Embedding Psychiatric Risk Flags Within an Electronic Health Record: Initial Findings and Lessons Learned

Paterson, Jane; Fernandes, John J.; Hunter, Kimberly; Hubert, Sheldon; Strudwick, Gillian

doi:10.12927/hcq.2019.25739

Cited by 11 publications

(23 citation statements)

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“…Similar to other studies (e.g., Burkoski et al, 2019;Paterson et al, 2019), we found several gaps in flagging policy and procedures. Some gaps were particularly frustrating that, according to one manager, led workers to not comply with the policy.…”

Section: Discussionsupporting

confidence: 89%

“…Four of the five hospitals had a formal flagging policy and procedures, and in general, participants expressed positive views about flagging similar to other studies (e.g., Burkoski et al, 2019;Paterson et al, 2019). One hospital did not meet our criteria for inclusion because they did not have a flagging policy at all, despite legislation requiring measures and procedures to communicate personal information about a person's HOVB.…”

Section: Discussionmentioning

confidence: 56%

“…The authors speculated that the return to pre-implementation rates (and higher) may have been due to intervention sustainability issues or increased reporting due to heightened program awareness. Paterson et al (2019) found a decrease in flag-related incidents for 61% of patients, but an increase in incidents for 28% of patients, and no change in number of incidents for 11% of others. The authors discussed that the flags have some value as a communication mechanism and that the reduction in incidents may have been because of other reasons such as improved mental health due to hospitalization.…”

Section: Introductionmentioning

confidence: 78%

“…The authors discussed that the flags have some value as a communication mechanism and that the reduction in incidents may have been because of other reasons such as improved mental health due to hospitalization. Despite the question of how effective flagging is on rates of violence, research shows that flagging heightens health care workers' vigilance of the potential for danger (Burkoski et al, 2019;Paterson et al, 2019). This awareness may lead workers to proactively seek and implement preventive safety precautions such as requesting immediate security presence.…”

Section: Introductionmentioning

confidence: 99%

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Workplace Violence Prevention: Flagging Practices and Challenges in Hospitals

Ferron

Kosny

Tonima

2021

Workplace Health Saf

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Background: Flagging is a standardized way to communicate the risk of patient violence to workers. We add to the limited body of research on flagging by describing hospitals’ approaches to and challenges with flagging patients with a history of violent behavior. Methods: We used a qualitative case study approach of hospitals in Ontario, Canada and their patient flagging practices. Key informants and our advisory committee identified 11 hospitals to invite to participate. Hospitals assisted in recruiting frontline clinical and allied health workers and managers to an interview or focus group. A document analysis of hospitals’ flagging policies and related documents was conducted. Thematic analysis was used to analyze interview and focus group data. Findings: Five hospitals participated. Of the five hospitals, four had a flagging policy where frontline clinical workers ( n = 58), frontline allied health workers ( n = 31), and managers ( n = 42) participated in an interview ( n = 43) or focus group ( n = 15). Participants described three challenges: patient stigmatization, patient privacy, and gaps in policy and procedures. Conclusion/Application to practice: Flagging patients with a history of violent behavior is one intervention that hospitals use to keep workers safe. While violence prevention was important to study participants, a number of factors can affect implementation of a flagging policy. Study findings suggest that hospital leadership should mitigate patient stigmatization (real and perceived) and perception of patient rights infringement by educating all managers and frontline workers on the purpose of flagging and the relationship between occupational health and safety and privacy regulations. Leadership should also actively involve frontline workers who are the most knowledgeable about how policies work in practice.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 56%

Section: Introductionmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 99%

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Workplace Violence Prevention: Flagging Practices and Challenges in Hospitals

Ferron

Kosny

Tonima

2021

Workplace Health Saf

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“…This issue's last article describes another modest intervention that can yield improvements in an area of growing concern -the safety of health professionals. In this case, the intervention was at Canada's largest psychiatric hospital where a riskflagging system -embedding alerts in a patient's electronic health record --was implemented to make health professionals aware of potentially aggressive or violent patients (Paterson et al 2019). The study found that violent incidents decreased during the implementation of the "alert system" but increased after the end of that phase.…”

Section: Workplace Safetymentioning

confidence: 99%

From the Editors

2019

hcq

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Things We Do for No Reason™: Indiscriminate use of behavioral alerts

Kopp,

Kryzhanovskaya,

Cornes

2023

Journal of Hospital Medicine

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A 20-year-old Black male with a history of a seizure disorder presents to the epilepsy monitoring unit for supervised seizure monitoring.The patient has a history of agitation and self-harming postictal behavior. Following a seizure during a prior hospitalization, a behavioral alert (BA), entitled "History of Violent Behavior," was placed on his chart. As part of the current admission, the patient's providers reviewed prior documentation, including the BA. The clinical team placed the patient in restraints during his seizure-an action that is not standard of care-and did not remove the restraints despite the patient's calm postictal behavior and request for removal.The patient became increasingly agitated, resulting in a call for security presence and a violent interaction between patient and staff.

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Embedding Psychiatric Risk Flags Within an Electronic Health Record: Initial Findings and Lessons Learned

Cited by 11 publications

References 0 publications

Workplace Violence Prevention: Flagging Practices and Challenges in Hospitals

Workplace Violence Prevention: Flagging Practices and Challenges in Hospitals

From the Editors

Things We Do for No Reason™: Indiscriminate use of behavioral alerts

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