Bedside Risk Assessments, Part 4 – What’s the point?

Hello again, I thought we might take a break from our tour of violence risk assessments this week. I was thinking now might be a good time for a quick check-in on how things are going. As stated in my opening blog, I want this to be a forum for ideas and conversation on security best practices and violence prevention best practices. To that end, I started our conversation on bedside violence risk assessments with the aim of presenting a tool that I think has tremendous potential for arresting and reversing the rising tide of violence against healthcare workers. Give me a moment to make my case.

Most security and policing practice is designed to be reactionary. An event happens (in this case an assault of a healthcare worker) and security forces swing into action to help stop the violence and return everyone to a peaceful state. In many cases this works well, as training helps to mitigate crisis and the presence of uniformed officers can help calm all involved. But… there is a fundamental problem with this model, someone – the healthcare worker – still got assaulted. No matter how well trained, no matter how professional the response, if all your plans start with reaction then you are not addressing the violence at all.

So then, how do we address the problem? We have to better understand the predictors of violence and that can only happen with the successful risk assessment of each patient. As the famous Benjamin Franklin axiom suggests; “an ounce of prevention is worth a pound of cure”. Assessing risk is nothing new to security professionals. It is a core function, a foundational duty. We assess risk every day to help plan and prepare for all manner of physical security crisis. Why then are we so slow to adopt a bedside risk assessment tool to assess the potential for violence?

I would suggest that this is a function of two potential problems. Either, we (healthcare security professionals) don’t trust our bedside nursing staff, or perhaps they don’t trust us. In either case, it is the fundamental brokenness of our relationship that adds unnecessary barriers to the pursuit of collaborative tools. But, collaboration is exactly what is needed. No one department or group within a healthcare facility is going to solve workplace violence alone. To make a tool like this successful we need both security expertise, and we need clinical expertise. It is the melding of these two disciplines that makes violence prevention possible.

As I discussed in my introduction of the Aggressive Behavior Risk Assessment Tool (ABRAT), what makes a violence risk assessment really stand out is the clinical assessment. The ABRAT looks at both clinical history and current condition as part of the overall assessment. This extends the tools validity beyond the current state behavioral observations of the STAMP tool and the Bröset Violence Checklist, and incorporate knowledge of the medical contribution to the violent behavior. This is critical to success, and it is a knowledge base security cannot access without clinical support.

On the flip side of that argument is the need for professional de-escalation and proactive intervention. Nurses have enough to do with clinical assessment and ongoing medical care. Once the risk is known, they need to be able to rely on equipped professional violence preventionists. Care providers need qualified healthcare security professionals to help them provide care to high risk patients without allowing them to become victims.

This is the match, this is the team that is needed; operational experts on the clinical side working hand-in-hand with operational experts on the security side. Collaborative care that identified the threat early, and leverages the whole team to stop violence before it happens. How does this look in your facility? Does this vision of violence prevention make sense to you? Add your thoughts to the conversation below.

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