Practice of Medicine

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Preventing Workplace Violence: 10 FAQs and 6 Actions You Can Take

Executive Summary


As incidents of workplace violence increase in the outpatient setting, your staff should be prepared for any sudden or threatening situations that might arise. Staff members who can anticipate and quickly use emergency protocols can help ensure safety for both patients and colleagues. Following is a list of the most frequently asked questions we receive on workplace violence and actions you can take to prevent an incident.

Recommended Actions to Increase Workplace Safety

  •  Anticipate that workplace violence can occur and prepare response guidelines for different types of emergencies before they happen. 
  • Train all staff on emergency guidelines and provide ongoing training. Workplace violence training can include de-escalation techniques, active-shooter protocols and practice drills.
  • Consider implementing physical and routine safety measures, such as panic buttons, third-party alert systems, video surveillance and/or security personnel.

Top 10 FAQs


Unfortunately, workplace violence in healthcare is an increasing reality. This is especially true in the outpatient care setting, as it tends to be less secure and more vulnerable than others. Workplace violence can include emotional, mental, verbal and physical harassment or abuse as well as cyber bullying and online stalking. When a patient threatens violence in any form, a healthcare organization must focus on the safety of its staff and other patients.  

  1. What should I do if someone violently threatens a staff member over the phone or threatens to come in-person to the office?
    If a patient threatens a staff member on the telephone, that is equivalent to an in-person threat. Record the caller’s name, number and what they said. Let all staff members know of the incident and, depending on the seriousness of the threat, notify security or call 911. It is always better to err on the side of caution with unpredictable and threatening callers.
  2. When is it okay to terminate a patient’s care?
    You can terminate care if a patient harasses, threatens violence or behaves rudely to staff or other patients. The physician-patient relationship is voluntary for both parties, and so either side can terminate the relationship at any time. If they are a threat to safety, you do not have to give 30 days’ notice. To prevent the patient from returning to the office, you can send them their medical records via mail or email.
  3. Should I be cautious when terminating care?
    Yes. Be mindful that the issue that led to termination could trigger a medical liability action, a Medical Licensure Board complaint or other legal action. Additionally, termination of care must occur without abandonment or discrimination.  
  4. What should I do if someone continues to call and harass the office staff?
    First, notify the caller that their conduct is inappropriate, amounts to harassment and is impacting the ability of the organization to provide care to other patients. If the patient continues to call the office, consider blocking the number or obtain legal counsel to prepare and send a cease and desist letter.
  5. How can I best prepare my staff?
    Make them feel comfortable and confident with their ability to handle situations that could lead to workplace violence. This can be done by developing emergency guidelines and educating staff member about them. Workplace violence training can include de-escalation techniques, knowing when to call 911, following active-shooter protocols and practice drills. All employees need to know what to do in an emergency.
  6. What de-escalation techniques should I use?
    A variety of verbal and non-verbal techniques to build rapport with an upset patient can help ease tension and frustration. Active listening, maintaining neutral facial expressions and tone and creating a calm environment can usually de-escalate most disruptive patients. However, if a situation worsens, staff should be instructed on how to obtain support from a manager to assist with reducing conflict.
  7. Can I have security monitor the office?
    Yes. Hiring private security is a great way to make staff and patients feel safe while also cautioning upset people to not react violently. If private security will be on the premise 24/7, they can successfully establish a perimeter. Additionally, security can be used to safely walk patients and staff to their cars at night. Practices can also consider contracting private security for a limited time if a recent threat has occurred.
  8. What are some physical safeguards I can use?
    The layout of the outpatient office is crucial to maintain barriers from any threatening person that comes into the office. For example, while there should be multiple emergency exits in the lobby and waiting room, consider utilizing only one door from the waiting room to patient treatment rooms. This door should be operated by staff only, have key access and automatically lock behind anyone who walks through it. The reception desk can also serve as a physical barrier between staff and the waiting room. In addition, when nurses and physicians enter treatment rooms, maintaining a position close to the door will ensure that they have the ability to exit should a threat occur.
  9. What other security measures should I take?
    Using wireless panic buttons, a messaging/call system that alerts others or a security system connected to a third party can provide an additional layer of security. These mechanisms can be increasingly important in situations that involve firearms and immediate need to notify multiple people of a threat. Additionally, internal and external video surveillance systems are a great way to document threatening interactions that occur. Areas to observe include the reception desk, nurse stations, hallways, and all entrances and exits. 
  10. Can we prohibit patients and visitors from bringing firearms and weapons onto the premises?
    Even though states have differing open carry and licensing laws, you can prohibit firearms in your office. Politely remind anyone carrying a weapon that firearms are prohibited on the premises. Ask them to leave and return without the firearm. If they refuse, follow emergency guidelines to address the non-compliance or threat if applicable. (See below for more detail.)


Six Actions You Can Take to Prevent Workplace Violence

  1. To make it clear that you don’t allow firearms on your property, display notices on the outside of the building as well as on entry doors.
  2. Develop a script to offer guidance on talking with patients or visitors who bring firearms into your practice. For example, you can say, “Weapons are prohibited in our practice; please see the sign we have posted. Can you please safely store your weapon outside in your vehicle? If not, we would be happy to reschedule your appointment for another convenient day and time.” If you receive pushback, the staff can get assistance from a manager who can explain that the practice is private property and it is within their right and the law to designate it as a weapons-free environment.
  3.  If you feel threatened or believe that patients and staff are in danger, call 911 immediately. 
  4.  If you consider terminating care to a disruptive or threatening patient, call a MagMutual risk consultant to discuss the situation. 
  5. Supervise patients when they are in any area of the practice other than the lobby or waiting room.
  6. If you decide to implement video surveillance, here is some additional information to keep in mind:
    1. Place cameras only in open areas of egress, not in rooms where a person would have a reasonable expectation of personal privacy, such as exam rooms, bathrooms and changing areas.
    2. Do not use cameras to monitor or record patient care.
    3. Clearly post signage that notifies patients and visitors that video monitoring is underway.
    4. Determine who will have access to footage and implement secure storage safeguards.
    5. Create protocols around video footage retention. 
    6. Consult your MagMutual risk consultant before you release video footage to anyone.
Lessons Learned
  1. As a private business, you can take measures to ensure the safety of staff and patients, such as restricting firearms and other weapons.
  2. Always err on the side of caution; do not be afraid to call 911 if staff or patients feel threatened or unsafe.
  3. Physical barriers and safeguards increase security and can help staff members take appropriate action in case of emergency.

Potential Damages


Taking all possible measures to promote workplace safety is the best way to avoid liability if violence does occur because it reduces the chances of placing anyone at harm. Medical offices can be held liable for not ensuring a safe environment if they do not take the necessary precautions or potentially could have prevented harm. Employers should follow the recommended actions in this article to decrease liability exposure.


Quiz
Answers are provided below
True or false?
Question 1: You cannot prevent a patient from bringing a firearm onto the premises.
Question 2: Video surveillance systems are not allowed because of their invasive nature.
Question 3: All staff members should be routinely trained on all emergency protocols.
 
Answers:
Question 1: False. You can prohibit firearms and weapons in your medical office. Post signage inside and outside the building and train staff on how to address deviations from the policy among patients and visitors.
Question 2: False. Video surveillance systems are allowed in areas where there isn’t a reasonable expectation of privacy. Notices about the video surveillance system should be posted so patients and visitors are aware they are being filmed. 
Question 3: True. Staff should receive training on emergency protocols such as de-escalation techniques, active-shooter response and physical safeguards on an annual basis. Workplace violence training should be documented and maintained in the appropriate manner for your organization. 

07/22

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Disclaimer

The information provided in this resource does not constitute legal, medical or any other professional advice, nor does it establish a standard of care. This resource has been created as an aid to you in your practice. The ultimate decision on how to use the information provided rests solely with you, the PolicyOwner.