Children’s of Alabama is implementing an initiative to prevent an de-escalate workplace violence against health care workers.
Health care workers are five times more likely to experience workplace violence than those in other industries. They account for 73% of all nonfatal workplace injuries from violence.[1] The incidence has been rising since the pandemic, with one survey from the American Nurses Foundation finding a 119% increase in nurses reporting worsening workplace violence between March 2021 and March 2022.[2]
That is why the Children’s of Alabama’s Behavioral Event Support Team (BEST) initiative is so critical. The program is designed to ensure a rapid response and de-escalation to potentially violent incidents on medical units. It also helps identify patients at risk for “behavioral events” to prevent them before they occur.
Before BEST was created, it was rare for behavioral health staff to interact on the medical side of the hospital, said Bonnie Moore, RN, nursing director at the hospital’s Behavioral Health Inpatient Ireland Center. And yet, given their training in managing patients who may become violent, they had the skills the rest of the hospital needed. Now, she said, “we’re talking about how we’re meeting the needs of patients who are not housed within the inpatient behavioral health space.”
It starts with a patient and family assessment before admission, with patients (or their caregiver) describing how they think they’ll respond to being in the hospital. The caregiver also shares if the patient has shown any behavior in the past six months that could have harmed someone.
“Partnering with the patient at the beginning of the admission to help them have the most therapeutic environment as possible allows them the best opportunity of healing while they’re here,” said Brandy Reeve, senior executive leader of Behavioral Health Services at Children’s.
The medical staff is trained to identify early signs of problems in both patients and family. For instance, parents are observed daily for any signs of escalating stress or anxiety, such as asking more questions than normal, pacing in the room, or raising their voice on their cellphone when they previously weren’t. “That’s when a social worker will come in and visit with the family to make sure they have their needs met,” Reeve said, “and that there’s nothing else that they can do to help better support them so we’re not getting to a place where it’s escalating.”
Staff are also trained to recognize signs of acute behavioral stress and activate the BEST team to de-escalate the situation.
In one instance, a patient admitted for tonsilitis with no behavioral concerns on assessment became quite agitated at night. The mother spoke only Spanish and tried to communicate with the staff via Google translate that she needed help and didn’t feel safe with her son. The nurse activated the BEST team, which de-escalated the situation within a few minutes with no further problems.
“Sometimes it’s just being able to communicate appropriately; to help the patient better understand what they need to do and why they need to do it,” Reeve said. “Having been a medical nurse all my life, we’re not great at that,” she said. “We’re like, ‘just sit still, I’ve got to get this thing done.’”
The effort is working. “Anecdotally, I believe since we have rolled out the BEST pathway that the things we’re doing on the front end appear to be successful,” Moore said, “which results in fewer calls for the ‘heroes in the capes’ to do all the magical behavioral things. All the pieces come together.”
The pilot phase of the program launched in February, and the team hopes to roll it out throughout the hospital in the fall.
The BEST program represents a shift toward viewing patients holistically, Reeve said. “I think that we’re increasing awareness to all of those that would claim to be, you know, ‘I work on the medical side, not the behavioral health side,’ that they are recognizing that our psychosocial health is just as important as the health we have with any other medical ailment because when it’s not OK, everything else is affected.”
[1] Ninan RJ, Cohen IG, Adashi EY. State Approaches to Stopping Violence Against Health Care Workers. JAMA. 2024;331(10):825–826. doi:10.1001/jama.2024.1140
[2] American Nurses Foundation. Pulse on the Nation’s Nurses Survey Series: 2022 Workplace Survey. Available at: https://www.nursingworld.org/practice-policy/work-environment/health-safety/disaster-preparedness/coronavirus/what-you-need-to-know/covid-19-survey-series-anf-2022-workplace-survey
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