June 2022
Safety against violence – New solution for systematic risk assessment
Working alone can be dangerous – especially with out-of-control citizens. There have been too many deaths and far too many dangerous incidents. New smart technology will not solve the problem by itself, but with systematic risk assessment, 63% of all cases can be predicted and prevented with educational intervention.
Read the exciting article about the work with seriously out-reacting citizens and the new app that has been developed specifically for residential care, nursing homes with dementia patients and psychiatric patients, etc. Knowledge sharing is central to the care of our citizens. But also within software development. Also read the story of how our digitalization consultant and her father worked together to develop an app that provides better knowledge sharing - and thus safety for the staff.
Security and knowledge sharing go hand in hand
Right up in the red zone.
We can all get there when we get really angry.
But green-yellow-red is also an effective and well-known method for systematic risk assessment of citizens. Now a new app is coming that also supports knowledge sharing.
Systematic Risk Assessment of Vulnerable Citizens – BVC
(Brøset Violence Checklist)
Many skilled employees within the primary healthcare sector, both in municipalities, regions and especially staff within residential institutions and places of residence, work daily with risk assessment of citizens, also called BVC: Brøset Violence Checklist.
These are often citizens who, for example, are demented, mentally ill, developmentally disabled, etc. Several studies have been conducted that demonstrate that systematic documentation and especially sharing of knowledge about the citizens' condition is a significant contribution to reducing the number of dangerous episodes.
The Danish Board of Health describes, among other things, how a study in Norwegian hospitals has shown that BVC makes it possible to predict a violent incident with 63 percent certainty, while it makes it possible to predict the absence of a violent incident with 92 percent certainty. (Danish Board of Health's methodology manual)
For one thing, systematic risk assessment can help avoid violent episodes, but it also helps to give citizens a better everyday life. Because none of us wants to be in the red zone all the time.
The new app and IT solution from Pallas is now also adapted for smaller institutions.
Our experience is that risk assessment is often done manually. It can be quite impractical to put a red magnet next to a citizen who is extremely reactive,
says Sofie Hansen, a digitalization consultant at Pallas and the woman behind many of the ideas for the new app. “But the red warning color can be difficult to see for a colleague who is in another citizen's home or in a completely different building,” she emphasizes.
Serious assault figures
Since 2021, six people have lost their lives working at a residential facility for the mentally ill in Denmark. It is known from the press that assaults at residential facilities are a problem. TV2 made an in-depth documentary that showed that 20 of the 474 cases they had seen involved knives, while 79 of them involved so-called lone working - meaning that the employee is at work without colleagues at the facility for a given period of time.
The new app and IT solution for systematic risk assessment ensure that staff can very easily both register the citizen's condition, but also show how the citizen can regain balance. At the same time, department management can follow up via a digital information screen, so that they can, for example, see that several citizens are responding to emergencies at the same time in a small department - and quickly send colleagues in to help. All of this contributes to safety.
Two meters tall, one meter wide with the consciousness of a 2 year old
Jan Hansen, who originally trained as a school teacher and has more than 25 years of experience working with challenged citizens in residential facilities and institutions, knows what he is talking about.
A particularly challenged citizen is 25 years old, strong as a horse, without language and often very violently outwardly reactive. He has the consciousness of a 2-year-old and at the same time suffers from both very severe ADHD and autism.
“He hits, bites, shouts – or tears the room apart,” says Jan Hansen. But Jan Hansen has also noticed that when the citizen has not had enough healthy food to eat and their blood sugar drops, the risk of a violent reaction is much greater. It is probably not that strange, because who does not know the commercial for Snickers, where the football players behave like angry divas until they get something to eat.
The one with the food is just a small detail in a complicated picture about the citizen. But it means that when leaving a shift, it is important to note that the citizen, for example, did not eat bread for dinner – so that the morning shift has that information.
Jan Hansen
Read more about how systematic risk assessment can predict violent episodes
Taking a shower and getting shaved can be a huge physical impact on many citizens. This citizen's habitual behavior is that when he is hungry in the morning, he becomes overreactive about the shower situation. My pedagogical intervention is to sneak a cup of tea with sugar and a cheese snack into him before the shower, then everything goes much easier", says Jan Hansen.
Knowledge sharing prevents violence
It is precisely such an example that lies behind the studies that show that 63% of all violent incidents can be predicted through systematic risk assessment.
"When I come back on duty and see that he hasn't been shaved for days, it's a signal to me that there hasn't been any knowledge sharing between the staff. There's no time or energy to write it down or read it," says Jan Hansen.
As an educator you can do a lot – as a team you can make a difference. That is why knowledge sharing and knowledge about pedagogical intervention is so crucial,
Jan Hansen says
Jan Hansen is part of a team of up to 15 people that the citizen will meet over the course of a month. “We are 15 people who meet at different times in different contexts.”
"Sharing knowledge about the details of each individual citizen is really difficult, because we don't necessarily meet each other. Not everyone is equally good at writing down in the citizen's logbook what has happened during the day," he says.
Systematic Risk Assessment – the solution from Pallas provides individual advice
It consists of 5 main elements
Target group
Registration of basic information such as name, CPR information, contact persons, etc. This is information that only needs to be changed rarely.
Habitual behaviors
Habitual behavior, i.e. a description of normal behavior. For example, if the resident is normally very loud or quiet, this is something to pay extra attention to. The habitual behavior, which is briefly described, gives new staff a quick introduction to the resident's special circumstances.
Pedagogical intervention
Pedagogical intervention covers what you can actively do to make the citizen feel better again. How do we move from a citizen who is on the way up into the red zone to a more stabilized mood. It is also here that the new employee in the team can read that it might be a good idea to serve some food, to draw the curtains - or read that you should run out of the room, close the door and call for help.
Systematic Risk Assessment
Up to 8 times a day you have the opportunity to click on a risk assessment. As soon as there is a deviation from the citizen's normal habitual behavior, it is answered with a yes/no and for each point the citizen is marked as more red.
At the same time, staff can constantly see which pedagogical interventions they can use.
Episode Chart
Finally, there is an episode chart where staff can describe what preceded a citizen becoming yellow or red. What happened, what strategies were used – and what needs to happen in the future.
Safety for staff
Many institutions are divided into smaller departments, often spread across multiple buildings. All input in the solution is secured against sharing, so it complies with GDPR legislation. The system is integrated with the Smart Center information screens, so that the central management or department can see how the citizen in the same building is doing.
This means that you can stay updated on what your colleagues are doing/where they are – and lend a hand. Or whether the entire house should be evacuated if the resident turns red – that is, if the resident is excessively reactive.
Fact box
The new solution for systematic risk assessment is available in 2 versions.
A cloud-based version, specially adapted for small and medium-sized residences, which also includes an administration module and a version with integration
to the municipality's care system. All sensitive personal data is stored in a GDPR-secured manner.
You can subscribe per number of citizens and it is very easy to install on all types of phones and tablets.
Like all other Pallas solutions, it is an open app that can be integrated with other solutions, so you avoid double entry.
Behind the solution
Father and daughter collaborate on new app
Knowledge sharing applies not only between staff but also between generations and different professions. New IT solution developed by an engineer and her father, who is a specialist in residential facilities.
This year, Pallas hired Sofie Hansen, who has a Bachelor's degree in Health and Welfare Technology from SDU. She has both professional and practical experience from the care sector – including social housing – because her parents have run such places for many years. When Sofie visited home and told about the solutions that were developed for the health sector, her father was amazed.
Together they have come up with several concrete ideas for the IT solution Systematic Risk Assessment, which is based on the BVC method to systematically assess the risk of citizens reacting to external events. Pallas has already collaborated with Aalborg Municipality on the development of the BVC solution.
Her father Jan Hansen was originally a trained school teacher, but has spent most of his career working in residential care facilities, boarding schools, etc. and currently works as an employee in a highly specialized department for very outgoing citizens.
I know, as a former head of institutions, that our efforts only improve if we share knowledge and reflect on our work. But it will only be good if we actually pass on that knowledge. And not everyone feels they have the time or resources to either write down or, for that matter, read what is written about the citizen,
Jan Hansen says
Pallas has a tradition of involving the users of the systems very early in the development phase. This applies to both Early Detection and the also widely used Systematic Wound Triage module.
"My father has left a really big fingerprint on both content, functionality and design. Right now we are working on what small texts should be, for example, for "habitual behavior". And these are the kind of gems you can only get from someone who really knows the target group - which is both citizens and staff", says Sofie Hansen.
“Just a detail like remembering during the pedagogical intervention that the citizen is not always at home at the institution,” says Sofie Hansen.
“My father told me about a citizen who only hit his head when he was riding the bus. A pedagogical intervention could be to stop the car, sing a song, etc. to divert the reaction.
It is precisely this kind of insight that makes the new solution possible to create descriptions in relation to different situations, e.g. in the room or other places in the residence or outside the residence, with activities that are often done, which can be anything from taking a walk in the forest, visiting a swimming pool or transportation.
The new app and IT solutions are now adapted specifically for smaller residences to both provide greater security for staff and better treatment for citizens.
