OR Excellence - Where Leaders Meet, Learn and Grow Together

Red Rock Casino Resort & Spa
Las Vegas, Nevada
October 11-13, 2017

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Check Out These Exciting Sessions

Resuscitating a Dying Surgical Facility

Fear: The Hidden Killer

Building a World-Class Outpatient Total Joints Program

Get Ready for Surgical Price Transparency

What Can Surgical Facilities Learn From the Ritz Carlton and Other World-Class Corporations?

Every 1/2 Second Counts: A Victim's Perspective on Patient Safety

How to Transform Your Facility into a "High Reliability" Organization

Patient Safety: 54 Years of Progress ... or Stasis?

Addiction & Abuse: Medicine’s Dirty Little Secret

What If a Killer Walked Into Your Facility?

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Beth Chrismer, MSN, RN, CPHRM

Beth Chrismer, MSN, RN, CPHRM

What If a Killer Walked Into Your Facility?

A conversation with OR Excellence Speaker
Beth Chrismer, MSN, RN, CPHRM

Add security officer to a surgical facility manager's long list of job titles. It was just before 7 a.m., 2 days before Thanksgiving 2013. A 22-year-old man had accompanied his mother, who was about to undergo a GI procedure, to the Ambulatory Surgery Center of Good Shepard Medical Center in Longview, Texas. Without warning or provocation, the patient's son went berserk. He emerged from the men's room armed with a hunting knife and started screaming and stabbing people. He plunged his knife into 5 people during the 30-second attack. A perioperative nurse and a father who was seated in the waiting room died in the attack. And it could have been much, much worse had the facility not been properly prepared, says Beth Chrismer, MSN, RN, CPHRM, Good Shepherd's risk manager. We took some time to catch up with Ms. Chrismer to find out what security lessons other facilities can learn from her experience.

Q: Was your staff prepared for the ambush?

Ms. Chrismer — As awful as it was, I feel the situation could have been even worse. The staff at the center just completed a training session a few weeks earlier on what to do if an armed assailant entered the facility. I can't help but believe that this helped shape our staff's response that day and ultimately saved lives.

Q: What puts surgical facilities at risk of events like these?

It's better to be prepared and avert a crisis than to do these things after something has already happened. You can avoid the scars and wounds and trauma.

Ms. Chrismer — People must understand that workplace violence can occur in unexpected settings. Really tragic things can happen in the places we least expect them to, like in a beautiful ambulatory surgery center. That's why it's so important to be prepared for the unthinkable.

There are also unique factors that put healthcare facilities at risk. Most of the time, patients and family members in these settings are stressed. They feel out of control, and there is sometimes this perception that there is easy access to drugs or other mood-alternating substances. The nature of our business makes us a target. If you combine mental health problems with the stress of health-related incidents, it can take people to a place you hope they never go.

Q: How can facilities keep their patients and staffers safe, then?

Ms. Chrismer — You must be prepared for the unexpected. Develop a plan and drill with that plan, just like you would for any other potential emergency. The good news is that you don't have to reinvent the wheel to have this plan in place. There are plenty of resources available. Look to organizations like FEMA and the Department of Homeland Security, which have plans that you can adapt to your facility.

It's also a good idea for these plans to teach employees and physicians how to run, hide and fight. The general idea is that if you can run away, do it. If you can't, then hide, and if neither of those options is available, then fighting the attacker is the last resort.

Q: Does this mean facilities need to choose between being open and welcoming, or being safe and secure?

Ms. Chrismer — No. One of the biggest challenges — especially for ambulatory surgery centers — is finding a balance between these 2 ideas. It's not like a hospital's emergency room. People are more tolerant of metal detectors and being patted down in those larger settings. But in a center where people pay for elective surgery, it's off-putting to have these in-your-face security measures. You want patients to feel safe, not that you're always anticipating something bad to happen.

For example, before the attack, patients and family members could come and go as they pleased at our center, for the most part. But afterwards, we began using radiofrequency identification technology, so staff and physicians now must swipe their badges to access certain areas. Facilities should look for subtler ways like this to keep their building secure.

Q: In addition to updating a facility's technology, is there anything else staff can do to keep patients and colleagues safe?

Ms. Chrismer — A key characteristic of having a secure facility is that everyone, from leadership on down, is engaged. There's a situational awareness present. People are aware if a patient or escort is acting "weird," or they notice if one of the doors isn't closing shut as it should. It also means staff feel comfortable being assertive with visitors. They can say to someone tailgating them through personnel-only doorways, "Is there a way I can help you? Because this isn't an authorized area for visitors."

Leadership plays a key role in this as well. If you want your staffers to be aware of security concerns, but when they report these concerns you brush them off or don't make them a priority, you'll encourage complacency. If you get a report of a loose lock or RFID doors not working, have a sense of urgency to fix the problem. It should be a priority. Believe me, it's better to be prepared and avert a crisis than to do these things after something has already happened. You can avoid the scars and wounds and trauma.

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