Dialogue Volume 14 Issue 4 2018 - Page 29

PRACTICE PARTNER Keeping Cool When Patients Get Hot I n a packed hospital ED, a patient is agitated. He’s clearly in distress, complaining loudly. When he’s finally seen, he protests the medical attention and gets even more belligerent. Suddenly, he takes a swing. Meanwhile, in a long-term care home a resident is upset at meal time. After unleashing verbal abuse at staff, she flings her tray. Violent episodes are a huge problem in health care. In fact, just this past DOC TALK November, gunshots were fired inside By Stuart Foxman a Kingston hospital. In a world where code whites are increasingly com- mon, how do you crack the code to reduce or prevent incidents of aggressive or violent patients? Curbing aggression and violence requires de-escalation skills The causes and remedies are complex. For instance, some medical conditions and circumstances – from dementia, to metabolic disturbances, to the effects of certain drugs – boost the chances of acting out. Sometimes patients won’t respond to reason or can’t due to psychosis. Other times weapons, or items that can be used as weapons, are involved, posing an imminent threat. There are different challenges in different health-care settings. This patient and work- place safety issue requires responses on many fronts. That includes systemic action around issues like staffing, security and risk assess- ments. Doctors and health care colleagues also play a key role in taking steps to try and de-escalate. ISSUE 4, 2018 DIALOGUE 29