Purple flag initiative proves successful at BWFH

At Brigham and Women’s Faulkner Hospital, staff safety continues to be just as much a priority as patient safety. In fact, continuing to improve workplace safety has been identified by President Michael Gustafson, MD, MBA, as a key goal for 2018. One intervention in place—placing purple signs near the doors of patients who have the potential for aggressive or violent behavior—has proved to be a step in the right direction.

As part of their work on the Workplace Safety Committee, Executive Director of Patient Safety, Quality, Risk, Infection Control, CDI and Clinical Compliance Christi Clark Barney, MSN, RN, and Patient Safety Project Manager Tayla Hough recently analyzed data from RL Solutions, BWFH’s safety reporting system, and found that incidents of physical violence by patients toward staff are down on the medical and surgical units of the hospital, thanks in part to the purple sign initiative. They presented their findings at Healthcare Quality and Safety 2017.

The purple signs are used on 6 South, 6 North, 7 North and 7 South to cue staff entering a patient’s room of the potential risk of aggressive or violent behavior from the patient in that room. Barney says, “When we looked at just these medical and surgical unit floors where the purple sign project is in place, the number of events related to physical violence by a patient toward a staff member reported in RL Solutions have gone down since the purple signs have been in use. To me, that suggests this is a good intervention for that particular setting. It simply increases our staff’s awareness for the potential of patient violence, which in turn allows them to prepare for how best to approach the patient and provide care.”

The purple signs are placed by members of the patient’s care team when there is a known history of agitation/violence or if there is concern that the patient may have these issues due to current status. For example, a delirious patient who may strike out at a staff entering the room due to current confusion may need a purple sign to cue caregivers of that risk.

Interestingly, while the rate of reports of physical violence have gone down, the rate of reports of verbal abuse or threats have gone up. For example, Barney and Hough’s analysis shows that in September of 2016 there were eight reports of physical violence and one report of verbal abuse/threat. In the month of September in 2017, there were just four reports of physical violence but three reports of verbal abuse/threat.

According to Hough, this finding speaks to the success of the purple signs and the increased communication overall around such events. “Previously we got very few reports of verbal events,” she says. “I think people thought it was ok to tolerate because it wasn’t physical. But we’ve created a culture change and people now see verbal events as reportable safety events. That allows the care team to intervene earlier and prevent things from escalating into physical events.”

Barney agrees and encourages all staff to continue to speak up and report any incidence of aggressive or violent behavior from a patient toward a staff member. “The more people tell us, the more we can learn and use that data to continue to improve,” she says. “We know we have to do everything possible to make BWFH a safe environment for our patients, family members and staff. Staff safety is foundational to patient safety. If staff do not feel safe, they are not able to provide the best care to our patients.”

For staff who are unfortunately involved in a verbal or physical event, Barney and the other members of the Workplace Safety Committee need to know about it. “Our goal is to make sure every employee who is involved in one of these events gets the chance to talk to someone about their physical safety as well as their emotional well-being,” she says. Staff may be connected with the Employee Assistance Program (EAP) or receive new or refresher De-Escalation Training to ensure they are well prepared going forward. “Reporting allows us to reach out to anyone impacted by the violence event and provide resources.” says Barney. In the future, the committee also hopes to implement a support group for staff who’ve been involved in these events.