Security Committee leads the way to safety
Boston provider uses formal approach to safety
For many years, the Visiting Nurse Association (VNA) of Boston had a security program in place that resembled many other providers. However in 1992, it opted to take a more formal approach to staff safety through its Security Committee consisting of clinical and administrative representatives as well as an outside consultant.
"Safety is our biggest concern, but it is a big-ticket item; we want to maximize our efficiency and spend our money the best way possible," says Michael Taylor, RN, MS, director of patient services for the VNA of Boston, and the chairman of its security committee.
The committee consists of Taylor, the director of the facility and administrative services, about six members of the nursing staff, nurse managers, representatives from the home health aide department, an ad hoc human resource representative, and an outside security consultant formerly with a local police department.
Outside sources help keep clinicians safe
Through the work of the committee, along with help from outside sources, the VNA of Boston has a very regimented approach to keeping its clinicians as safe as possible. For starters, each clinician has a VNA of Boston Police Service Directory.
"It is important that everyone who works in the field feel that they are connected," says Taylor. "We contacted all the police departments in our coverage area and have all the numbers for each department, from the community service officer number to youth services and most of the detectives."
When an area is deemed a high-risk neighborhood (see related story, p. 80), VNA of Boston has contracted with two local cab companies to provide escort services at a city-regulated rate of $20-an-hour. The specifics of each escort will vary with the visit, ranging from a walk-up who waits for the clinician, if necessary, to pairing up clinicians with one escort. After one clinician is in the building, the escort takes the second clinician to her visit and makes arrangements when to pick each of them up.
Taylor is quick to note that an escort does not guarantee safety. "If there is a group of young people in front of a building, you probably wouldn’t want a clinician walking through that group. We advise them, even if they have an escort, call the patient and say, I need to make arrangements for a later time in the day. Right now there are 10 to 12 young people in front of your building, and I can’t take that risk.’"
Problems inside the home
Not all problems happen outside the patient’s residence. In some cases, whether a patient makes suggestive remarks or other members of the family make the clinician feel unsafe, problems may not begin until the clinician is inside. The security committee has had to address such issues in the past.
"In some situations when an employee’s safety has been in question in a patient’s home, we have had to make other arrangements — be it to do a contract with a family or whatever — to ensure that our employee is safe, because that is our primary responsibility," Taylor says.
One tricky issue is the use of drugs in the home, but Taylor says that visits are not conducted during any drug activity. "I know people have rights within their own environment, but if there is any drug activity going on, you leave, no questions asked," says Taylor. "You tell the patient that you can’t be present while this is going on and that you are going to have to leave."
The VNA of Boston takes a similarly tough stand on weapons. "If there is a firearm, it must be removed," says Taylor. "Not necessarily leave the apartment, but it shouldn’t be present during the visit."
VNA of Boston recommends that clinicians leave if remarks are made that could be threatening. In any of the above cases, the clinician calls the nurse manager after leaving. The manager will then typically call the physician and point out that the clinician is being placed in an unsafe environment.
When such situations arise and a contract is required, the contract between VNA of Boston and a patient can consist of any number of stipulations, such as no one being present other than the patient during a visit, or that visits will be made during the early morning when others are not around.
"If we have to stop the visits, then we have to come up with another plan with the physician. We have stopped visits because there are too many risk factors for the staff," Taylor explains.
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