MUHC SERIOUS ABOUT SECURITY OF STAFF, PATIENTS:
We’re working to improve our ability to respond to — and prevent — violent situations, Martine Alfonso writes.
This week, a series was published by the Montreal Gazette examining the Sept. 2, 2017 attack at the Montreal General Hospital. We took this assault on staff very seriously and provided answers to the journalist’s questions.
As a teaching institution, we learn from such events and we strive to improve not only our ability to respond but, more important, to prevent.
A multidisciplinary team came together regularly to help improve security at the McGill University Health Centre. Here’s how far we have come since September.
Support: Our staff members are the backbone of our institution. They are moms, dads, sisters, brothers and friends who deserve respect. Following this incident, senior management met with the team seven times in one week to listen and respond to them directly.
Support also involved our employee-assistance team who came on site for five consecutive days for personal or group sessions.
In addition, the commissioner for a Respectful and Non-violent Workplace, who oversees the MUHC’s Respect and Civility policy, and our ombudsman provided eight sessions on deescalation techniques to all Emergency department staff.
Recent trends suggest health-care institutions will see an increase in the number of violent events.
Therefore, staff must be sensitized to the warning signs and the importance of declaring these events.
Training: At no point have we scaled back any Code White training for our teams, and certainly not for budget considerations!
The plan is to train 400 employees across the MUHC over the next few years in Code White procedures.
The MUHC recognizes training is essential to allow our personnel to safely intervene during potentially violent situations: necessary funding has been secured.
Over the past year, the Code White Steering Committee has evaluated training needs based on best practices with l’Association paritaire pour la santé et la sécurité du travail du secteur affaires sociales (ASSTSAS). Based on the review committee and employee feedback, the Crisis Prevention Institute (CPI) training program was chosen as the best fit for the MUHC’s needs: it targets patients experiencing trauma, head injuries, psychotic episodes and intoxication; it can be adapted to our medical specialties; and its content is more current, concise and includes an evaluation.
By next month, the last three of 11 trainers will have been certified to give CPI training. Other organizations have only one or two.
Recruitment for more Code White staff members has also begun, and the MUHC has hired a Code White co-ordinator to oversee training, team communication and evaluation of Code White responses.
Security guards: With regard to the number of guards, the MUHC lands within the average among health-care organizations. Our security budget has not been cut but rather increased since 2015.
We are conducting a risk analysis and best-practice review (including metal detectors) to establish how to best control access in the MGH emergency department and to ensure optimal safety throughout the organization. We have said it and I will repeat it: the MUHC does not preclude using any equipment per se; however, let the analysis be completed.
We now have extended the 24/7 security coverage that is already present in the main emergency department at the Montreal General. With two 24/7 guards — one in the main ED and one in the psychiatric ED — these security guards perform regular patrols, interact with the clinical teams and are supported by other hospital security guards in emergencies.
All guards are well-trained for their job. Following the Sept. 2 attack, one untrained guard from the Corps des Commissionnaires du Québec was placed in the emergency department, but she was replaced within an hour.
The MUHC also made the decision, at least a year ago, to hire an in-house manager to complement our existing security team at the Montreal
General instead of using the Corps des Commissionnaires, as most other Quebec hospitals do.
Code Whites: An emergency department in the downtown core, with a Level 1 Trauma Centre and a psychiatric ward, has a high risk for aggressive patient behaviours, and therefore a higher number of Code White calls.
The MUHC uses Code White as a preventative approach for crisis de-escalation. The message to staff is clear: Do not let stats restrict you — if you feel threatened, call a code!
Panic buttons: No malfunction of any panic button was reported on the night of Sept. 2. Personal panic devices are now tested daily. Since then, additional “talk through glass” has been installed in the nursing station with enhanced wireless connectivity, panic buttons have been added across the emergency department as well as strobe lights to instantly notify the team of a Code.
An emergency department psychiatry workgroup is finalizing a dangerosity tool that will be used by staff to recognize at-risk-of-violence patients, and flag them in our Med-Urge system.
With all these measures, we sincerely hope that this type of attack can be prevented. No one should have to be subjected to this kind of violence. We will continue to listen, learn and adapt to ensure the security and safety of our patients and personnel.
They deserve nothing less.