Newsletters

POSTED: March 18th, 2024
POSTED IN: 2024 Quarter 1, EM Pulse - The Official Newsletter of MOCEP,

Written by: Monica Miner, MSN RN

Workplace violence is on the rise.  Mitigation efforts in the hospital setting recommended by The Joint Commission include ongoing de-escalation training, physical disengagement training, manual holds, and a Behavioral Emergency Response Team (BERT).

The goals of implementing a BERT response do not have to be complex to make an impact.  If the patient is escalating by raising their voice, using profanity, calling staff names, or creating unease from staff then we can activate the response and de-escalate the situation.  A fresh face can turn an interaction that may have ended in restraints into an apology for having an outburst.  The intervention should be done early, staff should feel empowered to escalate an issue to another layer of protection.  If we wait until the patient is throwing objects at staff, the opportunity to impact their behavior is greatly diminished.   

This is the third year of the BERT intervention at a rural academic center in mid-Missouri, in that time, we have had an opportunity to learn from our missteps and now start with a better team to make an impact on staff safety. Implementation of a BERT intervention will need to gain the buy-in from all levels and all departments.  Naysayers are difficult to combat but the evidence supports that early interventions decrease the need for restraints and save money on staff injuries (Miner, Sampson, 2024).  Many programs teach staff how to safely intervene with an escalated patient verbally and physically, if necessary, do an in-depth review of those programs, and determine which one meets the needs of your organization.  Determining who among staff should be designated responders is another component that requires careful consideration.  Behavioral escalation is a clinical event, so clinical staff should be engaged throughout the interactions.  Picking the biggest staff is not always the best choice for all interactions, but focusing on training and early intervention will allow for staff of all sizes to manage an escalated patient.  Designating a team leader for the intervention and then creating a priority intervention of giving the patient time and enough space to process what is happening are two things that can be done to make a significant impact on the patient’s behavior.  Going in for a manual hold or restraints too soon often unnecessarily escalates the patient. When the intervention is complete and the risk to staff, patients, and visitors, is managed then it is beneficial to debrief about the incident.  A quick check-in to verify that no one was hurt, that staff is still in the right head space to care for other patients, verifying that they are not triggered by the event are all important pieces to address.  After the patient has reached a state of calm it is beneficial to review the expectations of behaviors and set some boundaries for ongoing care of the individual.

All interventions deserve improvements, and the behavioral rapid response is no different. Emphasis on earlier activation for the response is ongoing, staff should feel comfortable calling for the response without fear of retribution. Behavior does not occur in a vacuum and there are forces at work that staff may not always notice, but rarely does a patient go from 0-60 without giving some cues. Some patients do not fit into a standard mold, and they may require interventions that are atypical for an inpatient setting.  Accompanying a patient for a cigarette break may not promote health and healing in the hospital setting for ALL patients, but for some it is what they need to remain appropriate with staff and reduce violent outbursts.