Code Green for Workplace Violence

Purpose:
Workplace violence is a nation-wide problem. Healthcare is the most affected industry. It is critical to come up with initiatives to prevent workplace violence and to safely manage an agitated individual. Code Green assists in early recognition and prevention of escalated behaviors.

Relevance/Significance:
Safety is the culprit of quality of care and is a definite priority in healthcare setting. Code Green emerged in an effort to support a safe work environment and assist staff anywhere in the hospital to manage escalating or volatile situations, preventing potential injury and harm to patients and staff members. Adopted from Crisis Prevention Institute Workshop, the philosophy behind Code Green is early response by verbal de-escalation. It ensures quick involvement of expert resources.

Strategy and Implementation:
The Code Green Response Team was activated in April, 2013. The Code Green Response Team is the result of the improved standard of care, research, and experience in managing agitation and violence. The goal of the team is to employ the least restrictive means possible to help the person regain control of the violent behavior. The Intermediate Care Unit (IMCU) Charge Nurse leads the Team in the resolution of violent or escalating situations. The IMCU treats large volumes of behaviorally challenging, delirious, and violent patients. Their history of being the only inpatient toxicology unit in the country has provided immense experience in managing volatile situations. Other team members include supervisors, security, physician, charge nurse and bedside staff. Nurses on any unit in the hospital are empowered and encouraged to page the Code Green Response Team when an actual or potentially violent situation arises.

Evaluation:
A post-violent debriefing tool and incident report are completed after each Code Green episode. The information is used to evaluate the effectiveness and improve the process. 86.4 % of Code Green calls were successfully resolved with verbal de-escalation. There was a 34% decrease in restraint application with this practice. The Code Green Response Team is a young, but successful, intervention.

Implications for Practice:
Early recognition of a potentially violent situation and rapid intervention with verbal de-escalation results in less restraint application, better patient outcomes, and a safer workplace environment.