EXECUTIVE SUMMARY
A state psychiatric hospital made significant improvements to staff members’ security and safety after a psychiatric patient killed a staff member. A key improvement was providing staff with better personal panic alarms.
- The tech had a personal alarm, but it did not work outside the building, where she was killed.
- The hospital also developed a committee to develop ways to better assess and treat violent patients.
- Staff members were made more available and visible in treatment areas
where violence could occur.
A California state psychiatric hospital has improved the personal security systems for its staff members and revamped how it assesses potentially violent patients, with the changes coming five years after a technician was killed on the hospital grounds by a patient.
Napa State Hospital is a psychiatric hospital managed by California’s Department of State Hospitals and the destination for the state’s mentally ill patients referred by the criminal justice system. More than 80% of the hospital’s patients were ordered to the hospital by a court after being found incompetent to stand trial or not guilty by reason of insanity. Napa State reports that its patients committed more than 1,800 physical assaults at the 1,197-bed hospital in the past year.
The hospital has had elevated security for many years, with an extensive system of locked gates and doors, as well as metal detectors and personal alarm systems for the staff. But it wasn’t enough on Oct. 23, 2010, when a patient dragged psychiatric technician Donna Gross to a secluded spot outside and strangled her to death. Like all staff members then, Gross had a personal alarm she could activate for help. The alarm, however, did not function fully outside the hospital building. (More information about the murder can be found online at http://tinyurl.com/gq2bbob.)
The employee’s death was devastating to the hospital staff and prompted a thorough assessment of how security could be improved, says Ken August, assistant director of the Office of Communications at the Department of State Hospitals (DSH) in Sacramento. The first major improvement was to introduce a new personal alarm system with GPS capabilities that works on the entire hospital campus and can direct hospital police to the precise location of the emergency.
The personal alarm system was developed specifically for California’s DSH, at a cost of $56 million. Called the Personal Duress Alarm System (PDAS), it was the first of its kind in the nation.
It was introduced first at Napa State, and California has since installed the system at three other hospitals and is activating it at a fifth hospital this year. The system provides immediate notification and location during incidents. The PDAS is specific to the California hospital system, but similar products are available from manufacturers such as Capture Technologies in Oakland, CA, and TTI Guardian in Sayreville, NJ. (More information on the California PDAS is available online at http://tinyurl.com/gpetsmv.)
BETTER ASSESSMENT
The Department formalized the creation of a Violence Risk Steering Committee that develops evidence-based treatment proposals for the various types of aggression in the hospital system. To reduce violence, the department has developed the California State Hospital Violence Assessment and Treatment Guidelines (Cal-VAT). (An abstract of the journal article describing the guidelines is available online at http://tinyurl.com/zoelwvp.)
Annually, this committee holds a violence reduction summit that is attended by Department executives and executives from each hospital.
Also, the Department has improved the treatment of violent patients, August explains. Some of these activities have required new legislation. Laws approved in 2014 included several that will increase safety at California hospitals, he says. One law improves safety and security by allowing department clinicians to access the criminal history of all patients. Another allows for building enhanced treatment facilities where the most aggressive patients will receive specialized treatment. A new law also streamlines involuntary medication orders and court procedures to help staff treat the fastest growing segment of their population: those who are incompetent to stand trial.
New staff teams also were organized to create a consistent physical presence around the grounds and at special events, August says. This move was intended to address the scenario in which Gross was killed: supervising a patient outdoors and in transition from one place to another.
“This effort has increased the availability and visibility of staff on the campus and augmented the staff assigned to the residential units when patients were involved in activities off the residential units throughout the grounds. The Grounds Presence Team was expanded to create more strategic campus supervision and support to off-unit treatment sites,” he explains. “These staff were assigned to ensure that off-unit activities were monitored and that movement between activities happened efficiently and with accountability so that patients would be successful in attending treatment services and medical appointments as scheduled.”
POLICE SUBSTATION ADDED
In January 2012, the hospital police department’s community policing model was expanded to include a substation within the Secured Treatment Area, the area of the hospital that is locked at all times and requires a pass card to enter or exit.
August says that this expansion allowed for quicker response from hospital police officers for incidents within the Secured Treatment Area and also fostered better relationships between staff members, patients, and police officers. Having officers present during special events on the campus increased their visibility and involvement in campus activities versus only being engaged with patients or staff during adverse incidents. Increased visibility of officers also increased overall surveillance and monitoring of safety and security protocols throughout the campus, he says.
BETTER COMMUNICATION
Another improvement at Napa State is an increase in communications with staff regarding incidents. When staff members are off work due to injuries as a result of patient aggression, hospital-wide notification is made and posted at the two main entrances to treatment sites. This process is intended to alert staff members to the current risk level of treatment units before reporting to duty, August explains.
Periodic all-staff meetings, referred to as town hall meetings, are held to review the activities of staff committees dedicated to safety and violence reduction, and those meeting notes are posted on the hospital’s intranet for staff to reference.
“Six times a year, the hospital’s executive director and key leadership staff meet with the Safety Now Coalition, an employee group which includes labor representatives across several bargaining units. The purpose of these meetings is to review safety concerns and issues and collaboratively identify resolutions and updates,” August says. “In addition, the hospital’s leadership attends regular meetings with the Medical Executive Committee, Cooperative Advisory Council — patient participants representing the unit patient governance model — and the Family Support Group.”
Other changes were on a larger scale. In 2012, Gov. Jerry Brown and the California Legislature created the DSH, which now uses much more of an enterprise risk management strategy than the previous administration structure, August notes. The DSH director and the executive team have strong relationships and experience with the hospital management teams, he says.
DSH leadership has made preventing violence and increasing safety its top priority, August says, and there is a shared commitment to identifying enterprise methods to keep staff and patients safe by maximizing the people and tools available. The state’s Occupational Safety and Health Standards Board recently revised its General Industry Safety Orders with additional requirements for preventing workplace violence in healthcare settings. (The new rule is available online at http://tinyurl.com/jopxge3.) DSH also publishes an annual Violence Report that analyzes trends in hospital violence. (The most recent report is available online at http://tinyurl.com/gp5sn8s.)
The Department works with employee union representatives, patient rights advocate groups, and legislators in making changes such as these. Placing the county-run mental health programs under the supervision of the Department of Health Care Services in 2012 also proved to be a significant move.
“This was a key development as it allowed our hospitals to come together and operate as a hospital system for the first time,” August says. “Since that time, we have continued to progress with hospital executives serving on the executive team that sets the directions for the department.”
SOURCE
- Ken August, Assistant Director, Office of Communications, Department of State Hospitals, Sacramento, CA. Email: [email protected].
