Huddle Up: Establishing Patient Behavior Expectations and Frameworks of Care to Improve Employee and Patient Safety

Description of the project: Awareness of workplace violence experienced by healthcare providers from patients is increasing across the nation. Emphasis has been placed on violence experienced by hospital and emergency department staff; however, these behaviors are becoming increasingly present in the ambulatory setting. Few resources exist to increase staff’s knowledge, skills, and abilities for addressing violent patient behaviors. This lack of resources often leaves staff feeling unprepared to manage challenging patient behaviors. A multidisciplinary work group was formed to address a gap in staff safety and comfort level when working with challenging patient behaviors in an ambulatory clinic. A literature review was conducted using the following search terms associated with workplace violence: challenging behaviors, staff safety, healthcare, interventions, prevention, ambulatory. Search results identified existing literature focus on management of patients in emergency departments and psychiatric settings. Little to no research was found for inpatient or ambulatory clinic settings. Our team collaborated with the organization’s violent patient work group to identify tools and processes that could be used to accommodate the unique workflows of the ambulatory setting. The work group partnered closely with administration to navigate the system of a large institution to implement ambulatory behavioral patient safety plans. A key component of the ambulatory behavioral safety plan is a multidisciplinary team huddle. The main goal of the huddle is to improve communication amongst team members to ensure both staff and patient safety.

Methods
• Completed learning needs assessment to obtain baseline knowledge regarding workplace violence
• Formed a multidisciplinary work group to develop interventions to address the learning needs
• Education sessions conducted on managing challenging patient behaviors
• Developed processes and tools for staff to use when interacting with challenging patient behaviors during clinic visits and telehealth, including a multidisciplinary huddle and form
• Identified champions to ensure engagement
• Incidents were monitored and evaluated by nursing leadership

Analysis: Staff safety and violent/behavioral patients are key initiatives in the department of nursing’s goals of the institution and nationally noted by The Joint Commission. Dissemination continues and ongoing education needs continue to be addressed. This communication process is the first step in creating evidence-based practice for the violent/behavioral patient in the ambulatory setting. Anticipated results from creating an ambulatory violent patient process include increased knowledge for addressing escalating behaviors, multidisciplinary staff engagement, proactive communication, and an increase in reported incidences.

Results: Prior to the implementation of the pilot, zero violent events were reported in the past year. During the first 3 months of the pilot, low numbers of incidents were reported. Four to six months post-implementation, incident reporting doubled.

Conclusion: Workplace violence has attracted a significant amount of attention and is a high priority for healthcare institutions and accrediting bodies across the country. Implementing a multidisciplinary work group in the ambulatory practice to address this issue can help prepare staff to successfully manage violent patient behaviors while maintaining patient and staff safety through education, tools, and standardized processes.