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Help to institute a specific use-of-force policy for dealing with unruly patients

Nurse Leader Weekly, June 20, 2003

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A hospital that doesn't have a policy dealing with patient violence puts employees in awkward circumstances if a patient becomes physically or verbally unruly.

For example, a patient recently kicked Jose Hernandez, the safety officer at Mercy Medical Center in Roseburg, OR. Because Mercy Medical, an acute-care and behavioral health provider, didn't have a use-of-force policy for violent patients, there wasn't much he could do during the incident.

Mercy Medical has a management policy on assault behavior that discusses how to restrain patients, but doesn't go beyond those actions if a situation escalates.

Hernandez is trying to convince administrators to adopt a new policy that spells out exactly what steps security officers should take when confronted by a violent patient.

"Unfortunately, a lot of hospitals don't have [this type of policy] and should have it for legal reasons," says Hernandez, adding that in a courtroom, you don't want a lawyer badgering a hospital on why its security team didn't observe such a policy.

Former police officer J. Buford Tune agrees. It's best to aim such policies at security officers and not clinicians, says Tune, who is owner of the Academy of Personal Protection and Security Inc. in Nashville.

Otherwise, a hospital raises too many murky questions and risks someone asking why a nurse needs a use-of-force policy, he adds.

Consider using restraint teams An option to deal with these episodes is to develop a restraint team as part of the policy, says Earl Williams, HSP, safety coordinator at BroMenn Healthcare in Bloomington, IL.

BroMenn uses local police to train its contracted security force in handling unruly patients and developed the team approach to cope with out-of-control patients.

"Once the clinician exhausts verbal options, he or she calls a code for the restraint team." Every shift has designated workers on the restraint team who have undergone further training in takedown and deescalation techniques.

"Usually, just calling in the team is good enough to calm the patient, but if not, all verbal techniques cease and the clinician directs the team to subdue the patient," Williams says.

Tip: After calling the code for the restraint team, keep a safe distance from potentially violent patients, and always keep an escape route open, Hernandez says.

That distance should be far enough that the patient can't kick you. Never lock the door to the room, and always let another staff member know your location.

Adapted from: Healthcare Security and Emergency Management, www.hcmarketplace.com/Prod.cfm?id=742&S=ENMW.

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