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ED Violence Articles and News

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QUESTION? Does the Altered Mental Status Score (AMSS) Overestimate the Sedation Level of Violent Patients in the Emergency Department Following IM Droperidol but not Midazolam?

The investigators of the DORM study(1) in 2010 conducted a blinded, randomized, controlled trial of intramuscular sedation for violent and acute behavioral disturbance, comparing droperidol (10 mg), midazolam (10 mg), and droperidol (5 mg)/midazolam (5 mg).  Inclusion criteria were patients requiring physical restraint and parenteral sedation.  The primary outcome was the duration of the violent and acute behavioral disturbance, defined as the time security staff were required.  A secondary outcome was the percentage of patients with an AMSS < 0.   The AMSS scale of +4 to -4 assesses both agitation and sedation.

1. Randomized Controlled Trial of Intramuscular Droperidol Versus Midazolam for Violence and Acute Behavioral Disturbance: The DORM Study, Geoffrey K. Isbister, Leonie A. Calver, Colin B. Page, Barrie Stokes, Jenni L. Bryant, Michael A. Downes, , Ann Emerg Med. 2010;56:392-401

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In their recent book, E.R. Nurses, the authors have superbly captured the joys and frustrations faced by real-world emergency department nurses throughout the United States. Many of these personal accounts describe the biting, punching, and other physical abuses associated with working in an environment that is fraught with mental illness and drug addiction. Among other observations, this book will bring public awareness to the problem of violence in the emergency department, and the importance of the work being accomplished at Sollievo Pharmaceuticals to reduce the risk of physical injury to these professionals.   The Florida Times-Union Book review: Rewarding, heartbreaking stories of E.R. nurses, Mims Cushing - Oct 24, 2021 Authors: James Patterson and Matt Eversmann, Little Brown, 292 pages We clapped for them, we cheered for them, we banged pots and pans for them, we cried happy tears and sad. And now we can read about them. They were the first responders during COVID-19. But much of this book does not deal with the nurses who dealt with that. It’s about the nurses who go about their job as emergency nurses. They too deserve clapping. And the authors have dealt with, perhaps 100, day shift, night shift, and flight nurses. James Patterson and Matt Eversmann have come up with a book about the lives of hard-working men and women who work in emergency rooms in the United States. The authors have captured the essence and drama of their stories. The nurses’ stories are sometimes heartbreaking and sometimes frightening, but all offer a close-up view as to what it takes to be a nurse. The night shifts are particularly difficult, even hard to read about. Of course, the outcomes are often painful, especially when children have to see their father or mother slowly ebb away. The nurses take solace in the fact that sometimes something wonderful happens as when a father takes off his rosary and places it around his son’s neck before being wheeled off to surgery. A nurse suggested that he do that. A few days later, the father dies, but his son will always remember that gesture. It’s particularly frustrating when a patient is being particularly difficult when a nurse has just seen something tragic. A 7-year-old had fallen out of a treehouse and was in cardiac arrest and the nurses worked on him for 54 minutes — as someone else made a petty request. During one night shift, a nurse is nearly strangled, with a chokehold by a severely mentally ill man. No two days are the same. “Sometimes [one of the teaching nurses tells new nurses], “you get to be a part of a miracle. Other times no matter how well you do your job, it just doesn’t work out. People are going to live, and people are going to die. You have no control. You just do your job.” One of the nurses wishes that people impatiently waiting for help in an ER would realize that, if they are not being treated, it means someone else is in worse condition than they are: “If we don’t get to you right away, it means you’re stable. If you’re waiting, that’s a good thing. It’s when we all rush in and jump on you that you should worry.” Give this book to someone who is thinking of being a nurse or is one already. Read it yourself and bang pots and pans all over again, in your heart.


Lawmakers Move to Better Protect Healthcare Workers

Violence against healthcare workers is a subject recently highlighted by healthcare organizations across the U.S., which are asking patients to show kindness and patience to staff. It's also picking up steam among state legislators, who are introducing bills to protect healthcare staff. Warner Thomas, president and CEO of New Orleans-based Ochsner Health, is calling on the Louisiana state legislature to make violence against healthcare workers a felony after a nurse was attacked Jan. 28 at one of the health system's hospitals. Lawmakers in some states are already acting to better protect healthcare workers. Here are initiatives in four states:  Oregon In Oregon, lawmakers will consider House Bill 4142, which would make it a crime of assault in the third degree for a person to intentionally, knowingly or recklessly physically injure a hospital worker while the worker is performing official duties. The punishment would be a maximum of five years in prison, a $125,000 fine, or both. State Reps. Shelly Boshart Davis and Sheri Schouten are chief sponsors of the legislation, which is currently with the House Committee on Judiciary.  Utah Utah lawmakers in the state House passed House Bill 32 Feb.1 relating to the assault of an owner, employee or contractor of a healthcare facility. The legislation, which now moves to the state Senate, would enhance penalties for assault or threat of violence against healthcare facility workers. Under the legislation, assault or threat of violence against such workers while they are performing their duties would be a class A misdemeanor, and it would be a third-degree felony if the perpetrator "acts intentionally or knowingly" and the attack "causes substantial bodily injury." Michigan Two bills have been introduced in Michigan: House Bill 5682 and House Bill 5084. House Bill 5682 states that if someone assaults an emergency room worker, and the violation happened while the worker was performing official duties, then that person would be guilty of a misdemeanor with maximum punishment of 93 days, a $1,000 fine, or both. A person who assaults an emergency room worker without a weapon and inflicts serious harm without the intent to kill would be punishable to a maximum one year in prison, a $2,000 fine, or both. A person who assaults an emergency room worker with a dangerous weapon without the intent to murder could receive up to four years in prison, a $4,000 fine, or both. House Bill 5084 states that an employer would be able to post a sign that says it's a felony to assault a person who works in an emergency room and that the person is allowed to perform his or her duties. The bills are sponsored by state Reps. Mike Mueller and Ben Frederick. Maryland In Maryland, House Bill 0267 is being considered, which would make it illegal for someone to threaten a public health official with the intent to intimidate, interfere with or impede that worker from fulfilling official duties. That person would be guilty of a misdemeanor and could be imprisoned for up to 90 days, a fine of up to $500 or both. The bill is sponsored by 10 delegates in the state.

Texas Nursing Workplace Violence Study 

The purpose of this survey is to assess practices and strategies used by employers to prevent workplace violence against nurses. Continued study of this topic will help policymakers better understand what efforts exist in preventing workplace violence against nurses and also help identify best practices as well as gaps in implementation of such programs. In the future, improved response rates are critical for having high quality and reliable data to help inform recommendations and policy. 

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