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St. Luke's incident highlights concerns about observation training for security officers


St. Luke's incident highlights concerns about observation training for security officers

An investigation by the Pennsylvania Department of Health into the death of a patient at St. Luke's University Hospital in Bethlehem, Pennsylvania, has highlighted concerns regarding observation training for security officers at the facility.

On June 4, a patient who had been diagnosed with impulse control disorder at St. Luke's was under continual observation by a security officer when he entered the bathroom, locked the door, and jumped to his death from a sixth-floor hospital window. An investigation completed by the Department of Health found no evidence that the security officer received education, training, or an assessment of competence for continual observation of patients. As a Plan of Correction, the report required all current and newly hired security officers to complete continual observation training, and required the security supervisor to audit current officer education and review all new hires for one year to ensure continual observation training is completed according to the hospital's policy.

Additionally, the report revealed that not all patient rooms in the ICU, where the patient was being held, "were outfitted to accommodate patients with active behavioral symptoms, such as aggressive and impulse behavioral disturbances." Staff members were not trained on how to utilize the safety release feature on the bathroom door locks. The report's "Plan of Corrections" required emergency access to patient bathrooms to be included on the orientation checklist for security personnel.


Should security observe patients?

The recent event and subsequent report raises some interesting questions as to what kind of training is required, and whether officers should even be tasked with continual observation responsibilities. Although the Department of Health cited St. Luke's for failing to provide any training for security staff, there are no current regulations that spell out what that training should include or how it should be conducted.

"What is that training?" says John M. White, CPP, CHPA, president and CEO of Protection Management, LLC, in Canton, Ohio. "That is a question that a lot of people will have disagreements about until it's actually put down in black and white on paper."

In 2010, The Joint Commission released a Sentinel Event Alert on preventing suicide in medical-surgical units and EDs. In it, The Joint Commission suggests "educating staff about the risk factors for suicide, the warning signs that may indicate imminent action, and how to be alert to changes in behaviors or routines." Staff should be empowered to place an individual under constant observation if the person at risk exhibits any of these warning signs.

National Patient Safety Goal 15.01.01 requires hospitals treating patients with behavioral disorders to identify individuals at risk for suicide, but the standard does not address training requirements for continual observation.

More hospitals have been using psychiatric techs rather than officers to monitor patients because they are better equipped to recognize signs of suicide and appropriately intervene, White says. This recent event at St. Luke's raises the issue as to whether officers should be tasked with continual observation at all, but particularly if they have not received training to recognize the warning signs of suicide.

White says the majority of security officers are not adequately trained to provide continual observation for psychiatric patients. They are often unaware of the patient's medical condition because of HIPAA constraints, nor do they know the warning signs of psychological distress.

"That's a difficult thing if you're asking security officers to conduct clinical observations or psych observations in which security officers don't have the training or background on it," he says.

White adds that some security programs?particularly in smaller hospitals?have low staffing levels. If one or two officers are tied up with observing patients, that can be half or even three-quarters of the staff on duty during that time.

Michael Silva, CPP, of Silva Security Consultants in Covington, Washington, agrees that, ideally, officers should not be used to observe patients. In some situations, officers can be working under physicians or clinical staff to assist with a particular violent patient, but they aren't generally qualified to provide observation.

"Obviously if they see someone tearing the room up or trying to harm themselves they could intervene, but really, the observation is not just abnormal behavior, but general wellness: What is the person like, how are they breathing, etc.," he says. "A healthcare professional is going to spot what a security officer is not going to be able to spot."

Managing bathrooms

White adds that if officers are used to observe patients, they should undergo ongoing training on a quarterly basis. In addition to being trained to recognize changes in a patient's behavior, officers should also understand the ground rules, particularly involving patients using the bathroom.

At St. Luke's, the patient managed to lock the door of the bathroom. Many hospitals don't have locks on the bathroom door at all, White says, but there should be a clearly defined policy that balances safety and security with patient privacy. Hospital policy may dictate that the officer get a nurse or nurse assistant of the same sex to monitor the patient during that time.

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