CODE WHITE - WHAT DO YOU DO WHEN A PATIENT GOES WILD?
When a patient comes into hospital drunk, drugged, raving and fighting, the PA system calls a Code White. In a few minutes burley hospital staff members come to the scene from all over the hospital and stand by to help. Just a few days ago, while I was in Emergency in Montreal, I saw the police bring in a bull-size man on a gurney with his hands handcuffed behind his back. He was red-faced, raging, writhing and thrashing and threatening to kill everyone. I was just a few feet away. I felt completely safe.
The Ontario Nurses' Association is accusing the Royal Mental Health Care Group of failing to protect its workers after a health care worker was beaten in a violent attack by an agitated patient earlier this month.
The assault occurred Sept. 10 during a "Code White" — hospital jargon for a violent or aggressive patient — in The Royal's Recovery Unit on its Carling Avenue campus. It's the same location where three workers were badly beaten in a June 2012 Code White by a violent male patient being treated for schizophrenia.
That incident led to the hospital being charged with three violations of Ontario's Occupational Health and Safety Act. That trial resumes in November, nearly a year after it started. The Royal faces similar charges over an attack at its Brockville Mental Health Centre last October in which a nurse was stabbed in the throat with a pen by a female patient.
"These assaults can't continue like this," said Vicki McKenna, a registered nurse and provincial vice-president of the Ontario Nurses' Association. "Obviously, these can be very volatile situations, but if the workers are kept safe, then it's safe for everyone, including the patients."
Few details are known about the Sept. 10 incident, which involved a registered practical nurse. The hospital would not say if the injured worker was male or female, how badly the worker was injured or if he or she is off work.
McKenna said the hospital needs to step up its security, rather than spend money fighting the Ministry of Labour charges.
"The last thing nurses want to do is blame their patients," she said, adding that adequate staffing, a better security presence, panic alarms and improved video surveillance can all reduce risk.
The Royal said it conducted an immediate debriefing after the Sept. 10 attack and offered employee assistance help to workers who were involved. A review of the incident will also look at what the hospital knew about the patient and assess its response to the Code White call, said Susan Engels, chief nursing executive at the hospital and vice-president of quality and professional practice.
She said the hospital has stepped up its training on non-violent crisis intervention since the 2012 assault, added personal alarm buttons and does regular "safety walkabouts" to assess needs on the wards.
Patients at The Royal often have complex needs, may have been in contact with police or have aggressive tendencies wither drug or alcohol related or induced by their illness, Engels said. Previous involvement with police is the best predictor of violence, she said.
Adding security cameras might help monitor an incident as it unfolds or help determine what happened after the fact, Engels said, "but the most important thing is to get nurses freed up and out from behind the nursing station to engage in critical care."
Management and the unions will meet on Oct. 1 to review the Sept. 10 incident, she said.