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Planning to Commit Violence? Not Here!

1. Recognize the need to implement workplace violence policies and procedures.

2. Understand why two organizations spent the intensive amount of resources to create their workplace violence procedures and the results of their work.

3. Understand why they created proactive workplace procedures for known perpetrators that arrive to the facilities.

Training Objectives

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Solid Progress in Building a Clinically‐Integrated System of 

Care:o From 2 hospitals to 5 

o Nationally recognized for Clinical Integration and Quality o 140 total sites of care o 520 employed partner physicians o 12,000 employees o $1.8 billion operation o Comprehensive continuum of high‐quality care services: 

TITLE: Visiting Policy

SECTION: 04 POLICY NUMBER: SE12.00

EFFECTIVE DATE: 02/1998 REVIEWED/REVISED DATE(S): 02/1998, 01/2001, 12/2003, 06/2006, 11/2009, 01/2011, 02/2014, 08/2016

AFFECTED AREASAll TriHealth EntitiesThis policy acknowledges that other relevant and applicable policies and procedures exist that havebeen drafted, approved, and adopted by entities (and departments) within TriHealth and are specific tothose departments or entities. Interpretation of these other policies must comply with the principlesadopted by Corporate Policy #12_01.00, "Corporate Policies, Development & Implementation".

POLICY OWNER: Director Corporate Security

APPROVED BY:COO Bethesda North HospitalCOO Good Samaritan HospitalGSH & BHN SecuritySVP, Chief Nurse ExecutiveCorporate Policy & Procedure CommitteeExecutive VP & COO

APPROVAL SIGNATURE: Signed original on file

President & CEO

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Work Place Violence Committee CharterPurposeThe primary purpose of the Workplace Violence Committee is to provide support to enhance TriHealth safety program. This committee will be co‐chaired by the Corporate Security Director and the Occupational & Environmental Safety Consultant of the Risk Management Department. It will meet quarterly.  It will receive workplace violence incident data from TriHealth Incident Reporting Information System (IRIS) that will represent committee members departments from Risk Management, Human Resources, Behavioral Health Sciences and Corporate Security to review and make recommendations to the Safety Steering Committee. 

ScopeThe work of this committee focuses on the assessment needs related to workplace violence related to TriHealth hospitals and ambulatory services including physician practices.  This committee will work to assess needs, identified activities and collaborate with appropriate individuals who are subject matter experts (SME) to implement individual actions.

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Nationwide Children’s Hospital (NCH) Workplace / Family Violence• Administrative Policies

• Workplace/Family Violence• Code Violet• Code Silver

• Code Violet and Code Silver Procedures

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Workplace/Family Violence

• Conduct not tolerated by NCH. • Direct of implied threats. • Conduct that results in harm to people or property. 

• Intimidation or verbal harassment that disrupts work environment, results in fear for personal safety. 

• Use of NCH property for the means to threaten, harass, or abuse someone.  

Role and Responsibility • Employees: 

• Be knowledgeable about the Workplace/Family Violence Policy. 

• REPORT VIOLATIONS of the Policy to your Manager, HR, Security. 

• Attend training as required. • Contact Employee Health, Employee Relations, Matrix (our Employee Assistance Program) for assistance and counseling.

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Recognizing Aggressive Behavior

• Aggression, angry, frustrated - a rise in voice and tone, threats, shutting down.

• Confrontation / Verbal threats and/or abusive language.

• Body language, threatening gestures.

• Signs of drug or alcohol use.

• Obsessive behavior.

Code Violet Definition

• Code Violet is NCH’s response plan to follow when the actions of a violent and/or combative person poses a threat to self and/or others.

• A violent or combative person can be:• a patient• a visitor• a staff person

• Any employee can activate Code Violet.

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Code Violet Team

• For main campus, the Code Violet Team responds in a professional and controlled approach to ensure the safety of all.

• Different process at satellite facilities

Minimizing the Risk

• Notify the patient’s practitioner about the change in the patient’s mental status.

• Present a calm, caring attitude; acknowledge the person’s feelings.

• Do not match the threats or give orders.

• Avoid behavior that may be interpreted as aggressive.

• Be cautious and aware throughout the encounter.

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Minimizing the Risk

• Make your co-workers aware; wingman concept.

• Do not isolate yourself with a potentially violent person.

• Always keep an open exit path; do not let a potentially violent person stand between you and the door.

Listening: Rediscovering the Lost Art• Listen to the patient and family’s frustration.• Empathize with the patient and the family. • Try to understand how they perceive the

situation.• Ask them what do they want that they are not

getting.• Address patient and family concerns.• Offer a solution or an alternative.• Try to re-establish therapeutic rapport.

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Staff Actions

• In the event of physically intimidating behavior, threatening language or violent acts by anyone:

• If safe to do so, staff works as a team in an attempt to de-escalate a threatening situation.

• Charge Nurse or Supervisor assigns staff to direct all other patients and visitors to return to their rooms or a safe area.

• Shut the other patient room doors to shelter other patients, visitors, or staff from the individual displaying violent or combative behavior.

When to Activate Code Violet

Activate Code Violet, anytime an employee.• observes a person whose behavior is

increasingly out-of-control.

• sees behavior that threatens the safety of that person or others.

• feels that his/her own well-being is in jeopardy.

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After a Code Violet is Activated

• Main Campus: • The Code Violet Team responds and assumes

handling the situation.• Off-Site Facilities:

• Follow the directions of the police/EMS who respond.

• Senior NCH representative onsite remains involved with the event.

• Call the ECC so that Main Campus leadership is aware of the event.

• Off-Site Neonatal Units: • Follow the host hospital’s emergency

preparedness plans.

Recovery After a Code Violet

•A debriefing will occur to:• review the incident.• evaluate the response.• allow involved staff to discuss the incident.

• CS Stars event report needs filed: • report all emergent escalations.• verbal and physical threats. • property destruction. • elopement, actual or attempted.• aggression towards another.

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Code Violet

• Process Improvements• Identified need to reduce harm incidents• Created Code Violet- Proactive• Use of Electronic Medical Record System• Weekly Email list of Code Violet

patients/visitors

• Person with a Weapon and/or a Hostage

• Code Silver Definitions:• Person with a weapon: a person with a gun,

knife, or any item that could harm another. • Armed aggressor: a person with a weapon who

actively threatens the safety of patients, visitors and/or staff; may use a variety of weapons.

• Barricade situation: a person secures self in an area and prevents access by a threat or the intent to do harm if approached.

• Hostage situation: an aggressor holds others captive with a threat of harm.

Code Silver:

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Code Silver Activations

Spectrum of Responses• Appropriate Behaved Persons• Full Active Shooter Response

Code Silver

• Response Options• Evacuate• Shelter in Place• Take Action

• Recovery• Once the threat has been eliminated, all

lockdown and/or security procedures are in place until the area is declared safe.

• Code Silver “ALL CLEAR” announced.

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Speakers’ Contact Information

Ronald J. Morris, MS, CPP, CHPA Dan Yaross, MSM, CPP, CHPA

Administrative Director | Corporate Security Director of SecurityOffice 513 569 6167 Nationwide Children’s Hospital

Office Fax 513 569 5020 700 Children’s Drive

EFax 513-487-4375 Columbus, OH 43205Ronald_Morris@trihealth.com Dan.Yaross@Nationwidechildrens.org

TriHealth Corporate Offices Office: 614-722-2126619 Oak St, Cincinnati, OH 45206 Office Fax: 614-722-2133TriHealth.com | 513 569 6166

Questions