White paper Enterprise mobile duress alarm systems for healthcare
Table of Contents Table of Contents.............................................1 Security Concerns in Healthcare....................2 Enterprise Mobile Duress System Requirements ...................................................5 Location Requirements .......................................... 5 Notification Requirements ...................................... 6 Wireless Network Requirements ........................... 8
Radius ...............................................................10 Inovonics Positioning System™ ............................ 10 Adaptive Notification™ ........................................... 11 EchoStream Commercial Mesh Network™ ........... 11
Conclusion .......................................................13 Glossary............................................................14
5.8.12 WP1009B © Inovonics, 2012 - www.inovonics.com Page 1
Security Concerns in Healthcare Roughly two million Americans are victims of workplace violence every year.1 According to a U.S. Department of Labor Statistics survey, “nearly five percent of the 7.1 million private industry business establishments in the United States had an incident of workplace violence within the 12 months prior.”2 In the healthcare industry, the dangers are even more pronounced. As reported by the Center for Personal Protection & Safety, “healthcare professionals are 16 times more likely to be attacked on the job than any other service professionals.”3
Figure 1 Healthcare professionals are 16 times more likely to be
assaulted than any other service professional 500,000 nurses are the victims of violent crimes every single year.
The number of assaults is staggering, with roughly a half a million nurses being the victims of violent crimes every single year.4 In a study by the Emergency Nurses Association, 55 percent of emergency nurses report having experienced verbal abuse or physical violence in the last week alone, with 25 percent of nurses reporting being the victims of frequent physical violence — more than 20 or more reported assaults — in the last three years.5 1.Occupational Safety and Health Administration, 2012. “Safety and Health Topics/ Workplace Violence.” http://www.osha.gov/SLTC/workplaceviolence/ 2.U.S. Bureau of Labor Statistics, 2006. “Survey of Workplace Violence Prevention, 2005.” http://www.bls.gov/iif/oshwc/osnr0026.pdf 3.Center for Personal Protection & Safety, 2010. “Workplace Violence in Healthcare Settings.” http://www.fha.org/acrobat/JohnW/CPPSHealthcareWPV.pdf 4.Ibid.
5.8.12 WP1009B © Inovonics, 2012 - www.inovonics.com Page 2
Figure 2 One in four nurses report having been assaulted more
than 20 times in the last three years At best, only one in five assaults on nurses is reported.
As incredible as those numbers seem, they are only the reported events; they represent a fraction of the actual assaults that take place. At best, only one in five incidences of verbal abuse or physical violence is reported.1 Worse, the problem is increasing. According to the Joint Commission, “[s]ince 2004, the Sentinel Event Database indicates significant increases in reports of assault, rape and homicide.”2 There are a number of reasons to ensure the safety and security of the healthcare environment. In addition to the obvious moral obligation to patients, staff, and visitors, violence in the workplace can impose tremendous financial costs. The American Association of Critical-Care Nurses writes: Violence has been shown to have negative organizational effects such as low worker morale, increased job stress, increased worker turnover, reduced trust of management and coworkers, hostile working environments as well as significant costs associated with lost workdays and wages.3 Moreover, failure to provide a secure environment can result in loss of accreditation from licensing and regulatory agencies on the local, state, and federal levels. Juries also continue to level higher and more frequent punitive damages at institutions deemed not to have taken appropriate security 5.Institute for Emergency Nursing Research, 2011. “Emergency Department Violence Surveillance Study” http://www.ena.org/IENR/Documents/ENAEDVSReportNovember2011.pdf 1.Michael R. Privitera, Workplace Violence in Mental and General Healthcare Settings. (Sudbury: Jones and Bartlett, 2011), 10 2.The Joint Commission, 2010. “Sentinel Event Alert, Issue 45: Preventing violence in the health care setting” http://www.jointcommission.org/assets/1/18/SEA_45.pdf 3.According to the American Association of Critical-Care Nurses, 2004. “Workplace Violence Prevention4” http://www.aacn.org/WD/Practice/Docs/Workplace_Violence.pdf
5.8.12 WP1009B © Inovonics, 2012 - www.inovonics.com Page 3
measures in the event of an emergency. In most jurisdictions those punitive damages are not covered by insurance, and must be paid directly by the at-fault organization.1
Unlike other security applications, the purpose of an enterprise mobile duress system is to protect your most valuable asset: your people
While it is impossible to entirely eliminate the possibility of violence in the workplace, there are measures that can greatly reduce the risk. Of those measures, studies have found an enterprise mobile duress system to be the most effective. In fact, after surveying the complete range of security options available to emergency departments, the Institute for Emergency Nursing Research came to the following conclusion: “Only 1 [environmental control measure] was significantly associated with lower odds of physical violence – panic button/silent alarm.”2 Unlike other types of security applications, an enterprise mobile duress system exists for the sole purpose of protecting people from personal harm. It does so by providing instant alerts to security personnel in case of an emergency event. This can be when an employee considers his or herself in imminent danger, needs immediate assistance, or even when he or she becomes aware of a broader emergency in need of reporting. An enterprise mobile duress system provides protection not only for the staff member carrying the wireless alarm transmitter, but for the entire workforce and healthcare environment.
1.Russell L. Colling Tony W. York, Hospital and Healthcare Security, (Burlington: Butterworth-Heinemann, 2010), 21 2.Institute for Emergency Nursing Research, 2011. “Emergency Department Violence Surveillance Study” http://www.ena.org/IENR/Documents/ENAEDVSReportNovember2011.pdf
5.8.12 WP1009B © Inovonics, 2012 - www.inovonics.com Page 4
Enterprise Mobile Duress System Requirements At its simplest, an enterprise mobile duress system consists of three components: • A wireless alarm transmitter used to send an alarm in the case of an emergency • A wireless network to carry the alarm signal • An RF gateway to receive the alarm and disseminate it to responders Because the purpose of a mobile duress alarm system is to ensure the safety of the employees carrying the alarm transmitter, the system must meet certain requirements to be effective.
Location Requirements Location capability is necessary for an effective enterprise mobile duress system.
As Russell L. Colling and Tony W. York write in Hospital and Healthcare Security: Today's healthcare environment poses daily tests for security administrators charged with protecting these critical infrastructures. The delivery of healthcare changes rapidly and is vastly different from what it was just a few years ago. Hospitals are no longer an isolated group of free-standing buildings. They are critical infrastructures forming complex medical centers.1 The difficulty of providing adequate security is increased exponentially when the inherent mobility of healthcare employees is considered. This is why an enterprise mobile duress system must provide the location of the emergency event along with the alarm to ensure an appropriate response. Without location capability a mobile duress alarm system is of little use in today’s complex healthcare settings.
1.Russell L. Colling Tony W. York, Hospital and Healthcare Security, (Burlington: Butterworth-Heinemann, 2010), 1
5.8.12 WP1009B © Inovonics, 2012 - www.inovonics.com Page 5
Figure 3 As healthcare campuses grow larger more complex, the
difficulties or providing security increase accordingly
Since techologies like GPS are ineffective indoors, location is typically provided using algorithms that take advantage of the system’s repeater backbone and/or fixed end devices. An enterprise mobile duress system must be able to locate employees with a high enough level of location granularity to provide an effective response.
Notification Requirements An enterprise mobile duress system must be able to alert mobile responders to ensure a rapid response.
According to Patricia Allen’s Violence in the Emergency Department: Tools and Strategies to Create a Violence Free ED: Hospitals need to anticipate that violence will occur and have a plan to prevent it. Each staff member, whether employed full-time, part-time, or [per diem], needs to be trained in de-escalation tactics and to have the tools, support, and empowerment necessary to know how to act rapidly when a violent episode does erupt in the Emergency Department.1 The key word in that statement is rapidly. Due to the nature of the emergency situations that face the healthcare industry today, it is not sufficient that an alarm be sent to only a central station or a single command center. Just as employees are inherently mobile in a healthcare setting, so are healthcare 1.Patricia Allen, Violence in the Emergency Department: Tools and Strategies to Create a Violence Free ED, (New York: Springer, 2009, xii
5.8.12 WP1009B © Inovonics, 2012 - www.inovonics.com Page 6
emergency responders. An enterprise mobile duress system must be able to alert responders, no matter where they are, to provide a response that is rapid enough to be effective.
Figure 4 The ability to alert mobile responders is critical to a rapid
response
Mobile responders are not the only people necessary to respond to an emergency, however. An enterprise mobile duress system must also be able to effectively alert everyone from administrative staff to patients, and even, in certain crises, the entirety of the healthcare facility. As such, the devices that can receive alerts must be as broad as possible. These should include, but not be limited to:
An enterprise mobile duress system must ensure that the right information is delivered to the right responders
• Telephones • Cellular telephones, using voice and text • Pagers • Two-way radios • Public address systems • Email Because the emergency events that can occur in healthcare are as complex and diverse as the medical facilities themselves, notification must be also flexible and adaptive. Violence can arise from individuals patients forced to wait for healthcare due to understaffing or overcrowding; psychiatric patients, especially those not being medication-compliant; gang members and criminals seeking access to drugs; substance abusers undergoing withdrawal; and violent individuals who see medical facilities as providing easy targets.1 An enterprise mobile duress system must provide a method for coordinating the delivery of alarms such that the
5.8.12 WP1009B © Inovonics, 2012 - www.inovonics.com Page 7
right information is delivered to the right responders. Additionally, if some or all of those people are unavailable, delivery must then proceed to others able to deal with the emergency. Likewise, because healthcare facilities usually operate on twenty-four-hour schedules, different people will be available at different times. For this reason, the system must also allow for different alerting actions based on the time of day, or the day of the week.
Wireless Network Requirements Most wireless technologies are not capable of operating reliably in healthcare environments
An enterprise mobile duress system must be able to protect employees in the entire healthcare campus, including parking garages, stairwells, and on the grounds
There is no requirement for a mobile duress alarm system more important than reliability. There are numerous kinds of wireless technology, and most are not capable of operating reliably enough in demanding healthcare environments to support an enterprise mobile duress application. The demands placed on a wireless network by the healthcare industry differ dramatically from those of most other industries. The building materials themselves create incredible challenges to RF propagation. An enterprise mobile duress system needs to penetrate a variety of structural materials, including bricks, steel, insulation, and even the lead used in radiology departments to shield patients and staff from radiation. Nor are the buildings on the campus the only places that need protection. Staff must also be protected in stairwells, parking lots, and on the grounds. As Russell L. Colling and Tony W. York remind us, “[t]he assault problem is also evident outside the facility. The facility grounds, parking facilities, and streets surrounding the facility may offer opportunities for assault to occur.”1
1.Patricia Allen, Violence in the Emergency Department: Tools and Strategies to Create a Violence Free ED, (New York: Springer, 2009), xi 1.Russell L. Colling and Tony W. York, Hospital and Healthcare Security, (Burlington: Butterworth-Heinemann, 2010) 54
5.8.12 WP1009B © Inovonics, 2012 - www.inovonics.com Page 8
Figure 5 An enterprise mobile system must be able to cover
employees no matter where they are
Moreover, because of the scale of most healthcare campuses, an enterprise mobile duress system must be capable of supporting a virtually unlimited number of mobile duress pendants, to ensure that every single employee is protected. Because of these demands, many commonly used wireless technologies are inadequate for mobile duress. Those that allow other applications to run on the same wireless system as their mobile duress system can incur interference and down time, for instance. Likewise, those that are not designed specifically to provide scalable, campus-wide coverage can experience unacceptable dead spots. An enterprise mobile duress system demands a dedicated network, the characteristics of the wireless technology carefully balanced to meet the unique demands of personal security.
5.8.12 WP1009B © Inovonics, 2012 - www.inovonics.com Page 9
Radius Inovonics designed the Radius enterprise mobile duress system specifically for the healthcare industry.
Inovonics designed Radius specifically for the healthcare industry. With our twenty years of experience with wireless technology and mobile duress, we designed Radius as a complete enterprise mobile duress solution. Radius provides immediate notification when help is needed and directs responders to the exact location of the call, allowing a rapid, accurate, and effective response.
Event: A mobile duress pendant is activated by an employee
Location: Radius determines the location of the call for help
Notification: Radius directs responders to the exact location of the call
Figure 6 How Radius works
Inovonics Positioning System™ Knowing that help is needed without knowing where is really no help at all. As such, Radius features the Inovonics Positioning Technology, a proprietary location alghorithm used to pinpoint mobile duress alarms. Inovonics understands that the location technology used for other applications is inadequate to the demands of life safety. In the case of a real-time location system (RTLS), for example, location usually relies on nothing more than a comparison of the raw signal strength of an RFID tag to the nearest reader. Because the readers have limited range, typically two to three meters, the cost of providing complete coverage in a health care campus is often extraordinarily high. Moreover, wiring readers in tunnels and parking garages can be difficult at best, and determining location on common grounds nearly impossible. RTLS systems are
5.8.12 WP1009B © Inovonics, 2012 - www.inovonics.com Page 10
typically also WiFi based. Meaning, they are neither dedicated nor secure. Dead spots can occur and other applications shared on the WiFi network will inevitably cause interference and, in some cases, system downtime. The Inovonics Positioning System uses the fixed end devices and repeaters already in place to establish the EchoStream commercial mesh network to determine location. EchoStream’s coverage has been proven in the most difficult of RF environments, including tunnels, stairwells, parking garages, and common grounds. Location granularity can even be refined through the use of soft points. Likewise, the EchoStream commercial mesh network is dedicated, secure, and self-healing, carefully optimized to ensure the complete coverage necessary to lifesafety.
Adaptive Notification™ Radius can notify staff and administrators of alarms no matter where they are, even if they’re not on the campus.
In the event of an emergency, nothing is more important than making sure the right people get the information they need to act effectively and rapidly. Radius ensures that emergency alerts are delivered by using the devices hospital employees depend upon, including two-way radios, VoIP telephones, email, mobile phones, and text messaging. No matter where the responders and administrators are, even off campus, Radius ensures they are immediately notified of emergency events. As events escalate, the recipient list can escalate accordingly so that emergencies are targeted and handled by the appropriate personnel, ensuring the safety of everyone. Notifications are easily configurable by time of day, day of week, and event type.
EchoStream Commercial Mesh Network™ Radius functions on the self-monitored and fully supervised Inovonics EchoStream commercial mesh network. Designed to move small amounts of data over a moderate range in commercial environments, the commercial mesh network uses a frequency-hopping, spread-spectrum technology that sends redundant messages across multiple channels to avoid interference obstacles. Due to its low latency and high reliability, the commercial mesh network is an ideal solution for security applications. The network is secure and dedicated, ensuring personal
5.8.12 WP1009B © Inovonics, 2012 - www.inovonics.com Page 11
security messages are delivered without interference from less critical applications. The EchoStream commercial mesh network is removed from the common faults and down times that can create problems for other wireless technologies. Operating on the EchoStream commercial mesh network, Radius can be used within single buildings, or scaled to cover entire multi-building campuses spread over hundreds of acres. Parking garages, stairwells, even common areas, including walking paths and gardens, are covered. Likewise, the number of staff members that Radius can cover is virtually limitless.
5.8.12 WP1009B © Inovonics, 2012 - www.inovonics.com Page 12
Conclusion Healthcare workers have a right to safety; Radius can help provide that.
Whether in emergency departments, behavioral health programs, or human resource departments, hospital employees are increasingly at risk of physical violence. The problem has reached epidemic proportions, and shrugging it off as simply a part of the job is no longer morally, financially, or legally tenable. Beyond the considerations of accreditation and freedom from punitive damages, healthcare staff have a right to a safe working environment. Fortunately, there is one security measure that can help prevent violence: an enterprise mobile duress system. Just as an intrusion system protects against illicit entry and a fire system protects against fire, an enterprise mobile duress system protects against harm to individual employees. It is a critical component of any security system concerned with employee safety. It is with this aim in mind that Inovonics developed Radius, a complete enterprise mobile duress system featuring Inovonics positioning system technology, adaptive notification, and the dedicated EchoStream commercial mesh network. With Radius, you can be assured that the most effective measures to ensure the safety of your staff are being taken. For more information, contact an Inovonics sales representative by email at
[email protected] or by phone at 800.782.2709.
5.8.12 WP1009B © Inovonics, 2012 - www.inovonics.com Page 13
Glossary Central station A centralized command center that takes alarm signals from traditional security systems, verifies them, and then alerts the appropriate authorities. Dead spots Places within a wireless network from which a wireless transmission cannot be recieved. Fixed end devices Devices in a wireless system that are fixed in place and cannot be removed. Fixed point Location information provided by fixed end devices that are already part of the EchoStream commercial mesh network, such as door/window transmitters, motion detectors, and even environmental transmitters. GPS A satellite based navigation system. Intrusion system A security system designed with the protection of property in mind, using glassbreak detectors, door/window transmitters, motion detectors, and other traditional security devices. Latency The time that elapses between the activation of a wireless alarm transmitter and its dissemination to responders. Location granularity The degree of accuracy with which an alarm can be located. Can range from a single building, to a floor on that building, to a segment of the floor, to even a specific room. Mesh network A wireless network made up of devices that are organized in a mesh topology. Mobile duress system A security system designed specifically with the protection of people in mind, using wireless alarm transmitters that can be activated in the event of an emergency. Repeater A device in a wireless network that receives transmissions from wireless transmitters and repeats them at a higher power to ensure they reach the RF gateway.
5.8.12 WP1009B © Inovonics, 2012 - www.inovonics.com Page 14
Repeater backbone The repeater infrastructure of a wireless system that allows the transmission of signals from the wireless alarm transmitter to the RF gateway. RF gateway The device at the head-end of the mobile duress system that receives the alarm and disseminates it to responders. RF propagation The behavior of radio waves as they encounter construction materials and other environmental factors. Real-time location system (RTLS) An RFID based location system used to track equipment and assets. Soft point Location information provided by activating a wireless alarm transmitter and storing its unique RF characteristics. Wireless alarm transmitter A mobile device used to send an alarm in the case of an emergency. Wireless network The wireless infrastructure used to carry an alarm signal.
5.8.12 WP1009B © Inovonics, 2012 - www.inovonics.com Page 15
