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Abstract：
A Code Black is the coordinated response by healthcare staff and security to an act or threat of verbal and physical aggression or violence perpetrated by a patient, family member or visitor towards healthcare staff within a hospital setting. Behavioural disturbance is often verbally de-escalated by staff. However, as a last resort physical and/or chemical restraint may be necessary. Reports show that there is an increasing number of violent incidents in Emergency Departments (ED), emphasising the importance of staff training for Code Black events. This research examines the response of healthcare staff to aggression and violence in the ED, the supporting structures that manage a Code Black event and potential avenues for restructuring the response.
We used a constructivist methodology to evaluate the training needs of healthcare staff. In 2019, we interviewed 20 staff and conducted a series of ethnographic observations in EDs across four hospitals in the Western Sydney Local Health District (WSLHD) in New South Wales (NSW), Australia. We focussed on staff experiences of Code Black events and the current departmental response. Staff recounted experiences of 45 Code Black events which were collated and thematically analysed.
Our findings show that there are no guidelines for: assessing the risk of an agitated patient, best practice de-escalation techniques, when exactly to call a Code Black and the pre-determined allocation of staff roles for patient restraint. Code Black response efforts lacked a systematic approach to coordinating resources and personnel, and there was confusion over the role of security. When poorly managed, this placed healthcare staff, security personnel and patients at serious risk and had a negative impact on staff wellbeing. We found training in Code Black interventions relies heavily on learning on the job from experienced staff members.
A systematic, coordinated and consistent organisational response to Code Black events is essential for the safety of ED staff. The roles and responsibilities of health workers and security require clear definition, and health workers across the WSLHD require easily accessible and repeatable experiential training in managing Code Black events.
We used a constructivist methodology to evaluate the training needs of healthcare staff. In 2019, we interviewed 20 staff and conducted a series of ethnographic observations in EDs across four hospitals in the Western Sydney Local Health District (WSLHD) in New South Wales (NSW), Australia. We focussed on staff experiences of Code Black events and the current departmental response. Staff recounted experiences of 45 Code Black events which were collated and thematically analysed.
Our findings show that there are no guidelines for: assessing the risk of an agitated patient, best practice de-escalation techniques, when exactly to call a Code Black and the pre-determined allocation of staff roles for patient restraint. Code Black response efforts lacked a systematic approach to coordinating resources and personnel, and there was confusion over the role of security. When poorly managed, this placed healthcare staff, security personnel and patients at serious risk and had a negative impact on staff wellbeing. We found training in Code Black interventions relies heavily on learning on the job from experienced staff members.
A systematic, coordinated and consistent organisational response to Code Black events is essential for the safety of ED staff. The roles and responsibilities of health workers and security require clear definition, and health workers across the WSLHD require easily accessible and repeatable experiential training in managing Code Black events.
摘要：
CodeBlack是医护人员和安全人员对患者实施的言语和身体侵略或暴力行为或威胁的协调反应，医院环境中医护人员的家庭成员或访客。员工通常口头上降低行为障碍。然而,作为最后的手段，物理和/或化学限制可能是必要的。报告显示，急诊室（ED）发生的暴力事件越来越多，强调CodeBlack事件员工培训的重要性。这项研究调查了医护人员对ED中的侵略和暴力的反应，管理CodeBlack事件的支持结构以及重组响应的潜在途径。
我们使用建构主义方法来评估医护人员的培训需求。在2019年，我们采访了20名员工，并在新南威尔士州（NSW）的西悉尼地方卫生区（WSLHD）的四家医院对ED进行了一系列人种学观察，澳大利亚。我们专注于CodeBlack事件的员工经验以及当前的部门响应。工作人员叙述了45次CodeBlack事件的经验，这些事件经过整理和主题分析。
我们的研究结果表明，没有关于以下方面的指南：评估躁动患者的风险，最佳实践降级技术，何时准确调用黑色代码和预定的员工角色分配以约束患者。黑代码应对工作缺乏协调资源和人员的系统方法，对安全的作用感到困惑。当管理不善时，这个安置了医护人员，安全人员和患者面临严重风险，并对工作人员的福祉产生负面影响。我们发现CodeBlack干预方面的培训在很大程度上依赖于经验丰富的员工在工作中的学习。
系统的，对CodeBlack事件的协调和一致的组织响应对于ED员工的安全至关重要。卫生工作者和安全的作用和责任需要明确的定义，WSLHD的卫生工作者需要在管理CodeBlack事件方面进行易于访问和可重复的体验式培训。
我们使用建构主义方法来评估医护人员的培训需求。在2019年，我们采访了20名员工，并在新南威尔士州（NSW）的西悉尼地方卫生区（WSLHD）的四家医院对ED进行了一系列人种学观察，澳大利亚。我们专注于CodeBlack事件的员工经验以及当前的部门响应。工作人员叙述了45次CodeBlack事件的经验，这些事件经过整理和主题分析。
我们的研究结果表明，没有关于以下方面的指南：评估躁动患者的风险，最佳实践降级技术，何时准确调用黑色代码和预定的员工角色分配以约束患者。黑代码应对工作缺乏协调资源和人员的系统方法，对安全的作用感到困惑。当管理不善时，这个安置了医护人员，安全人员和患者面临严重风险，并对工作人员的福祉产生负面影响。我们发现CodeBlack干预方面的培训在很大程度上依赖于经验丰富的员工在工作中的学习。
系统的，对CodeBlack事件的协调和一致的组织响应对于ED员工的安全至关重要。卫生工作者和安全的作用和责任需要明确的定义，WSLHD的卫生工作者需要在管理CodeBlack事件方面进行易于访问和可重复的体验式培训。
