Security interventions are frequently undocumented in emergency department clinical notes

Abstract

Objective To compare the documentation of security interventions in ED presentations between clinical notes and security records. Methods Presentations (n = 680) were randomly selected from all ED presentations to a public tertiary referral hospital in Queensland, Australia between April 2016 and August 2017 that were perceived by the treating clinician as alcohol‐related. Retrospective data, manually extracted from clinical notes and the security service database, were compared for the documentation of any security interventions. Security interventions were defined as observation without physical contact, verbal de‐escalation or physical restraint by security officers. Results Forty‐one presentations had security interventions documented in the security services database and, of those, 20 (48.8%) had documentation in the clinical notes. Patients who required security interventions were admitted to hospital in higher proportions compared with those who did not (73.2% vs 26.8%, respectively, P < 0.0001). Conclusion The rate of documentation of security interventions in clinical notes was less than 50%. Documentation of critical information, including alerts and risks, in the clinical notes is an essential component of communication that the multi‐disciplinary team use to ensure patient safety. Strategies aimed at improving the documentation of security interventions in clinical notes will help to optimise risk management and the safety of patients, staff and visitors along the continuum of care.

Factors associated with paediatric and adolescent Emergency Department presentations involving acute behavioural disturbance events

“…Within the context of a retrospective study, we believe our decision to use the security log for case inclusion is a strength as this has previously been reported to be the most reliable record of security events, outperforming other clinical records and minimising the likelihood of missed cases 21 . The relatively large size of our case series as well as the extensive population covered by the facility is in our opinion also a strength.…”

Workplace violence in emergency departments: The health professionals and security personnel alliance

“…As the authors stated, ED staff in responding to behavioural problems, in particular aggression and violence because of people who experience intoxication, agitation, distress, psychosis and so on, 4 habitually call hospital security to assist them. However, the contribution of security personnel in the management of violent incidents is not yet properly documented 5 and evaluated. 6,7 The study by Wand et al showed that for security personnel, communication between health professionals and security staff must be improved, legal issues clarified, teamwork and respect should be given.…”