A SAFER PLACE TO PACE — New TV islands in the day rooms at the Central New York Forensic Psychiatric Center provide a walking area for restless patients. Fewer fights occur because pacers don’t obstruct the view of other patients watching TV. OMH member seriously injured Joint L-M effort cuts injury rate nearly 50% at forensic hospital Story and photos by DEBORAH A. MILES It’s been called one of the most dangerous places in the state to work. Last year, the level of violence at Central New York Forensic Psychiatric Center (CNYPC) in Marcy escalated to 329 reported staff injuries. And when a PEF nurse was severely assaulted, the union started spinning the wheels that led to establishment of a joint labor-management committee on violence prevention that has cut the injury rate by nearly half. The effort began last May when a 51 year-old nurse, who has worked at this facility for nearly two decades, was seriously hurt. A patient near the medication cart became argumentative and aggressive. When staff tried to escort him away, he suddenly became “explosive.” In the struggle to control him, the nurse was pulled to the floor and his head was severely injured, requiring emergency surgery. The nurse suffered a fractured skull, bleeding in the brain, hearing loss, a black eye, lumps and blood loss, along with severe emotional trauma. It was a turning point for violence prevention efforts at CNYPC — one of three facilities in the state that house mentally-ill felons with histories of violent criminal behavior. Enough is enough already Local leaders of PEF and the NYS Corrections Officers and Police Benevolent Association (NYSCOPBA) formed a joint committee with CNYPC management to create an effective violence-prevention plan. “This is one of the most dangerous places in New York state to work,” said PEF Division 344 Council Leader Kevin R. Conley, a nurse at CNYPC for 23 years. “Something needed to be done,” said PEF Director of Occupational Safety and Health Jonathan Rosen. “The forensic hospitals historically have the worst rates of violence toward staff and among patients. But everyone was very alarmed to see injuries increasing so dramatically at CNYPC.” The startling number of injuries — 109 in April through June of 2001 — propelled the violence prevention committee to waste no time in making significant changes,. PEF and NYSCOPBA representatives walked through the facility and asked the nurses and aides what they thought was causing the increase in violence and how to curb it. PEF arranged for an architect, paid for by the state Office of Mental Health, to do an environmental analysis of the facility and recommend ways to make it a safer workplace. Making it a safer world “Several of the recommendations are already being implemented,” Conley said. “Because of the environmental survey, we are realizing actual changes. Management is moving forward. They are remodeling some of the wards.” One improvement is the installation of new television islands with room for patients who pace up and down the day room to walk behind the TV, rather than in front of it, which provoked arguments and fights. The survey also recommended replacing hardware such as using continuous hinges on doors, instead of heavy-duty hinges that can cause injuries. Other recommendations included replacing lightweight, blunt furniture with very heavy furniture that’s harder to pick up and throw. The survey even recommended fastening relish dishes to the dining room tables, so they cannot be used as weapons in an assault. Anchoring bedroom furniture was also suggested, to stop patients from barricading doors, which some have done in suicide attempts. The plan also emphasized the need to renovate nursing offices and patients’ day rooms. Community also safer Along with making physical changes, the joint committee launched a pilot project with the local court system that allows patients to remain in the facility during their court hearings and participate through video conferencing. Previously, unarmed aides transported felons to court in a facility vehicle. “Sometimes assaults occurred on the way to or from court, and it was dangerous for the community as well,” Rosen said. “Through the efforts of this committee, we were able to change that. It’s a major accomplishment.” An ounce of prevention The committee also addressed issues concerning policies and procedures when a patient becomes violent. “Violence seemed to increase when the new restraint-and-seclusion policy was introduced,” Rosen said. Now, nurses and security hospital treatment assistants have received more education about restraining patients. “There’s more emphasis now on observation and early intervention,” Conley said. “This way, we can counsel a problematic patient before a situation escalates. ”The bottom line is: fewer injuries are occurring,” The committee reports patient assaults on employees has dropped by nearly 50 percent from what was almost a daily occurrence last year. Employee safety and creating a safe work environment remains a priority for the committee. “We are committed to this project and in agreement that it remain functioning as a standing committee,” Conley said. “This is a unique example of a cooperative endeavor between labor and management to strongly address the subject of staff safety.”