lisa cox - monash health
DESCRIPTION
Safe and Secure HospitalsTRANSCRIPT
Introducing Code Grey at
Monash Health
Lisa Cox – Deputy Director of Nursing Emergency Program & Monash Health Community
Background – Monash Health
• Largest health service in Victoria
• Located in the SE suburbs of Melbourne
• Serving 25% of Victoria’s population
• Over 40 sites with 6 hospitals, with 3 ED’s
• 2130 acute, sub acute, mental health and aged care beds
• Approx. 220,000 admissions; 185,000 ED presentations
• Approx. 13,000 staff
Our care locations
Policies/legislation
• Violence occurring within hospitals has been an increasing concern in Australia.
• Hospitals reflect the larger community and can be highly charged environments where stress, anxiety and illness create pressure that can lead to violence.
• OH&S legislation/policies:Preventing occupational violence in Victoria health services
• WorkSafe – prevention and management of aggression in health services handbook
Government response
• Improving the safety and security in Victorian hospitals and reducing violence against hospital staff is a key government commitment
• concurred recommendation from the Victorian Taskforce on Violence in Nursing: final report, at the Inquiry into Violence and Security Arrangements in Victorian Hospitals
Recommendation 10 That the Department of Human Services introduces into Victorian health services, standardised Code Grey (violence and aggression emergency) and Code Black response (armed threat)
Government commitment
In 2012, the Government announced funding of $5.8 million over four years ($1.4 million per annum indexed) to improve safety and security in Victorian health services
• FY12/13 prioritised to establish or upgrade duress systems in ED
• $25K per emergency department
Government Commitment
FY 13/14
• Training for clinical staff, particularly ED staff, on violence and aggression prevention, procedures and practices, including ‘Code Grey’
• specialised training for hospital security staff on dealing safely with aggressive behaviours in health settings
• Initiatives to enhance the communication with patients and visitors of waiting times and alternative options to ED care
• Enhanced security systems and in particular, effective duress alarms for at-risk staff
• Enhanced cross agency collaboration between the ED, police and ambulance services.
Project brief
• Monash Health Code Grey Strategy and network wide Project Plan in line with a review of resources to support implementation
• Finalisation of draft procedures aligned to the Monash Health Code Grey strategy whilst leaving enough flexibility for local customisation for each site
• A Monash Health reporting framework to assess the ongoing efficacy of the Code Grey response
• A move from overhead paging to Silent Hospital principles
• Initial scope – MH hospitals with emergency departments
Code Grey model development
Governance
• Organisational priority
• Organisation wide, Executive led steering committee
• Site level working parties
Aims
• Standardised principles
• Site specific tailoring
• Procedure, Background document & site specific implementation tools
Example: Team Composition (Casey)
Emergency Department Rest of Hospital Mental health
DDON/NCO
Security staff x 2
Managed locally by ED
RNs (x3)
All zone wardens
NCO will release zone wardens as
appropriate
Managed locally by MH
staff (x3)
ED Consultant Med registrar Psych registrar
ECATT (if available) Cognition CNC/Cognition
Resource staff member
(when available)
Training
• Utilised experts & material within health service
• Train-the-trainer model
• 2 day training
• Training incorporated
Patient centred care
Trauma informed care
Communication & de-escalation
Legal and organisational policies
Safe physical restraints/Mental Health Act
Patient and staff safety is
our number one priority
Barriers or opportunities
• Trainers
• Training schedule
• Cost – direct and backfill
• Staff attitudes & engagement
• Sites
• Reporting
• National Standards
The journey continues …
• Smaller sites
• Review of incidences and learnings
• Code Grey Coordinator
• Sustainability
