Quality Improvement Project Proposal: Using Jail Pens to Enhance Sharps Safety for Patientand Staff Population in Turning Point Program

by Jeffrey Cheng, BscN RN, Clinical Coordinator Unit 3-6, Alberta Hospital

Background

Setting: The Turning Point program on Unit 3-6 within 3-Building at Alberta Hospital is a maximum security adolescent forensic setting. The population consists of patients who are in custody for remand assessment, mental health stabilization, and rehabilitation treatment purposes. Patients of both genders may range from 12 to 21 years of age.

Health Care Service: This proposal will focus on enhancement of pencil safety which can pose a major challenge on a busy unit where accurate tracking and awareness of same can adversely affect safety of staff members and patients.

Problem: Lead pencils are used by patients on the unit and at school for writing and drawing. They are considered as sharps and can be used as weapons to slash and stab people. During January and February 2014, there have been dangerous incidents where patients have used pencils in an aggressive manner. There were two incidents at school where patients became angry and began stabbing their desktops with their pencils. Also, there was a critical incident on the unit where a patient advanced towards a psyche aid making downward stabbing gestures with pencil in hand. Security was involved to safely contain the patient, who in the process of restraint, stabbed the pencil into a guard's stab vest. In the past, a pencil was also used by a patient to attack the program psychiatrist.

Barriers to Quality: Four major barriers to effective pencil safety were identified 1) Hardness of traditional lead pencils which makes them a dangerous weapon for stabbing 2) Inaccurate tracking of pencils on the unit and school environments 3) Patients leaving pencils out in the open on the unit 4) Staff members slipping in non designated patient pencils in varying lengths to meet sharp count quotas

Intervention:

While scouring Google for forensic sharp count best practice literature, a website called jailpens.com was discovered. In their product line up was the following description for the following:

York 117 High Security Pen

Since 1991, the York 117 High Security Pen has been the pen of choice for NYC Department of Corrections. Since then it has been incorporated into many other prisons and secure institutions across the country. It is the only soft, all-plastic writing instrument available today.

With 100% flexible plastic construction, it's difficult to be turned into a weapon. (Even the smooth writing roller ball tip is plastic.)

It cannot be used as a hidden receptacle.

Water-based, non-toxic ink.

Rolling ball tip for easy writing.

http://jailpens.com/products.php

Please refer to column #117 for the pen Turning Point is using for the trial

According to the website, the York 117 High Security Pen has been utilized since 1991 by New York City Department of Corrections due to stabbings with stick pens. Samples of the jailpens were passed out to various staff members of the unit to test. Pens were bent out of shape and manipulated. The plastic writing point seemed to snap quite promptly when plunged against thighs and forearms of staff members. The pen did seem a little stiffer than expected and there was some mention that it may still cause some kind of damage if put into a person's eye. However, the shaft was definately much more flexible and bendible than a traditional pencil which compounded with the breakable writing point would theoretically make the York 117 a much safer alternative. The implementation of these pens may help circumvent problem 1) Hardness of traditional lead pencils which makes them a dangerous weapon for stabbing.

The design of the York 117 with its black plastic barrel and skinny writing point differentiates itself from the orange wooden pencils that float around the unit. The designation of the jail pens to patients means that they should only have the black plastic pens. This may help with problem 2) Inaccurate tracking of pencils on the unit and school environments and problem 4) Staff members slipping in non designated patient pencils in varying lengths to meet sharp count quotas. Because they are so different in design from traditional lead pencils, staff no longer face confusion of mixing patient designated pencils with those that are meant for staff use. In addition, because of the black plastic barrel design of the jail pens, staff can longer just non chalantly toss in any traditional orange lead pencil to manipulate sharps count. There will be only be a limited amount of pens alloted to the patient count on the unit and at school.

With respect to problem 3) Patients leaving pencils out in the open on the unit; the built in features of barrel flexibility and breakable writing point does not totally eliminate risk of stab injuries but should reduce significance of injury if a stray pen were to be used as a weapon by a patient.

Implementation

The supply of jail pens will be controlled by manager and mental health coordinator. A tracking system wil be devised to document outgoing movement as well as destruction of pens used in violent incidents.

A total of 36 pens will be alloted to the floor and school. 18 pens will be held in the nursing station. 18 pens will be alloted to each of the two teachers at Highwood School.The program trial run will occur over a span of one month with start date pending on senior management approval of proposal.

Measurable Aims

Feedback will be attained from the following avenues:

Patient feedback during community meeting Teacher feedback during interdisciplinary team meeting Floor staff feedback regarding ease of identifying and tracking of jail pens for sharps count Documentation of feedback through specific jailpen survey

Although it is not something the team desires, any actual real life incidents where patients do use the jail pen to stab staff resulting in minimal or no injuries will strengthen our case for 3-Building wide implementation of jailpens.

Barriers to Change

The major barrier to change will be from opinion leaders within Turning Point program that want to protect status quo. Once early adopter group (unit floor staff and teachers) work out kinks in implementation, leadership from senior managment will play a key role in further adoption of the jail pens.

Cost Implications

Twelve dozen pens were ordered at a cost of $X per unit.