Practice Improvement| Volume 49, ISSUE 3, P387-394, May 2023

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Staff Duress Alarms for Workplace Violence in the Emergency Department: A Mixed-Methods Evaluation



      Complex personal duress alarms may be implemented as part of a multicomponent approach to preventing and mitigating workplace violence in emergency departments. Evaluation of duress alarms after implementation has been identified as a gap in the literature. The purpose of this quality improvement project was to examine the impact of a duress alarm system on workplace violence and user experience in an urban emergency department.


      A comprehensive system evaluation was performed using a mixed-methods approach, which included retrospective data review, key informant interviews, observations, and a survey. Forty clinical staff at an emergency department in North Carolina were interviewed and provided feedback on the duress system.


      Findings indicated that the duress system was not associated with a decrease in workplace violence, and that the majority of clinical staff did not even wear the duress alarm. Staff indicated that the primary barriers to use of the alarm were the bulky design of the alarm badge, inadequate education about the alarm device and process, and the lack of a reliable and timely response from security.


      Ongoing engagement of clinical staff is critical to the success of health care technology implementations. Staff feedback, periodic re-education, and recurring process evaluations are vital to ensuring the continued relevance of systems, especially when staff safety is the intended purpose.

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      Meredith A. Carr is a Nursing Informatics System Specialist and Emergency Nurse, Duke University Health System, Durham, NC


      Anne Derouin is a Professor and Assistant Dean MSN Program, Duke University School of Nursing, Durham, NC