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Security guards employed at hospitals might be ill-prepared to deal with Code Black situations, underpinning the need for further training research reveals.

The research, conducted by Flinders University, suggests security guards may apply a disproportionate use of physical restraint in Code Black situations when hospital patients or visitors appear threatening or violent.

The study, The role of security guards in Code Black events in medical and surgical settings: A retrospective chart audit, was conducted on medical and surgical wards in a South Australian metropolitan public health network area. It examined the response of privately contracted security guards called to deal with more than 1,600 Code Black events – emergencies of personal threat involving patient and/or visitor violence – over more than two years.

“Outside the context of EDs or mental health wards in Australia or overseas, this is the only study we know of which examines the role of security guards’ involvement in Code Blacks in these general settings,” says Professor Muir-Cochrane, noting such emergencies were connected to less than 1% of total admissions in these wards, said Study Lead Flinders University’s Professor of Nursing (Mental Health) Eimear Muir-Cochrane.

Over the 2.5‐year study period, security guards attended 1,664 code black events on medical and surgical wards, representing 0.63% of admissions to the wards over that time.

Events were more frequently reported in medical than surgical wards. The most common reasons for security guard attendance were patients threatening/harming staff or themselves.

The most frequent security guard actions logged in their reports were ‘Attend only/standby,’ and ‘Physical restraint’, with physical restraint of patients the most common response. Chemical restraint and ‘de-escalation’ were the next most common response.

“The prevalence of security guards in healthcare settings is growing worldwide, so there is a need to understand their role to inform policy and training and support least restrictive practices in healthcare,” Professor Muir-Cochrane says.

“Given the tragic death of a patient restraint by a security guard in Queensland in 2018, it is clear that health services need to maintain and increase efforts to support least restrictive practice through policy directives and staff training.”

The study was published in Nursing and Health Sciences.