Reducing Contraband From Outside Sources in a Healthcare Setting, Exams of Advanced Education

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D221 Organizational Systems and Healthcare

Transformation TASK 2 2024 Reducing Contraband From

Outside Sources in a Healthcare Setting Western

Governors University

Reducing Contraband From Outside Sources in a Healthcare Setting WGU: Leavitt School of Health D221: Organizational Systems and Healthcare Transformation

Hospitals tend to revolve around a safety-focused culture with dedication to all those involved. Steps are taken to reduce instances of violence, such as posted signs regarding “zero- tolerance” for violent behavior, security personnel posted in high-risk areas such as the emergency department and specific protocols for potentially violent incidences. Mandatory search of all patients, belongings, and visitors upon entering the hospital environment would be a vital step in increasing safety for everyone. There have been instances of individuals bringing in contraband that negatively impacts the health and safety of all present in the hospital. Weapons, such as guns and knives, can be used to maim or even kill others. Outside medications can be snuck in through concealment through purses or pockets, which, if taken by the patient unbeknownst by the nursing staff can cause serious harm or even death. Drugs can be injected through an IV access, causing a harmful medical event. While these instances negatively affect the hospital and all involved, there are ways to lower the risk and improve safety outcomes. Contraband in hospital can range from tobacco and alcohol to more nefarious drugs such as cocaine and heroin, which significantly increases the risks for the patients, staff, and visitors. (Grewal et al., 2021) According to Grewal et al. (2021), 44% of participants who reported using illicit drugs had also used illicit drugs while in the hospital. Patients who use illicit drugs are more likely to be discharged prior to completing treatment due to non-compliance with hospital policies, resulting in negative health outcomes and greater rates of readmissions. Increased security personnel with specialized training would be a necessary asset to the safety team. Emergency departments would benefit greatly with increased security measures, as a great deal of violent events occur in this department compared to other units in the hospital.

Nursing leaders and managers would need to educate their staff on proper protocol on the individual units. There have been instances of individuals bringing in contraband that negatively impacts the health and safety of all present in the hospital. Weapons, such as guns and knives, can be used to maim or even kill others. Outside medications can be snuck in through concealment through purses or pockets, which, if taken by the patient unbeknownst by the nursing staff can cause serious harm or even death. Drugs can be injected through an IV access, causing a harmful medical event. While these instances negatively affect the hospital and all involved, there are ways to lower the risk and improve safety outcomes. High reliability organizations (HROs) are those that are committed to, and maintain, higher safety and excellence in practices that are complex and essential. HROs would benefit from increased safety measures implemented within their respected facilities. “Patients encounter circumstances increasing their emotional and/or physical vulnerability to harm, leading to experiences of fear and anxiety. Without intervention, fear and anxiety lead to a decreased sense of security, increased distress, and suffering” (Groves et al., 2023). Physiological and psychological safety needs would be improved by implementing these changes, as well as increased accountability on the part of the environment, staffing, and patient/visitors themselves. I will be discussing sensitivity of operations, preoccupation with failure, and resilience in regards to HROs and how changes could be implemented to satisfy the need to create the proper environment of safety, healing, and patient satisfaction. “Effective January 1, 2022, new and revised workplace violence prevention standards will apply to all Joint Commission-accredited hospitals and critical access hospitals. According to US Bureau of Labor Statistics data, the incidence of violence–related health care worker

injuries has steadily increased for at least a decade. Incidence data reveal that in 2018 health care and social service workers were five times more likely to experience workplace violence than all other workers—comprising 73% of all nonfatal workplace injuries and illnesses requiring days away from work. However, workplace violence is underreported, indicating that the actual rates may be much higher. Exposure to workplace violence can impair effective patient care and lead to psychological distress, job dissatisfaction, absenteeism, high turnover, and higher costs” (The Joint Commission, 2021). Sensitivity to operations and preoccupation with failure traits of HROs would be addressed by increasing security and implementing searches. Nurses are typically the first in line to witness how contraband brought into hospitals can negatively affect those involved. There are instances that we are able to report to higher authorities after witnessing how the events occur. After reporting and having new procedures implemented, it would be the nursing staff’s duty to ensure repeat offenses are prevented from occurring in the first place. Many would believe the mandatory searches would impede upon their constitutional rights. I propose the same procedure present in courthouses, as safety is of the utmost importance. Visitors or patients would have the right to keep their items, either locked safely away while in hospital, or sent with a trusted individual to return it to their residence. Of course, should illegal items be involved, so shall the proper authorities. Another barrier would be similar to what most detention centers go through; humans are both determined and creative. People can sneak in items sewn into clothing, disguised as other substances or even in their own orifices. Drug dogs or metal detectors would deter most, but those particular components may not be readily accessible or acceptable. I have been to a hospital where these preventative measures are already in place. The hospital was located in a

city with a higher crime rate, necessitating the extra security. While inconvenient, I feel that the extra safety measures provide a reassurance that the likelihood of incidence would be greatly reduced. A single set of guidelines would not be suitable for all healthcare organizations. A governing body would be responsible for developing and implementing an approach that would be ethical and sustainable for their specific environment. Negative implications of such widespread violence in healthcare sectors have a significant impact on the delivery of health care services, including a decline in the quality of care delivered, increased absenteeism, and health workers' decision to leave the field” (Lim et al. 2022). By reducing the number of instances in which safety events occur, there would be a great deal of improved factors, not only for the patients and visitors, but the employees as well. The healthcare field is always in need of dedicated employees that last the long term. The trait of resilience of a healthcare worker in an HRO is beneficial in so many ways, though there are certain aspects that must be provided by the organization rather than only relying on the individual. The key to reducing turnover rate may be improving working conditions by decreasing negative events. Healthcare workers should not go to work expecting to be hurt. “Approximately 25% of registered nurses report being physically assaulted by a patient or family member, while over 50% reported exposure to verbal abuse or bullying” Many healthcare environments require only identification and a room number or patient name to gain access. While this creates a more welcoming environment, safety is of the utmost importance. According to Strike et al., participants in a 2015 study reported having illicit substances brought to them by hospital visitors or leaving the hospital to access the substances in their vehicle on hospital property (Strike et al., 2020). Drugs and other substances are typically

removed from the patient and visitor access may be restricted to prevent further access. Existing protocols for armed individuals are mandated education in most hospitals across the US. These protocols are in place to protect the self in case of an emergent situation, not prevent the event from occurring in the first place. By taking steps to prevent such events from occurring, the healthcare facility would be proactive rather than reactive. Litigation proceedings would be reduced, as the number of uncontrollable safety events would be further minimized. Specific studies on workplace violence have varied results due to many factors. Execution of intervention is one such hinderance on studies. Staff members can be encouraged to report issues, but one staff member may only report instances of physical violence and disregard all instances of verbal abuse while another would report every perceived issue. Some patients may be incapable of controlling their violent behavior, such as those with altered mental status. As specific criteria would have to be met to qualify the evidence, the quantitative data may be negated, skewed and, ultimately, nullified. I believe a team nursing approach would be the most effective method to be implemented in regard to safety of the patient as well as reducing burnout for the nurses providing care. While the nurse would be responsible for those working under their license, the amount of work that could be delegated to unlicensed personnel would greatly reduce the workload on the nurse allowing focus to be more focused on the clinical aspect. Ancillary personnel would also be responsible for reporting illicit products to be reported to the nurse, manager, or even directly to security. Teamwork is the foundation of the floor on which I currently work and I find that we work like a well-oiled machine to provide excellent care for our patients. The chain of command is clearly outlined, and issues can be escalated up a specific set of stairs until a resolution is reached by the proper authority.

A thorough review of the changes would be beneficial to determine the results of the implemented changes. Patient and employee satisfaction scores would be one way to determine how the changes are perceived from a subjective standpoint. Press Ganey and HCAHPS scores are presently utilized to evaluate patient satisfaction levels, though there is some disparity between direct nursing care versus brand loyalty. A homed in focus would benefit studies on nursing care improvement over ensuring a specific hospital system is preferred over another. Employee satisfaction questionnaires serve to allow the staff to anonymously express their thoughts on their workplace, managers, administrators and working conditions. As an employee with Sentara Healthcare, I have found the MOT surveys allow me the opportunity to speak up on subjects that I feel need improvement or alteration. The Safety Tracking and Reporting System (STARS) is available to provide objective reports regarding safety events pertaining to outside sources of contraband as well as violent interactions. Even though these protocols would require an extra step towards entering the hospital, I believe the benefits would greatly outweigh the drawbacks. It is common knowledge that healthcare facilities are no place for weapons or illegal drugs. Healthcare workers are supposed to help those in need without having to fear for their lives or safety. Patients should feel safe and cared for. Finding contraband before endangering the lives and safety of others supersedes any reason that a person would have for bringing in a potentially harmful item.

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