National Development and Implementation of a Democratized Disruptive Behavior Reporting System in Health Care.

INTRODUCTION: Workplace disruptive behavior/ violence (WDBV) is underreported in health care. This study evaluated a 7-year implementation of the Disruptive Behavior Reporting System (DBRS), the most robust consolidated WDBV reporting system developed in the United States within the Veterans Health Administration (VHA). METHODS: After implementation of the system, implementation success was measured in real time by number of reports, types of staff entering reports, time to review the reports and time between when the incident occurred and report entry. RESULTS: Over the seven years since implementation, there has been a significant increase in reporting within DBRS with more than 50,000 reports in fiscal year (FY) 2021 up from 0 to 2014. Types of staff reporting increased to 67 from 54. The median number of days to review events in FY19 Q2 was 4.79 days and the report latency has almost completely disappeared. DISCUSSION: DBRS was designed to democratize reporting so staff can report WDBV anytime and anywhere playing a large role in the successful implementation. The increase in total number of reported events is an indication of the success of the system as it captures data historically lost due to underreporting. CONCLUSION: DBRS development and implementation showcases how information systems can empower front-line personnel to voice behavioral safety concerns.

A Comparison of Shift Length and Nursing and Quality Outcomes in Acute Inpatient Mental Health Units.

OBJECTIVE: This study compared outcomes between units that used either 8-hour or 12-hour shifts in acute inpatient mental health units. BACKGROUND: Most hospitals continue to use 12-hour shifts despite research suggesting safety concerns with longer shifts. There is a gap in the literature on effects of shift lengths on nursing and patient outcomes in acute mental health units. METHODS: This study is a retrospective comparative analysis of cross-sectional data between 32 inpatient mental health units that used 8-hour versus 12-hour shifts. Independent samples t test was used to examine differences on several staffing, quality, and safety measures. RESULTS: A moderate effect size was found between the groups in quality and safety measures involving patient disruptive behaviors, with the 8-hour group having more desirable outcomes. CONCLUSIONS: Nurse leaders in acute mental health units should consider the impacts of shift length on quality and safety when determining staffing patterns. More research is needed to evaluate correlations or causality.

Impact of STAR-VA on Staff Injury and Disruptive Behavior Reports in VA Nursing Homes.

OBJECTIVES: Workplace disruptive behavior incidents can be costly for organizations, employees, and customers. Persons with dementia living in long-term care settings have a high risk of exhibiting distressed behaviors. We examined whether a resident-centered, behavioral intervention for residents with dementia led to a reduction in reported workplace disruptive behaviors and staff injury rate due to assault. Impactful interventions are important for quality of care. DESIGN: We examined whether a team-based behavioral program in community living centers (CLCs), where a nurse champion and behavioral coordinator were trained to work with the clinical team to understand and manage distressed behaviors commonly associated with dementia, was associated with reductions in behavior incidents. SETTING AND PARTICIPANTS: The setting was Veterans Health Administration CLCs. The sample consisted of 120 aggregated CLCs operating between 2012 and 2017 with 62 completing training. CLCs were distributed across the United States. METHODS: Outcomes included CLC-level rates of staff injury and number of workplace disruptive behavior incidents. Outcomes were regressed on measures of intervention completion, time since intervention, and several CLC characteristics. RESULTS: The intervention was significantly associated with lower incidence of assault with staff injury rates overall, particularly following the first year of training, but not with other reported workplace disruptive behavior incident rates. CONCLUSIONS AND IMPLICATIONS: A team-based behavioral intervention was associated with reduction of employee assaults, a critical repercussion of distressed behavior in dementia. Given rapid growth in patients with dementia in nursing homes, effective treatment practices, such as interdisciplinary behavioral management approaches may be impactful and valuable to implement.

Workplace violence prevention standardization using lean principles across a healthcare network.

Purpose The purpose of this paper is to describe the process used to standardize a Workplace Violence Prevention Program (WVPP) within a five-hospital healthcare system in Veterans Health Administration (VHA). Design/methodology/approach A description of the lean process improvement principles, used to bring the WVPP into compliance with Occupational Safety and Health Administration (OSHA) and other agencies through streamlining/standardizing processes. Findings There was significant standardization in both the threat assessment and education arms of the WVPP. Compliance with all major US Department of Labor OSHA requirements, as well as substantial time savings, were realized as part of this process improvement. Originality/value VHA is leading the way in inter/multidisciplinary assessment and mitigation of workplace violence, however, there are significant competing demands on staff time. This first ever use of lean principles to streamline processes around workplace violence prevention freed up clinician time for care while improving internal and external customer satisfaction, representing a major step forward in workplace violence risk mitigation.