Issue:
Violence on HWs is increasing in Italy. In our Trust violence-related working days lost(WDL) and Incident Reports (IR)raised from 134 and 19 in years2015-16 to 342 and16 in 1st semester2017.For this reason,the Risk Management Unit (RMU) launched a FMEA,a proactive tool to identify and reduce risks.
Problem:
RMU assembled a team of 20HWs from Hospital (Emergency, Psychiatry, Occupational Health), Long-Term Units (Mental Health, Addiction, Rehabilitation), Health Directorate. The team met 6times (12hours) from June to December 2017 and worked remotely to design the process and identify phases, failure modes and causes.Each cause got a Risk Priority Number (RPN), product of 1-10 rates for Severity, Probability, Detectability. The 3rd quartile filtered highest RPNs to prioritize interventions.Safety actions were planned and, simulating their realization, new RPNs were given. Wilcoxon test compared pre/post RPNs.
Results:
The process was built in 3phases(violence from patient, from caregiver (CG), post-aggression), 17failure modes and 116 causes. Starting RPNs range was 276, median 81.5, interquartile range 42. Of 30 causes above cut-off (RPN>97), the higher were: patient managing (primary violent, substance abuse, behavior disturbs), communication (with patient, CG, coworkers), lack of post-aggression legal+psychological path, absence of a Trust Statement of Intent for no-tolerance to violence on HWs. Literature research and team multidisciplinarity allowed the detection of key actions: a course on de-escalation and communication, Unit tracers with prevention-protection service, legal+psychological support path and a Statement of Intent were planned for implementation with the Health Directorate. Wilcoxon test showed a significant decrease in pre/post RPNs (p < 0.0001).
Lessons:
The FMEA identified risks and interventions, and the same approach may improve HWs safety in other health trusts. Once completed all planned actions, RMU has scheduled WDL and IRs surveillance for a continuous safety and quality improvement.
