Code Strong: An approach to creating a safe environment while caring for aggressive patients Abby Moog, MSW, LSCSW, LCSW Children’s Mercy Kansas City, Kansas City, Mo.
Introduction
Methods
Caring for aggressive patients can pose many issues and risks, the biggest risk being injury to staff or the patient/caregiver. Code Strong was developed after several staff members sustained injuries. Best practices were reviewed, which identified the lack of a protocol available to assist staff caring for aggressive patients.
A focus group came together to develop a protocol to protect staff and provide a safer environment for aggressive patients. • Code Strong was developed, which is similar to other codes throughout the hospital, ie: Code Blue, Code Pink, etc. • Code Strong deploys multiple staff members throughout the hospital to respond to the patient’s room and assist in deescalating the situation. • Staff members include the Hospital Shift Supervisor, Social Work, Security, Pharmacy, a hospitalist, a psychiatrist, charge nurse, bedside nurse, and facilities. • Identified need for protective equipment to keep staff and patients safe while a patient may be aggressive, including spit hoods, bite sleeves, and padded arm guards. • Ensured a “Disruptive Event” note would be documented in the EMR so all staff can see what occurred and have it carry across all encounters the patient has within the health system.
Objectives •Identify actions to decrease staff and patient injuries •Create a safer environment for staff, patient’s, and families •Staff will be able to identify warning signs and triggers, and apply appropriate de-escalation techniques when caring for aggressive patients
Outcomes •Two staff injuries since the implementation on August 1, 2018 •More resources available for immediate response to threatening or dangerous behavior, including staff trained to de-escalate the situation, protective gear for staff and patients, and creating a safer room for the patient •Staff have more awareness of triggers and warning signs of patients beginning to escalate their behaviors •Created a planning and debriefing tool to assist medical team and additional staff in caring for this patient throughout admission •Working to create “safe rooms” within the hospital
Overall, the implementation of Code Strong has created a safer environment for staff and patients/caregivers. Staff are better trained on how to interact with behavioral health and/or aggressive patients and how to de-escalate some situations. When a patient isn’t able to de-escalated, a team is in place to assist with additional resources. . Patients and families are safer and better cared for by having staff trained on how to care for this patient population. Although we don’t have any data prior to the implementation of Code Strong, it is our hope and belief that staff injuries have decreased and will continue to decrease after implementing Code Strong.