How to Keep Your Facility Safe and Secure

Some security risk factors at urgent care centers (UCCs) are difficult to control, such as the demographics of the surrounding community. Other factors, however, can be improved by the awareness and training level of UCC owners and staff members.

Many urgent care facilities keep untraditional hours and that can invite danger. Overall, however, there is no difference in safety between a UCC and any other public business, such as a post office, says Bill Wenmark, chairman of the National Association for Ambulatory Care (NAFAC). “For the most part, the level of security is directly related to the community, and location — city, suburban, rural, urban, good part of town, bad part of town, etc.,” he says.

A professional security assessment could be a good idea, suggests Jeff Aldridge, president and principal consultant of Security Assessments International (SAI), an 18-year-old company that helps hospital emergency departments protect their patients, staff, visitors and property by identifying potential threats. There is considerable crossover of safety issues between hospital emergency departments and UCCs.

State-of-the art security equipment can aid in overall security, but the most necessary security step is to create clear safety protocols and training programs for staff so that they’ll know what to do if faced with a violent or potentially violent situation.¹

Behind Closed Doors

Medications, medication samples, injection equipment and chemicals should be stored in locked rooms or cabinets and access to them should be limited to authorized personnel. Authorization should be in writing and should be signed by the clinic medical director and/or manager. Sharps containers should also be in a secure location where they are not accessible to patients.

Separate records must be kept for all controlled substances, with notations for each dose dispensed. Every site physician who dispenses controlled substances must have an individual U.S. Drug Enforcement Agency (DEA) certificate on file, Aldridge says.

Having dangerous and/or coveted materials behind lock and key does discourage misconduct, but far more precaution is needed.

“Now, internally, you (should) have some special security planning related to drug seekers who may come in as a break-in or as a patient looking for the drug storage,” Wenmark says. “Urgent care facilities, like almost all other medical clinics, carry a limited supply of schedule II drugs. If they do, a good security plan is to have multiple (locked) cabinets in the lab area... All but one is the cabinet with the drugs. This can sometimes dissuade the person breaking in and have the same effect on the person on site looking for an opportunity to get some drugs.”

Urgent care leaders should forge relationships with local law enforcement so they will be in the loop about crime trends, and so authorities can suggest solutions for that particular center.

Drug Theft

There are obvious differences between UCCs and veterinary clinics, but one sad commonality is that both can become victims of drug thieves. According to the DEA, most ketamine that is sold illicitly comes from veterinary clinics. There are no national statistics for drug-motivated robberies at veterinary clinics, but a trend is apparent in several states.²

Since roughly 2001, an “alarming number” of veterinary clinics have been victims of people who seek ketamine, a tranquilizer that is most commonly used on animals. It comes in clear liquid or whitish powder and can be drank, injected, or added to smokeable materials.³

Ketamine is valued in some dance club scenes because of its euphoric and hallucinatory effects, according to the Journal of the American Veterinary Medical Association.Due to its dissociative effect, it is reportedly used as a date-rape drug.³

In most of the vet robberies, one or more people enter the facility with an animal and demand ketamine from the veterinarian at gunpoint. In any armed robbery the clinic staff should give the perpetrators anything they request and should not try to subdue them or place them in custody, Aldridge says.

Heat of the Moment

Urgent care centers should have a zero tolerance attitude toward any kind of violence, even situations far less dangerous than the typical drug robbery. Facility leaders should develop policies that will help staff members know what to do in a host of precarious situations.

If the person in question (say, a patient or patient escort) is not armed, but seems to be escalating toward a dangerous mode, staff members may be able to diffuse the situation. Aldridge recommends that the staff member:

• maintain personal space

• allow some degree of venting

• calmly and firmly set limits

• avoid arguing or defending

Just because someone doesn’t bring a weapon into a facility doesn’t mean they can’t find one. Pens, scissors, and the many other sharp objects available in UCCs can be quickly wielded by any resourceful person in a rage. Aldridge says there is statistical proof that many weapons used on emergency department staff are from within the facility. Violence is tough to predict, but is more likely to occur in open-access, high-stress areas that have a wide range of clientele, he notes.

Cash and Keys

Keys to any part of the facility should be under close regulation, says Phillip Disraeli, MD, a family physician and part-owner of Metro Urgent Care in Frisco, Texas. Disraeli recommends that only a limited number of employees receive keys to the facility, the cash collection, and the narcotics/vaccines.

As far as the employees who receive an alarm code, each person should receive a different code. That ensures that the code doesn’t have to be re-done every time an employee quits or is fired.

Disraeli says it is wise to keep two cash collections in the clinic. One should be at the front desk and should be used for taking payments and giving change. That collection should be counted at the end of every day. The other batch is petty cash and can be used for cleaning products, decorations for the clinic, lunch for the staff, etc. Keep each collection in a lock box, and put that in another lock box for double protection, he recommends.

Aldridge says that anyone who is assigned a key should keep that key in their possession at all times. When they are discharged, all keys must be returned without exception. The clinic director or manager should maintain a spare key for use under emergency conditions and should be kept in a secure location in a sealed envelope with the clinic director or manager’s name across the seal, Aldridge says.

Advice

Regardless of the neighborhood in question, staff parking should always be in well-lit spots that are visible from the building, and staff members should escort each other outside after dark, Disraeli says. This is especially important for women, since they are frequently targeted in parking lots.

Lots and walkways should be low on foliage and shadows. If the facility is located in a high-crime location, emergency call stations should be installed in the parking lot, Aldridge says. He also recommends the following:

• Waiting rooms should be separate from patient treatment areas and patient treatment areas should be under controlled access. A digital lock can be used with a buzz-in capability at the reception desk.

• A security camera should be installed in the patient waiting location to record visitor and patient activity. Video surveillance is a deterrent.

• All staff members should have access to multiple ways that they can call the police.

For better or worse, urgent care isn’t much different than any other business when it comes to safety risks, Wenmark says. “They will all have similar designs of security based on the community they serve and law enforcement advisory.” icb

References

1. Security Assessments International. www.saione.com/mission.htm 2. Nolen RS. Ketamine robberies plague Philadelphia clinics. Journal of the American Veterinary Medical Association. Sept. 2001. 3. U.S. Drug Enforcement Agency. www.usdoj.gov/dea//concern/k.html

How to Prevent Violence in Urgent Care

• Always give yourself access to the door

• Store or remove supplies or equipment that could easily be used as weapons (scalpels, needles, and electrical cords)

• Use an examination room with two doors if possible

• Try to create a calming office so there is less external stimuli

• Be forthcoming, but not overly friendly

• Present clear limits and options

• Use non-confrontational posture, such as keeping arms uncrossed and hands in view

• Avoid entering the patient’s personal space

• If possible, always ask before you touch someone

• Observe the person for tense posture, threatening speech, staring, hyper-awareness, tremors, sweating, pacing, clenching fists, gritting teeth, pounding walls or pacing).

• Use defusing techniques early to prevent escalation

• Don’t approach the person from behind

• Give immediate attention to any agitated patient or visitor

• Alert staff and security personnel immediately if you feel threatened or uncomfortable

• Take “gut feelings” seriously

Source: Jeff Aldridge, SAI

How to Handle People Who Become Violent

• Speak in a calm, soft voice and empathize with the patient’s concerns

• Acknowledge the patient’s anger

• Do not be judgmental or critical

• Do not make promises you cannot keep

• Never take the person’s anger personally, even if is directed at you

• Offer food, drink, or medication to reduce a patient’s anxiety, but do not give hot drinks or eating utensils, since they could be used as weapons

• Avoid “why” questions since they could be perceived as an attack

• Don’t make excessive eye contact with the person

• Try to stay at least one arm’s length from them

• Stand sideways to the threat since this is a less provocative stance, and provides a narrower target

• Don’t run or fight unless your success chances seem favorable

• Don’t argue, cry, or whine

• If you are choked, tuck your chin to protect your carotids

• If you are bitten, push toward the person and hold their nose closed, which forces the mouth open

• Calmly state that violence will not be tolerated

• Let police disarm patients

• If the patient has a weapon, comply with demands but try not to show fear. Ask the patient to place the weapon on the floor, then both leave the room. Don’t try to retrieve the weapon.

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