Veterans hospital enhancing security measures in response to patient death

Wednesday, February 5, 2014 | 10:18 a.m. CST; updated 11:40 a.m. CST, Wednesday, February 5, 2014

COLUMBIA — In the aftermath of a patient being beaten to death by another patient last February, Truman Veterans Hospital has changed its violent patient response system.

A Nurse Locator System was implemented Friday in the mental health unit of the hospital, facilitating a quick response to a disruptive patient.

The nurses working in the mental health unit will wear locator badges on their uniforms. By pressing the badge, they will be able to notify the nursing station and telephone operator of a "code orange." The code signals a behavior emergency, alerting VA police, nurses, psychologists, psychiatrists and social workers to an incident of disruptive behavior.

Definitions of disruptive behavior vary among VA hospitals but typically range from verbal aggression to an active suicide attempt, according to a report released last March by the VA Inspector General. 

While former policies required a "code orange" to be called during a behavior emergency, it didn't specify what personnel should do once they arrived at the place where the emergency was happening.

Nurses in the mental health unit previously had no way to quickly alert staff of a behavior emergency without getting to a computer keyboard or a phone, said VA hospital spokesman Stephen Gaither.

The new procedures come a year after a mental ward patient beat another patient to death and "was a direct result of reviews and recommendations" by the VA's Office of the Inspector General, Gaither said.

Rudy Perez Jr. attacked 78-year-old Robert O. Hill in the common room of the mental health unit on Feb. 1, 2013, according to previous Missourian reporting. After the two were separated by a VA police officer for three hours, they were allowed back in the same common room. Perez then attacked Hill a second time, kneeling over him and striking him repeatedly in the face and head. Hill was later pronounced dead at University Hospital.

The veterans hospital declined to answer questions about personnel response due to patient privacy laws, and it was unclear if a "code orange" was ever activated.

Perez was found not guilty by reason of insanity.

Gaither said that along with the Nurse Locator System, a certified instructor was contracted in December to train a team of nurses — who then will train other staff — in a four-level training program called "Prevention and Management of Disruptive Behavior."

All staff are required to complete level one, a computerized training of hospital policies on disruptive behavior. The remaining three levels are a combination of computerized and hands-on training designed for personnel working in emergency and in-patient psychiatry departments "where they are most likely to deal with potentially disruptive behavior," Gaither said.

Previous policy required new employees to complete the computerized training, but no annual re-certification process was in place. The hospital also offered hands-on training but did not have a certified instructor on staff at the time, requiring personnel to travel to other VA hospitals to complete the training.

Gaither said the technology is already in place, but he said the cost of the new locator system was minimal.

Supervising editor is Katherine Reed.

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