According to research, incidents of workplace violence in the healthcare setting has increased by 23% in the United States since 2015. It is considered the second-leading cause of on-the-job fatalities. Healthcare settings are complex, and each setting has different variables in terms of staff, space, and workplace functionality. The healthcare settings are also unique as they are made to be easily accessible. On a daily basis, they are full of patients and family members who are experiencing tremendous amounts of stress, leading to an environment full of potential for violent outbursts. Despite the increase in workplace violence incidents, unit-based training against active shooters has been limited to written materials, instead of active discussion and practice sessions. Healthcare workers including Registered Nurses (RNs), unit secretaries, and Patient Care Assistant (PCA) in a Post Anesthesia Care Unit (PACU) at a large academic medical center voiced a concern in regards to the lack of knowledge in terms of what to do if active shooter situation occurred on in the hospital. Operating Room (OR) suites and critical care units are considered some of the most vulnerable areas in regards to active shooter activity. The PACU, being both a critical care unit and part of the OR suite was identified as an ideal unit for receiving training, as guidelines recommend that active shooter training should be occurring at the unit level.
Purpose
The objective of this project was to increase the academic medical center’s healthcare workers awareness, knowledge, and confidence in response to active shooter situations at the unit level through true interdisciplinary collaboration in order to strengthen the healthy work environment.
Description of the Project
A gap analysis revealed that 91% of staff in the PACU did not feel safe at work against active shooters. Also, only 27% of the participants knew the current recommendations from the Federal Bureau of Investigations (FBI) in regards to the first step to take during a Code Silver. Code Silvers are activated at this healthcare facility whenever an active shooter is present. The PACU unit is often alone in the building during evenings due to extensive surgery schedules. A literature search revealed that training should be conducted at the unit level, as well as throughout the hospital. For unit-based training, a team was created and it included perioperative educators, security personnel, and PACU leadership. Using true collaboration, the team created an in-service that allowed for the security leaders to present their master plan for Code Silvers throughout the hospital. They also explained unit and nurse-specific patient care responsibilities that are in place during an active shooter situation. A video presentation of a reenactment that showed what a Code Silver looks like within the hospital environment was also presented. Afterwards, an open forum allowed the staff to communicate their thoughts and concerns with the security team. After the question and answer session, a unit walkthrough was conducted with security and PACU personnel to identify potential weak points and to identify possible areas for barricading within the specific unit.
Evaluation/ Outcome
Active shooters are an unfortunate but true problem in today’s healthcare environment. Staff was prepared by the implementation of a unit-based in-service using true collaboration with PACU leadership and security services. Based on our findings, an overall improvement in staff knowledge, awareness, and confidence in regards to Code Silver procedures was seen post-intervention. These results were obtained by the administration of a six-question survey. The survey was given to assess the participants’ knowledge and confidence levels pre-intervention and post-intervention. After the unit-based education was completed, overall knowledge and confidence levels improved. 89% of the staff reported that they knew their role in regards to patient care during a Code Silver. Furthermore, 89% of the staff reported that they felt like they were adequately prepared to respond in a Code Silver as compared to only 18% pre-intervention. The briefing with security personnel did create awareness of potential weaknesses in the system, creating an awareness of areas for improvement in security measures. After the intervention, 78% of the staff reported feeling unsafe in the current environment and its level of protection during a Code Silver. After the walkthrough of the unit with security, nursing staff submitted a variety of suggestions for ways to improve the safety on their specific unit. Per the survey, nursing staff’s overall feeling towards their ability to influence the policies and procedures around them did not change post-intervention. Their suggestions were submitted to PACU leadership to promote a healthier work environment and true collaboration.