Violent Events In Healthcare Facilities

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A new Joint Commission Sentinel Event Alert warns that healthcare facilities are being confronted with steadily increasing rates of crime. Published for Joint Commission accredited organizations and interested healthcare professionals, Sentinel Event Alert identifies specific sentinel events, describes their common underlying causes, and suggests steps to prevent occurrences in the future. This recent Alert cautions that the actual number of violent incidents is significantly under reported and advises organizations to mandate the reporting of all real or perceived threats.

To prevent violence in healthcare facilities, The Joint Commission’s Sentinel Event Alert newsletter suggests that facilities take a series of 13 specific steps:

  • Work with the security department to audit your facility’s risk of violence. Evaluate environmental and administrative controls throughout the campus, review records and statistics of crime rates in the area surrounding the health care facility, and survey employees on their perceptions of risk.
  • Identify strengths and weaknesses and make improvements to the facility’s violence prevention program.
  • Take extra security precautions in the Emergency Department, especially if the facility is in an area with a high crime rate or gang activity. These precautions can include posting uniformed security officers, and limiting or screening visitors (for example, wanding for weapons or conducting bag checks).
  • Work with the HR department to make sure it thoroughly pre-screens job applicants, and establishes and follows procedures for conducting background checks of prospective employees and staff. For clinical staff, the HR department also verifies the clinician’s record with appropriate boards of registration. If an organization has access to the National Practitioner Data Bank or the Healthcare Integrity and Protection Data Bank, check the clinician’s information, which includes professional competence and conduct.
  • Confirm that the HR department ensures that procedures for disciplining and firing employees minimize the chance of provoking a violent reaction.
  • Require appropriate staff members to undergo training in responding to patients’ family members who are agitated and potentially violent. Include education on procedures for notifying supervisors and security staff.
  • Ensure that procedures for responding to incidents of workplace violence (e.g., notifying department managers or security, activating codes) are in place and that employees receive instruction on these procedures.
  • Encourage employees and other staff to report incidents of violent activity and any perceived threats of violence.
  • Educate supervisors that all reports of suspicious behavior or threats by another employee must be treated seriously and thoroughly investigated. Train supervisors to recognize when an employee or patient may be experiencing behaviors related to domestic violence issues.
  • Ensure that counseling programs for employees who become victims of workplace crime or violence are in place.

Should an act of violence occur at your facility—whether assault, rape, homicide, or a lesser offense—follow-up with appropriate response that includes:

  • Reporting the crime to appropriate law enforcement officers.
  • Recommending counseling and other support to patients and visitors to your facility who were affected by the violent act.
  • Reviewing the event and making changes to prevent future occurrences.

“Healthcare facilities should be places of healing, not harm. But, unfortunately, healthcare settings are not immune from the types of violence that are found in the other areas of our lives,” says Mark R. Chassin, M.D., M.P.P., M.P.H., president, The Joint Commission. “The recommendations in this Alert give healthcare institutions and caregivers specific strategies to take action that will keep everyone safer.”

In addition to the specific recommendations contained in the Alert, The Joint Commission urges hospitals to comply with the requirements described in its accreditation standards to prevent violence. The standards require accredited healthcare facilities to have a security plan as well as conduct violence risk assessments, develop strategies to prevent violence and have a response plan when a violent episode occurs.

Read the full Alert on this topic here.

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