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In 2016, an inpatient at UVA Medical Center experienced a medical event that caused him to become violent. The situation was so traumatic and extreme that team members still talk about it today, and looking back, it was a turning point for safety at UVA Health.

Susan Jackiewicz, Administrator, Neuroscience Service Line, and Ava Speciale, RN, Nurse Manager, 5 West and Wound Ostomy Care team, and were on duty that night, and that incident still stands out in their memories.

“We had a patient who had a seizure and then had what’s called an episode of postictal psychosis and became violent afterwards,” Jackiewicz says. “He was so violent that he went through multiple units and was difficult to contain and control. His violence impacted many team members that evening, and ultimately, himself.”

After the patient was under control, and the immediate danger subsided, it became evident that a change was needed to prevent a situation like that from happening again. From that point on, it became the mission of Jackiewicz and Speciale to make sure they and their colleagues would be better prepared to handle a violent event in the future.

“I am passionate because I don’t want any of our team members to be in that position,” says Jackiewicz. “There are signs and precursors before these events, and we need to notice them and take steps prior as much as possible. It is not uncommon for people to say, ‘We knew this person was on edge.’ What can we do, so that it doesn’t get to that point? A lot of our work has been to try and get to that moment and not let it go over the edge.” 

Jackiewicz, Speciale, and an interdisciplinary team began the work that is now known as the Situational Awareness Violent Event (SAVE) Program. SAVE focuses on prevention, mitigation, response, and recovery from violent events through a variety of measures like a taskforce and a library of resources.  

Part of the program includes a committee that reviews all violent or threatening situations, which should all be entered as Be Safe events. Jackiewicz and Speciale are cochairs, and members include Security, University Police, the Behavioral Emergency Response Team (BERT), Emergency Management, Patient Experience, Behavioral Medicine, inpatient and ambulatory nurses and leaders, representatives from the call center, patient safety officers with risk management, a clinical nurse specialist, and more. The focus is on both clinical and non-clinical environments — like the front door and lobby — throughout UVA Health.

“We have a team of people behind us that do threat assessment and risk management,” says Jackiewicz. “We have a lot of experts available here at UVA.”

The committee has had many successes that have resulted in team members being better trained, prepared, and educated:

• Created dedicated Workplace Violence icon in Be Safe to report violent events
• Established zero-tolerance policy on violence in the workplace, which is outlined in Policy 0172 : Reporting, Preventing, and Responding to Violence in the Workplace
• Introduced daily violent event counts in the UVA Health Data Portal 
• Debuted a SAVE desktop icon

SAVE Desktop Icon

Within the desktop icon, an extensive list of resources can be found, such as standard procedures; information on how to conduct a threat assessment, how to obtain private security, and how to set a behavioral flag in Epic; call scripts when calling emergency operators for help; contact information; and more.

The call script, for example, “helps [team members] push information to the operator,” says Speciale. “We were able to test that and found that it reduced seconds on a call, which is critical when you need an emergency response.”

Many of the resources are most effective when reviewed before there is an event, so they can be utilized quickly.

“Explore the SAVE icon, know it’s there, and look at the resources,” says Jackiewicz. “If you have any questions, reach out to Ava and I because we are always willing to be a resource to teams.”

Policy 0172 : Reporting, Preventing, and Responding to Violence in the Workplace

Policy 0172 was revised Oct. 1, 2021, to include a zero-tolerance position for violent or threatening behavior in the workplace.

“That’s a significant step forward for our organization,” says Speciale. “We put a lot of work into getting that through.”

Reporting

Speciale also stresses that it is important every event is reported to deploy resources and prevent escalation. 

“We recognize that we have a challenge with under reporting of workplace violence events at UVA Health, and that’s also known to be a challenge across the nation,” says Speciale. “We know from the American Nurses Association that under-reporting is common with workplace violence. It’s definitely encouraged to report even verbal or threatening behaviors, so that we can make sure their local leadership can pull the right resources to prevent that from escalating to physical violence.”

For more information about preventing workplace violence or any of the available resources, you may contact Susan Jackiewicz at scj4t@hscmail.mcc.virginia.edu or Ava Speciale at ab3yk@hscmail.mcc.virginia.edu.