This week I am breaking down the recent study by the International Association of Healthcare Security & Safety Foundation’s titled Mitigating Workplace Violence via De-escalation Training by Abigail Shulman. While the paper provides a wealth of information related to de-escalation training and methods, it does not provide clear guidance on what specific steps should be taken. The author is careful to present information clearly and concisely without bias and leaves it to the reader to determine what may work best for them. The primary take away from her work is the critical need for accurate assessment and training of de-escalation tools in order to determine effectiveness. This clear message from the author makes it worth the read.
Ms. Shulman does an excellent job of presenting the need for de-escalation to control the rising violence in healthcare. She points to the extra-organizational pressures to move away from tools like restraint and seclusion, restricting them to last resorts measures. In my view, this is right on point as tools like restraint and seclusion are reactionary at best. To shift the focus to prevention, we must move away from reaction as a default response mode. The extra-organizational pressure from organizations like The Joint Commission (TJC) or the Center for Medicare and Medicaid Services (CMS) only helps us to move in that direction sooner rather than later.
The paper goes on to discuss areas of higher risk, and some of the key factors in those areas. These explanations are excellent for anyone who is looking to support and articulate the needs associated with high risk areas. Next, is a discussion on de-escalation frameworks. This is a robust discussion that covers information on three frameworks endorsed by TJC; Turnbill et al, Dix and Page, and Bowers Safewards. This section was extremely informative, and Shulman does an excellent job of identifying both the strengths and weaknesses of each framework. The next major section is a breakdown of accurately assessing aggression, and how staff members can determine if a patient is about to become violent. This discussion focuses on key warning signs, and assessment tools that help identify violence risk. For a more in-depth discussion on Violence Risk Assessment (VRA) tool look at my blog series on VRAs via the links below.
Ultimately, Shulman’s paper is extremely informative while remaining an easy read for anyone. I recommend it for every healthcare security leader. In conclusion she notes: “De-escalation training has promise for its potential to prevent violent incidents and diffuse incidents as they occur…”. I wholeheartedly agree. Take a read for yourself I’ve placed a link to the paper below.
What are your thoughts? What type of de-escalation tools and training do you utilize at your facility? Join the conversation in the comments below, and don’t forget to like, follow and share to support the proactive security blog.
Thank you for setting up this group, Mike and for the excellent content launch!
Don’t forget the original OSHA document. Although a bit dated, there are still valid key points: