Moore Regional’s new ED policies aimed at maintaining safety

Steven Strobel, M.D.

PINEHURST – After a gunman opened fire on the residents and staff of a Moore County nursing home last year, anxious relatives and law enforcement and rescue personnel converged on the Emergency Department at FirstHealth Moore Regional Hospital, further taxing what is always one of the hospital’s busiest areas.

As physicians and staff tended to critically injured patients, including the alleged gunman himself, the hospital went into lockdown for several hours. No one was allowed to enter the building, and no one was allowed to leave.

A more recent incident in the Emergency Department at neighboring Scotland Memorial Hospital further illustrates the fact that, while hospital-based episodes of violence are rare, they do occur. And even on the best of days, an emergency department is a busy place with lots of incoming and outgoing traffic.

The ED at Moore Regional, which records about 66,000 patient visits each year, is no exception.

In an effort to better control the everyday visitor flow in the ED and to assure patient, visitor and staff safety on normal days as well as in times of heightened security, the administration of Moore Regional has implemented new emergency department policies regarding visitor access and security levels.

“Our duty is first and foremost to our patients,” says Steven Strobel, M.D., medical director of Moore Regional’s ED, “and the unfortunate escalation of violence in today’s society now forces us to operate under new rules for patient safety. While we recognize that these changes in policy and procedure may prove frustrating to some of our visitors, we expect that, with appropriate education, they will understand why we are taking the steps we are taking.”

According to Kris Owens, R.N., clinical director of Moore Regional’s Emergency Department, the policy changes are designed to improve security and safety throughout the department. “That’s the bottom line,” she says. “We’re trying to provide more safety and security to individuals using the service.”

The changes, which are scheduled to go into effect July 8, involve normal day-to-day operations as well as situations that involve threats to life, property or hospital services. They involve the Emergency Department at Moore Regional Hospital only.

In a change that affects everyone who enters the ED on any given day, the department’s patient family communicator (PFC) will now ask all visitors their name and the name of the patient they want to visit. The PFC will then attempt to communicate with the patient and/or caregiver to get permission for the visitor to enter the treatment area.

If the patient is unavailable, the visitor will be asked to take a seat in the lobby until the patient can be contacted. If the patient’s condition is such that he/she is unable to make a decision about visitation, the patient’s primary nurse may make the decision.

Once approved for treatment room visitation, visitors will be given a blue arm band that must be worn while they are in the treatment area.

Another change to ED procedures involves the implementation of ED Lockdown Stage I, which can be put into place if the department becomes seriously over-crowded. In the event of this situation, visitor access to treatment areas will be limited and hospital Security may be called in to ensure the limited access.

A significantly heightened security level, ED Security Stage II, can be called in situations that threaten life, property or ED services – either in or near the hospital or even in the community, especially if they involve violent acts for which victims might be expected to be transported to the hospital.

In these cases, access will be limited only to essential clinical personnel and signage stating that message is placed on exterior doors. Visitors will not be allowed inside except for pediatric patients (and then only one per patient) or unless determined necessary by the ED charge nurse.

According to Cheryl Batchelor, executive director of Clinical Operations at Moore Regional, the hospital’s ED has been overwhelmed by community response to multi-patient incidents several times. The changes to the ED procedures are designed to respond to those situations as well as to maintain the flow of services on routine days, she says.

“It’s the culture of our community,” Batchelor says. “Everyone comes to find their family. The community reaches out, and it just adds to the confusion and chaos. We have to find out who the essentials are.”