhancing their knowledge and performance with customer service techniques because they often find themselves as one of the first contacts or responders when events escalate out of control.

Thus, the following competencies and knowledge indicators are required of hospital security officers:

- HEICS. Security officers should know their roles and responses pertaining to the organization and how HEICS interfaces with community and regional disaster plans.

- Meet and greet. Officers should know key strategies of successful customer service, such as welcoming and screening patients or visitors.

- Environment of care and safety. Officers should know their basic roles and responses for each internal or external code or emergency, such as fire, infant abduction or mass casualty influx.

- Restraints. Officers should be able to discuss the hospital's philosophy and policy on restraints, including alternatives to and the application of restraints.

- Crisis and workplace violence prevention. Officers should be trained in key strategies to prevent or respond to workplace violence situations by staff, patients or visitors.

- Handcuffs and forensics. Officers should be trained in the proper use of handcuffs through an accredited law enforcement class as well as hospital policy on the implementation of forensic situations (e.g., guarding a prisoner).

- Weapons/drugs surveillance and confiscation. Officers should be trained on search and seizure methods for possible weapons or drugs.

- Local and state criminal codes and standards. Security officers should be versed or able to access resources to validate local and state regulatory standards.

Additionally, in support of threats of terrorism, security officers must also be able to lock down buildings, tunnels and skybridges quickly or with the aid of the labor pool or automated systems, control traffic and crowds for mass casualty influx, and participate in decontamination procedures following the associated respiratory and hazard communication standards. (The use of personal protection equipment is compounded by typical barriers, such as limited sight, dexterity, hearing, communication and heat stress/fatigue.)

The security department is expected to be in the throes of any mass casualty influx resulting from a biological, radiological or chemical incident. When posed questions on this, officers must be able to respond clearly, accurately and assuredly. It is fine to refer to reference material, but the basic responses and initial setup and procedures should be second nature when time is of the essence.

The following are some heightened competencies that are required of security officers post 9/11:

- Emergent lockdown procedures. Security officers should be able to physically lock down perimeter doors, tunnels and skybridges to secure the hospital building.

- Respiratory etiquette, respiratory standards and fit testing. Officers should be trained on Centers for Disease Control and Prevention (CDC) standards for respiratory etiquette applied to patients and visitors (e.g., donning mask for uncontrolled cough) as well as fit tested according to Occupational Safety and Health Administration or state agency standards.

- Traffic and crowd control. Officers should be trained in how to safely redirect traffic and control crowds as it applies to emergency management procedures and potential decontamination scenes.

- Setting up decontamination and hot/warm/cold zones. Security officers should be skilled in setting up and maintaining zones in emergency management situations.

- Donning personal protective equipment (PPE). Officers should be trained to don and doff appropriate PPE based on exposure risks per incident.

- Facility security. Officers should know how to mitigate and respond to facility security issues.

- After-hours visitor access. Officers should know how to control access to the hospital after hours, when most perimeter access points have been locked down.

- Heightened awareness of potential terrorist activities. Officers should be able to proactively assess potential acts of terrorism by completing weapons of mass destruction/terrorism awareness training courses.

'Proving' the competencies
How will officers and managers need to prove such competencies? The JCAHO's new tracer methodology means staff directly or indirectly associated with 11 to15 commonly admitted patients traced throughout their normal course of care will be asked to speak to skills, knowledge and interdisciplinary plan of care. (These 11 to 15 patient tracers are chosen through a method called the "priority focus process.")

ED staff and security officers will be interviewed and asked to contribute to this discussion. While tracing patient care, JCAHO surveyors will likewise trace system issues, such as safety, infection control, emergency management, leadership and competencies. A wealth of information is gleaned at each stage during a tracer.

Documentation is provided on-site instead of at scheduled interview sessions. Staff and managers must be able to support the process at the patient's point of care, but keep in mind that the JCAHO survey process is driven to interact at the staff level. Managers and supervisors will be held aside while surveyors focus on "front-line" staff. Personnel on duty will be expected to explain and show competencies.

The best way to get officers comfortable with this approach is to get them used to explaining what they do, why they do it, and how they know how and what to do. The manager's role is to provide requested documentation of proof. This applies to all staff, including part-time and agency or contract services.

Building teamwork
In addition to these individual department efforts, what else can security and ED staff do to enhance security in the emergency department?

It is imperative that security officers and ED employees function on a first-name basis and easily recognize each other, sense when help is needed and build a rapport early to ease tensions during critical situations (or during a survey). This can be accomplished by having security participate in change of shift reports (i.e., both departments share key issues that occurred over the past 8 to 12 hours), physical and personal rounds performed by officers and ED staff versus having them sit behind a security or nursing post, actively soliciting input from both the security and ED staff sides regarding how emergency events unfolded, and seeking ideas and involvement proactively instead of when things escalate out of control.

Other team-building tactics might include holding joint staff meetings or in-services programs (e.g., security officers can give classes on verbal de-escalation and ED staff can educate on the pain response). In-house experts from education, safety, accreditation or quality improvement can also be utilized to educate, drill or facilitate team learning activities.

The following is a summary of these and other activities designed to encourage teamwork-based security:

- Developing familiarity. Officers and ED staff should be able to identify other key workers by name and face.

- Shift reports. Security and ED staff can participate in change of shift reports to update on key issues.

- Rounding versus desk duty. Security and ED staff should make direct appearances within departments.

- Debriefing sessions. Security and ED staff can conduct debriefing sessions after emergent incidents to capture improvement opportunities and address critical incident debriefing needs.

- Encouraging proactive safety efforts. Security and ED staff can look for ways to become more proactive in safety and security.

- Jointly participating in staff meetings. Employees from both sidesmay co-participate in existing or special meetings to build knowledge.

- Offering in-services programs. Security and ED staff can offer in-services programs to educate each other on their areas of expertise and interest.

- Joining hospital activities as a team. Security and ED staff can jointly participate in activities such as walks, United Way challenges and picnics.

- Asking the hospital's organizational development or education professionals to develop programs. Both groups may utilize internal expertise for specific courses on personality, team traits and collaboration techniques to enhance teamwork and relationships.

- Utilizing the hospital's safety officer to build and drill procedures. The safety officer can conduct drills and training specifically for security officers and ED staff.

- Utilizing the hospital's JCAHO coordinator to better understand standards and elements of performance. The regulatory coordinator can conduct mock surveys incorporating security officers and ED staff.

- Packaging goals in terms of quality improvement and getting credit for efforts gained. Security and ED staff leaders can present indicators according to the hospital's performance improvement methodology.

- Soliciting input from front-line staff. Leaders should ask workers in both departments for input on policies and procedures because the employees know what will work.

- Using data to support the case for staffing, surveillance or other safety ideas for both departments. For example, a security standby for suicide watch could lead to hiring a social worker in the ED; or theft data could lead to procuring a portion of a security officer to do internal investigations.

- Tracking employee satisfaction. Leaders can monitor satisfaction scores as an indicator of interdepartment team building.

- Encouraging security and ED staff to complete incident reports to capture internal data for quality improvement. Staff from both sides should understand use of forms and routing to communicate concerns for improvement.

Collaboration is key
Now more than ever, there are many reasons and opportunities for security officers and emergency department staff to work collaboratively.

Department silos must be broken down and, in turn, every department should join forces to work in a smooth, interdisciplinary manner--clinical, nonclinical and volunteers alike.

When this happens, staff and patients will both reap the rewards.

Marianne Klaas, R.N., is director of accreditation and safety at Swedish Medical Center, Seattle. This article is based on her presentation at last year's annual conference of the International Association for Healthcare Security and Safety. She can be reached via e-mail at marianne.klaas@swedish.org.


This article 1st appeared in the January 2005 issue of Health Facilities Management Magazine.

 

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