Quality, Safety & Injury Prevention

Committee Report to State Council

November 2019

CAL-ENA INSTITUTE QUALITY, SAFETY, AND INJURY PREVENTION COMMITTEE Minutes: November 8, 2019 Meeting called by: Wanda Pritts INTRODUCTION • Approval of August 2019 Minutes. • Vision: ENA defines the standards for quality and safety in emergency nursing practice. • Strategic Goals: 1. Establish & validate key metrics & procedures to improve quality & safety for emergency nursing practice & injury prevention 2. Promote the Lantern Award as the exemplar for quality and safety in emergency nursing care. 3. Expand advocacy to foster global recognition of ENA as an influential voice for safe practice, safe care in emergency nursing. 4. Lead the profession of emergency nursing beyond task-oriented care to evidence-based safe practice & safe care. . OLD BUSINESS: None . NEW BUSINESS: • The Resolutions passed by the General Assembly 2019 were reviewed. Four specific topics were selected for review of evidence-based literature and discussion of implications for practice: GA19-06: Forensic Nursing Education • Delgadillo, D. C. (2017). When There is No Sexual Assault Nurse Examiner: Emergency Nursing Care for Female Adult Sexual Assault Patients. Journal of Emergency Nursing, 43(4), 308–315. doi: 10.1016/j.jen.2016.11.006 • Simmons, B., & Grandfield, K. (2013). Focus on Forensic Nursing Education. Journal of Emergency Nursing, 39(6), 633–634. doi: 10.1016/j.jen.2013.06.010 • Discussion regarding the need for education related to charting an event with forensic evidence collection. In general group looks forward to the education and tools being developed by National ENA. GA19-05 Resolution: Hemorrhage Control • Whalen, K. C., Farrow, M., & Kelly, R. (2019). Joining the Stop the Bleed Program. Journal of Emergency Nursing, 45(2), 200–201. doi: 10.1016/j.jen.2018.12.014 • Discussion of successful Stop The Bleed Programs members are participating in, as well as brain-storming solutions to barriers various members are encountering. GA19-11: Multigenerational Nurses • Bell, J. A. (2013). Five Generations in the Nursing Workforce. Journal for Nurses in Professional Development, 29(4), 205–210. doi: 10.1097/nnd.0b013e31829aedd4 • Navigating a Multigenerational Nursing Workforce: Source URL: https://newsroom.vizientinc.com/vizient-blog/clinical/navigating-multigenerational-nursing-workforce • Discussion of integration of multi-generational literature into orientation programs and what tools ENA may generate. GA19-03 Resolution: PTSD & Suicide ED Professionals • Rehder, K. J., Adair, K. C., Hadley, A., Mckittrick, K., Frankel, A., Leonard, M., … Sexton, J. B. (2019). Associations Between a New Disruptive Behaviors Scale and Teamwork, Patient Safety, Work-Life Balance, Burnout, and Depression. The Joint Commission Journal on Quality and Patient Safety. doi: 10.1016/j.jcjq.2019.09.004 • Discussion related to how national ENA can tap into existing programs and ‘taylor’ to the ED nursing situations. Discussion of need to provide support and resources to our staff to mitigate cases of PTSD and attempt to do a better job preventing suicide in our ranks. It’s a multi-factorial problem that will require multi-factorial strategies. OPEN FORUM: no discussion

August 2019
Safety Evidence-based Topic—Active Shooter Preparedness in the ED, Trauma Triage. Articles reviewed: 1) Sanchez, L., Young, V. B., & Baker, M. (2018). Active Shooter Training in the Emergency Department: A Safety Initiative. Journal of Emergency Nursing,44(6), 598-604. doi:10.1016/j.jen.2018.07.002, and 2) New England Journal of Medicine: Journal Watch; Review of Assistant Secretary for Preparedness and Response: Mass Casualty Trauma Triage Paradigms & Pitfalls. Additional supporting articles: ENA Topic Brief: Active Shooter Preparedness in the Emergency Department (2016) • Discussion related to the two mass shooting in week before meeting. Review of evidence based articles with discussion related to strategies various facilities are utilizing (e.g. metal detectors, additional security personnel etc.), what seems to be successful and those that don’t seem to be helpful. Group consensus that active shooter drills are valuable for staff but some institutions are “hesitant” to opening “drill”—relaying concerns with how the public might perceive the drill and implication that the institution is “not safe”. Highlights of the ENA Topic Brief: 1) Develop a communication plan, 2) establish processes and procedures to ensure patient and employee safety, 3) train and drill employees, 4) plan for post-event activities. Participants shared strategies to drill, locate emergency supplies such as additional stretchers etc.

November 2018
Reviewed the many resources available on the national ENA webpage related to Lantern Award. Committee walked through the individual resources available to plan and submit the Lantern Application. Individuals shared their experiences and advice related to both successful and unsuccessful applications.

CA ENA “Violence in Healthcare” Toolkit

“OSHA” stands for the Occupational Safety and Health Administration of the United States Department of Labor, formed by the Occupational Safety and Health Act of 1970.  Cal/OSHA stands for the California Occupational Safety and Health Administration.  The Division of Occupational Safety and Health of California (DOSH, but more commonly known as Cal/OSHA) is an agency of the Government of California established by the California Occupational Safety & Health Act of 1973.  The Cal/OSHA standards, while inclusive of Federal OSHA standards, are one of the most stringent set of standards in the United States.

Cal/OSHA’s Violence Prevention in Healthcare standard became effective April 1, 2017 and is included in the California Code of Regulations as Title 8, Section 3342.  According to information provided on the California Department of Industrial Relations website, the standard applies to the following:

  • Health facilities, as defined in subsection b of the standard
  • Home health care and home-based hospice
  • Emergency medical services and medical transport, including these services when provided by firefighters and other emergency responders
  • Drug treatment programs
  • Outpatient medical services to the incarcerated in correctional and detention settings

Navigating the Cal/OSHA Standard can be overwhelming.  The purpose of this toolkit, offered by the California Emergency Nurses Association, is to assist you in implementing the requirements of Title 8, Section 3342.

There are subsections within the standard that must be implemented by specific dates:

  • April 1, 2017
    • Subsection (d) Violent Incident Log
    • Subsection (h) Recordkeeping
  • July 1, 2017
  • Subsection (g) Reporting Violent Incidents to Cal/OSHA begins
  •  April 1, 2018
  • Subsection (c) Workplace Violence Prevention Plan
  • Subsection (e) Review of the Workplace Violence Prevention Plan
  • Subsection (f) Training

The Workplace Violence Prevention in Healthcare Standard can be challenging to navigate. The Cal/OSHA Healthcare Workplace Violence Standard Resources section below contains links to specific Cal/OSHA and California Hospital Association sites regarding Title 8, Section 3342 Standard.

Additionally, in an effort to provide assistance to you in navigating the requirements within the standard, the CA ENA has created an excel spreadsheet that lists every item within each section of the standard.  The spreadsheet can be used for informational purposes or as a working document. The excel spreadsheet is located in the Cal/OSHA Healthcare Workplace Violence Standard Resources section below.

You will also find a section called Additional Healthcare Workplace Violence Resources, which includes more general healthcare workplace violence guidelines and information.

Cal/OSHA Healthcare Workplace Violence Standard (Title 8, Section 3342) Resources

Additional Healthcare Workplace Violence Resources

Dog Bite Prevention Program


QSIP CommitteeFollow the link to learn the story of Kay Thompson’s Dog Bite Prevention program.

Minutes of Injury Prevention Meetings