Avoiding Security Lapses in Care Facilities
AvoidingSecurity Lapses in Care Facilities
AvoidingSecurity Lapses in Fare Facilities
Iwas a new Nursing Services director (DNS) in a 150-bed long-term carefacility. This was the facility’s fourth DNS in a period of 6months. The facility served both young and elderly patients, who werehomeless, had behavioral problems, or were dual diagnosed. A keyresponsibility of the staff was making sure that the patients did notleave the facility without consent. There are two entrances to thefacility. It was also common for younger patients to escape thefacility using windows, which were at ground level.
OnDecember 23, 2013, a 55-year-old resident at the facility, who had ahistory of depression left the facility to go to a grocery store.While he was crossing the street, an oncoming vehicle fatally struckhim. I received a call at 2130hrs that night so that I could initiatean investigation, offer support to the other patients, and report theincident to the Department of health. Members of IDT were alsonotified so that we could begin the investigations. Department ofhealth visited the facility on December 24 and carried out aninvestigation, as per the State’s requirement. Their investigationconcluded that the facility was negligent, and imposed an “ImmediateJeopardy (IJ)” tag on the facility. This meant that our facilityhad not taken all the necessary measures to make sure that thepresidents were safe. As such, the facility was given a period of onemonth to come up with a compliance plan, and three months to take thenecessary steps required to make sure that the facility wascompliant. During this period, the facility could not admit newMedicaid/Medicare patients.
Staffand patients held an emergency meeting and came up with a plan ofaction. This plan required staff to do a head count at the end oftheir shift, and the patients to sign in/out of the facility using asign in/out form. Additionally, new locks, alarms, and cameras wereinstalled to upgrade the security of the facility. The windows werealarmed and the reception area was staffed from 0800hrs to 2000hrs.
Whiledeveloping the plan of action that was adopted after the incident, Ifelt that the administrator adequately considered, and implementedall the necessary measures to improve the security of the facility.The meeting held between the staff and patients ensured that everyperson contributed towards coming up with measures that would improvethe security of the facility. This made sure that even the frontlinehospital workers were engaged in the process of developinginterventions that would ensure patient safety.Sokas et al. (2013) observe thatit is important for facility administrators to involved frontlinehospital workers when developing intervention aimed at improvingpatient’s safety. This is because they play a key role in meetingpatients’ needs. An important step to improving the security andsafety of patients in US hospitals involving making sure thatpatient’s and worker’s safety is integrated (Ormsby, 2013). Byinvolving the staff and patients in the meeting, the administratorswere able to develop a plan that involved everyone in the decisionmaking process. This led to the adoption of creative ways to ensuresecurity in the facility such as the use of alarms in the windows.
Whilethe new plan of action was effective in preventing future cases, thefacility was reactive as opposed to being proactive in anticipatingpotentiality of such an incident occurring. There were intuitivesigns that such an incident could occurs. Initially, the facility wasestablished to meet the needs of geriatric and medically compromisedelderly population. This gradually changed as the facility startedadmitting psychiatrically ill patients, patients with history ofsubstance abuse, and younger patients. However, the administrationdid not accompany these gradual changes in patient admissions with arevision of security policies in place to ensure patient safety.Every health facility should be designed with patient safety andsecurity as the central component of its vision (Taylor et al.,2014). This means that the administration should have been moreproactive in addressing any potential security lapses that would haveoccurred in the facility. They should have recognized that youngerpopulation and psychiatrically ill patients required more security.
Conversely,the decision was forced on the administration when the ‘IJ’ tagwas imposed on the facility. The decision was based on best practice,but it was under duress. All the same, all the views were consideredduring the meeting.
Thefacility could have avoided the entire incident if they had been moreproactive. In order to prevent such incidences from happening in thefuture, it is important for the leader to make sure that theconsideration of patient safety and security is the overarching guideto various changes made in the facility. Before deciding to admit anew crop of patients in a facility, a leader should always considerwhether the facility is designed in such a way that it would be ableto ensure security for the patients. The incident also taught me thata leader can be able to develop effective patient securityintervention by involving all the key stakeholders in a facility.Frontline facility workers proposed some of the most ingenioussecurity interventions that were included in the action plan.
Ormsby,J. D. (2013). Integrating patient and worker safety policies. NEWSOLUTIONS: A Journal of Environmental and Occupational Health Policy,23(2),315-325.
Sokas,R., Braun, B., Chenven, L., Cloonan, P., Fagan, K., Hemphill, R. R…. & Storey, E. (2013). Frontline hospital workers and theworker safety/patient safety nexus. JointCommission journal on quality and patient safety/Joint CommissionResources,39(4),185.
Taylor,E., Joseph, A., Quan, X., & Nanda, U. (2014). Designing a tool tosupport patient safety: Using research to inform a proactive approachto healthcare facility design. In InternationalConference on Applied Human Factors and Ergonomics (AHFE).
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