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| Staff Safety and Workplace Violence in Children’s Hospitals: Behavior-Analytic Approaches to Mitigating a Systemic Issue |
| Sunday, May 26, 2024 |
| 6:00 PM–6:50 PM |
| Marriott Downtown, Level 4, Franklin Hall 9-10 |
| Area: CBM/DDA; Domain: Applied Research |
| Chair: Alec M Bernstein (Children's Mercy Kansas City; University of Missouri-Kansas City School of Medicine) |
| CE Instructor: Alec M Bernstein, Ph.D. |
| Abstract: Pediatric hospitals, both tertiary medical and psychiatric settings, continue to struggle with managing the challenging behavior of their patients. The inappropriate and unsafe management of challenging behavior often results in patient- and systems-level issues. Patients (many of whom with a neurodevelopmental disorder and limited vocal-verbal communication skills) experience high rates of physical restraint, chemical restraint, lengthy admissions, and foregone medical procedures. The hospital system experiences repeated staff injuries, low staff morale, turnover, and financial deficits. The fix to such a systemic issue is complex. Behavior analysts, however, have begun to empirically demonstrate their ability to mitigate the patient- and systems-level issues due to challenging behavior. This symposium includes three presentations that highlight the use of applied behavior analysis to address staff safety and workplace violence in various pediatric hospital settings from different perspectives. The first presentation focuses on reducing physical restraint by bringing simulation training to bedside staff. The second presentation focuses on improving staff safety through a behavior-based safety framework. The third presentation focuses on reducing chemical restraint and challenging behavior through a specialized-care pathway for patients most at risk for physical aggression. |
| Instruction Level: Intermediate |
| Keyword(s): behavioral pediatrics, hospital, restraint, workplace violence |
| Target Audience: The necessary prerequisite skills for attendees to gain the most from the symposium included (a) ongoing or completion of graduate-level work focusing on applied behavior analysis, (b) licensure and credentials as someone able to legally and ethically provide behavior-analytic services, (c) some experience providing behavior-analytic services in the healthcare setting. |
| Learning Objectives: At the conclusion of the presentation, participants will be able to identify (1) best practices for reducing challenging behavior and increasing staff safety within the hospital setting, (2) strategies for integrating behavior analysis into healthcare, and (3) the generality of behavior-analytic methodology to both patient- and systems-level issues in the hospital. |
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| Reducing Restraint Use by Bringing Simulation to the Bedside |
| OLIVIA MILLER (Children’s National Hospital; Simmons University ) |
| Abstract: The landscape of healthcare in the United States is currently undergoing significant challenges that are impacting both patient care and the healthcare workforce. This presentation addresses two pressing issues: the surge in patients experiencing behavioral crises and the nursing staffing crisis. These challenges have been exacerbated by the ongoing COVID-19 pandemic. Hospitals across the country have witnessed a notable increase in patients grappling with behavioral health crises. The pandemic has intensified the unmet need for behavioral health services, making it increasingly difficult for individuals with behavioral health conditions to access the care they require. Patients, for example, experience prolonged hospital stays, overcrowded emergency departments, and limited access to timely and appropriate care. This presentation will review a pilot simulation training created to meet the training needs to support a patient on the medical floor. Following the success of the initial pilot simulation, the training was replicated with over 100 bedside staff, designed to manage escalating patient behavior. The training had a direct impact on the reduction of restraint use and increased preparedness and confidence of participants who manage escalating patient behavior. Results suggest simulation can be an effective strategy to train medical staff to manage challenging behavior and reduce restraint use. |
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Using Behavior-Based Safety to Improve Employee Safety While Working With Individuals With Severe Challenging Behavior |
| ALISON M. BETZ (ABA Technologies, Inc. ), Patrick Romani (University of Colorado, Anschutz Medical Campus), Mathew C. Luehring (University of Colorado, Anschutz Medical Campus) |
| Abstract: The healthcare and social assistance industries continue to grapple with elevated rates of on-the-job injuries, surpassing those of any other private industry. In 2020, data from bls.gov (2021) underscored a concerning statistic: nonfatal occupational injuries and illnesses were nearly twice as prevalent in these sectors compared to other high-risk industries like mining and construction. One explanation for this pronounced disparity in injury incidence could be the distinct prioritization of employee safety in alternative industries, where evidence-based methodologies such as behavior-based safety (BBS) have been harnessed to enhance workplace safety for decades. As is customary with behavioral interventions, the initial step within the BBS framework includes a meticulous assessment of risk and safety to identify influential variables influencing on-the-job safety-related behavior. Our objective was to conduct a comprehensive safety assessment within a neuropsychiatric special care unit, which has been experiencing elevated instances of employee injuries, predominantly during interactions with patients who engage in severe problem behaviors. Through our assessment, we identified target behaviors linked to employee injury, along with their likely functions. We then implemented an observation and feedback system focusing on safe workplace behaviors. Results of the safety assessment and observation and feedback system will be presented and discussed. |
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A Specialized Care Pathway for Autistic Patients With Aggressive Behavior Boarding at a Children’s Hospital |
| ZHICHUN ZHOU OSTLUND (St. Louis Children's Hospital ), Brandon May (Washington University in St. Louis; St. Louis Children's Hospital) |
| Abstract: Individuals with autism spectrum disorder are more likely to be hospitalized for aggressive behavior than individuals with other behavioral health conditions. The heterogeneity of autism is more likely to require specialized inpatient care, which is largely unavailable. This leads to higher boarding rates, increased aggressive behavior, and longer lengths of stay in settings inadequate for managing aggressive behavior like medical hospitals. The following presentation outlines a specialized care pathway for autistic patients boarding at a Children’s Hospital, which includes changes in the physical environment and the implementation of a standardized set of behavioral strategies. Behavior planning was supported by changes in personnel, trainings, and process optimization. A case series outlines the effects of this pathway in reducing aggressive behavior, the use of crisis intervention, and PRN psychiatric medications. Workplace violence data shows a 50% reduction in OSHA recordable incidents across the hospital in the year since this pathway was implemented. |
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