Workplace Violence Training in Use at TCMH

New workplace violence reduction training is already being used in real life situations at Texas County Memorial Hospital, board members heard at their monthly meeting on Tuesday.

Doretta Todd-Willis, TCMH chief nursing officer, shared that since hospital personnel received training to manage verbally and physically abusive patients, there have been seven verbal abuse incidents and two physical violence incidents.  Patients attempted to bite, scratch, kick, and/or head butt hospital personnel in the physical incidents.

“We recently had a patient come to the emergency department to receive care and immediately became verbally abusive and physically threatening to the nurse doing triage,” Todd-Willis shared with board members.

According to Todd-Willis, the triage nurse noticed the patient digging in a bag trying to find something.  The nurse utilized recent training to recognize the signs for potential violent action, stepping out of the room to request assistance.  The house supervisor assisted the nurse with de-escalating the situation and assessing the patient.

After getting the patient in a bed in an emergency department room, TCMH staff saw the patient pull a large knife out of the bag and place it alongside their body on the bed.  The staff quickly used their training to get the knife from the patient without injury to the patient or to any staff members.

“Our staff felt like this incident would have ended differently if they did not receive STARR (Safe Training and Responsible Restraints) training earlier this year,” Todd-Willis said.

The Missouri Hospital Association (MHA) chose TCMH to participate in the STARR program along with other hospitals in the state.  Mitigation Dynamics in Lee’s Summit, MO worked with the MHA to train employees and to help participating hospitals put policies and procedures in place in their hospital to meet Centers for Medicare Services regulations for healthcare facilities to achieve a higher level of safety for patients, visitors, physicians, and staff.

STARR training includes 16 hours of manual, classroom instruction, training repetition, proficiency testing, report writing, policy review, and scenario-based drills.  Upon successful completion of the STARR training, the hospital staff receives STARR certification.

Fifty employees from a variety of departments at TCMH received STARR certification. The culmination of the training was on site scenario-based training that included 21 different role plays and six different scenarios for teams of STARR-certified hospital staff to handle.

Mike Murray, director of training for Mitigation Dynamics described the TCMH staff as “outstanding”.

“In our training at TCMH, we saw the commitment to excellence by everyone involved,” Murray said.  “The women were awesome, the CEO backed our program, and the employees were excited about the training opportunity.”

Murray noted that 89 percent of the time verbal de-escalation will work in a violent situation.

“In our training scenarios the employees did very well at verbal de-escalation,” Murray said.

Murray explained that the scenario-based training was conducted throughout the hospital, involving every department.

“TCMH is more than ready to respond to incidents of verbal and physical violence that may arise,” Murray said.  “We love giving people the ability to be safe.”

With the STARR training, TCMH has access to an “implementation toolbox” that includes an Activation and Response Flow map, a certification card template, a financial proposal template and a Microsoft Access program.  The Access program can store end-user data and incident reporting data.  The program can track and generate workplace violence incident reports, track employee certification and generate reports about end-user in incident, physical restraint by technique, and more.

Todd-Willis told board members that TCMH is looking at the possibility of a “train the trainer” course available through Mitigation Dynamics.  One or more hospital employees would become a facility STARR trainer so that all TCMH employees could receive STARR training.

“We greatly appreciate MHA allowing us to participate in the program with Mitigation Dynamics,” Todd-Willis said.  “We believe our staff will be able to continue to utilize the knowledge and tools they received to prevent any harm to our patients or our staff.”

TCMH has implemented a security alert STARR response as part of the hospital’s emergency preparedness plan.  STARR response drills will also be conducted regularly at the hospital.

In the monthly quality report, Amanda Turpin, quality management director at TCMH, noted that preliminary value-based purchasing scores appear to be improving.

“The data will not go public until the fall, and it looks like we will end up a little above ‘break even’,” Turpin said, indicating that TCMH will not lose any funds for Medicare patients, and there may be a slightly more funds paid to TCMH due to the scores awards by CMS for certain measures that are reported by all hospitals.

CMS looks at data from all hospitals in areas such as care for heart attack, pneumonia, heart failure, patient safety, mortality, readmission rates, and more.  The hospital’s annual score is based on data from the previous three years.  The score released this fall will be based on data from 2014, 2015, and 2016.

“We have improved what we can over time, and each year we get better,” Turpin said.

Preliminary data shows that TCMH is well below the state and national average scores for “Medicare spending per beneficiary”, the cost to care for a Medicare patient at TCMH.

“The lower the score, the better,” Turpin explained, noting that TCMH also has a very low patient safety composite score.  The current scores place TCMH in the top two percent of hospitals across the US for patient safety.

Turpin noted that re-admissions of hospital inpatients within 30 days of discharge from the hospital is hard to control at TCMH and at most rural hospitals.

“Our patient demographics such as our rural Missouri location and our socio-economic status are not accounted for in the CMS value-based purchasing score,” Turpin said.

A couple of years ago, TCMH began sending nurses to the homes of patients with chronic health conditions after the patients were discharged from the hospital, and that has helped with readmission rates at the hospital.

Turpin explained that CMS is considering ways to account for more patient demographics in the future.

For the month of May hospital inpatient revenues were lower than budgeted expectations, outpatient revenues were above budgeted expectations, and overall expenses were down, according to the financial report from Linda Pamperien, TCMH chief financial officer.

Inpatient admissions at the hospital are up by 91 admits for the year in comparison to 2016.  There were also 31 swing bed admissions in May.

TCMH ended the month of May with a positive bottom line of $88,626.46 and a positive year to date bottom line of $52,617.31.

Present at the meeting were Todd-Willis; Pamperien; Turpin; Joleen Senter Durham, public relations director; Dr. Jonathan Beers, TCMH chief of staff; and board members Dr. Jim Perry, OD; Mark Hampton; Jay Loveland; Janet Wiseman, and Omanez Fockler.

The next meeting of the TCMH board of trustees is Tue., July 25 at 12 p.m. in the hospital board room.