Patient-Induced Trauma: Hospitals Learn To Defuse Violence

SAN DIEGO — When Mary Prehoden gets dressed for work every morning, her eyes lock on the bite-shaped scar on her chest.

It’s a harsh reminder of one of the worst days of her life. Prehoden,
a nurse supervisor at Scripps Mercy Hospital San Diego, was brutally
attacked last year by a schizophrenic patient who was off his
medication. He lunged at her, threw her to the ground, repeatedly
punched and kicked her, and bit her so hard that his teeth broke the
skin and left her bleeding.

The incident lasted about 90 seconds, but the damage lingers.

“Even if I didn’t have a scar, the scar is in your head,” said Prehoden, 58. “That stays with you for the rest of your life.”

Violence against healthcare workers is common — and some say on the rise.

According to the Occupational Safety and Health Administration, workplace violence is four times  more
common in healthcare settings than in private industry on average, yet
it still goes underreported. Patients account for about 80 percent of
the serious violent incidents reported, but stressed-out family and
friends also are culprits. Co-workers and students caused 6 percent of
the incidents.

In a 2018 poll  of about 3,500 emergency room doctors conducted for the American College of Emergency Physicians, nearly 70 percent said violence in the emergency department has increased in the past five years.

About 40 percent of the doctors believed the majority of assaults
were committed by psychiatric patients, and half said the majority were
committed by people seeking drugs or those under the influence of drugs
or alcohol.

In California, a state law  requires
hospitals to adopt workplace violence prevention plans and report the
number and types of attacks to the state. The state then compiles the
data into annual reports.

In the first full report, 365 hospitals tallied 9,436 violent incidents  during
the 12-month period that ended Sept. 30, 2018, ranging from scratchings
to stabbings. Workers were punched or slapped in one-third of the
assaults and were bitten in 7 percent of cases.

“I don’t know that you ever expect to have to defend yourself at your
workplace,” Prehoden said. “It’s not anything you’re prepared for.”

Scripps Mercy Hospital officials have made a number of changes to
help protect employees from what they refer to as an epidemic of
violence. They’ve launched a “rapid response” team made up of staff
members who try to defuse potentially violent situations. And the
hospital has introduced a behavioral screening tool to help identify
patients prone to violence. When patients get flagged, they must wear a
green wristband, and a green peace sign is placed on their door.

Ryan Sommer, who is the head of security at Scripps Memorial Hospital
Encinitas, leads violence de-escalation training for Scripps staff at
different locations throughout San Diego County.

On one recent morning, about 20 employees at the Encinitas facility
learned how to deter an agitated and combative patient. One tip Sommer
shared: Behavior influences behavior, so listen with empathy and
establish a personal rapport with the patient. And, he told them, don’t
lose your cool; the goal is to get agitated patients to calm down.

Sommer also taught self-defense tactics should the situation
escalate. In groups of two, employees practiced how to disengage from a
hold and block strikes from an attacker.

“How many of you have been attacked on the job?” Sommer asked. Nearly all the participants raised their hands.

“This happens daily. They get punched, scratched, spit on, yelled at,” he said later.

Sommer said the number of violent incidents at the Scripps hospitals is rising and the injuries are becoming more severe.

Since earlier this year, security guards at all Scripps hospitals
have been armed with stun guns, said Janice Collins, a spokeswoman for
Scripps Health. They wear stab-proof vests and are stationed
strategically around the facilities. The stun guns are used when
security guards believe they are needed to protect life, Collins said.
Prehoden’s situation would have met that criteria, she said.

Hospitals across California are taking similar measures with the hope
of reducing violent confrontations, said Gail Blanchard-Saiger, the
California Hospital Association’s vice president of labor and
employment.

Some sites use panic buttons, metal detectors, security dogs,
increased police presence and security cameras, in addition to
de-escalation training.

The efforts vary by location and risk, Blanchard-Saiger said.

Additional support from local law enforcement would make a
difference, she said. “Unfortunately, I’ve heard plenty of stories where
they don’t even come to the hospital,” she said. “They’re
short-staffed, underfunded. They’re prioritizing.”

Prehoden has attended the de-escalation training and is now on the rapid response team at Scripps Mercy Hospital.

It took her three weeks to return to work after she was beaten in
August 2018. A nurse for almost 40 years, she admits being a little on
edge now, and feels as if her attacker robbed her of her confidence. He
served six months in jail for the attack.

“This cannot be the new face of nursing,” Prehoden said. “We can’t
afford to lose our staff because somebody decides not to take his
medication.”

This story originally was published on California Healthline, a
service of the California Health Care Foundation, then republished on
Dec. 6, 2019, by Kaiser Health News