Clin­i­cian groups wel­come Joint Com­mis­sion’s guid­ance on ad­dress­ing hos­pi­tal vi­o­lence

Modern Healthcare - - News | Providers - By Vir­gil Dick­son

The Joint Com­mis­sion’s ad­vice for health­care fa­cil­i­ties on how to ad­dress work­place vi­o­lence was praised by groups rep­re­sent­ing physi­cians and nurses work­ing in hos­pi­tals.

The na­tion’s largest ac­cred­it­ing body last week re­leased an alert that warns health­care or­ga­ni­za­tions to take seven steps to ad­dress work­place vi­o­lence— both phys­i­cal and ver­bal. They say hos­pi­tals need to more clearly de­fine what con­sti­tutes vi­o­lence, bet­ter fol­low up with and support vic­tims, and de­velop and as­sess preven­tion ini­tia­tives.

“In order to truly elim­i­nate work­place vi­o­lence, it is crit­i­cal that nurses, other health­care pro­fes­sion­als, and their em­ploy­ers shift the pro­fes­sional and work­place cul­ture to adopt a mind­set of zero tol­er­ance that di­min­ishes bar­ri­ers to re­port­ing,” said Ch­eryl Peter­son, vice pres­i­dent of nurs­ing pro­grams at the Amer­i­can Nurses As­so­ci­a­tion.

The Joint Com­mis­sion’s alert con­tains just rec­om­men­da­tions, but em­ploy­ers must act if an em­ployee faces vi­o­lence, a com­mis­sion spokes­woman said. Should it re­ceive com­plaints, the Joint Com­mis­sion would eval­u­ate whether an on-site sur­vey is needed. An un­sat­is­fac­tory sur­vey can af­fect ac­cred­i­ta­tion sta­tus.

“We en­cour­age our ac­cred­ited or­ga­ni­za­tions to use the alert to help their health­care work­ers rec­og­nize vi­o­lence from pa­tients and vis­i­tors, be­come prepared to han­dle it, and more ef­fec­tively ad­dress the af­ter­math,” said Dr. Ana Pu­jols Mc­Kee, ex­ec­u­tive vice pres­i­dent and chief med­i­cal of­fi­cer of the

Joint Com­mis­sion.

The ac­cred­i­tor’s data show 68 in­ci­dents of homi­cide, rape or as­sault of hos­pi­tal staff mem­bers in the past eight years. The Oc­cu­pa­tional Safety and Health Ad­min­is­tra­tion has found only 30% of nurses re­port vi­o­lent in­ci­dents. But ap­prox­i­mately 75% of nearly 25,000 work­place assaults re­ported every year oc­curred in health­care and so­cial ser­vice set­tings.

The rates of in­ci­dents noted by the Joint Com­mis­sion and OSHA dif­fer as it’s not manda­tory to re­port work­place vi­o­lence to the com­mis­sion, a spokes­woman said.

Health­care em­ploy­ees are four times more likely to be vic­tim­ized than work­ers in other in­dus­tries, ac­cord­ing to OSHA.

Health­care work­ers also are es­pe­cially em­pa­thetic. They may be­lieve pa­tients aren’t re­spon­si­ble for their ac­tions if they suf­fer from ill­ness or are tak­ing med­i­ca­tion that af­fects their men­tal state.

The in­dus­try has a bad rep­u­ta­tion for ad­dress­ing vi­o­lence against em­ploy­ees and as a re­sult has trou­ble with mo­rale and re­ten­tion, said Steve Al­brecht, a work­place safety con­sul­tant. “Hos­pi­tal and clin­i­cal set­tings can be a dan­ger­ous place to work,” Al­brecht said. “The days of treat­ing or in­ter­act­ing with peo­ple who threaten or hurt med­i­cal pro­fes­sion­als with­out con­se­quences for their be­hav­ior need to stop.”

Joint Com­mis­sion of­fi­cials could not say whether the vi­o­lent in­ci­dents re­port-

“It is crit­i­cal that nurses, other health­care pro­fes­sion­als, and their em­ploy­ers shift the pro­fes­sional and work­place cul­ture to adopt a mind­set of zero tol­er­ance that di­min­ishes bar­ri­ers to re­port­ing.”

Ch­eryl Peter­son Vice pres­i­dent of nurs­ing pro­grams Amer­i­can Nurses As­so­ci­a­tion

ed to them led to los­ing ac­cred­i­ta­tion.

Hos­pi­tals are work­ing to ad­dress the mat­ter both in­di­vid­u­ally and as a group, ac­cord­ing to the Amer­i­can Hos­pi­tal As­so­ci­a­tion’s top lawyer.

Hos­pi­tals and health sys­tems “view the safety and well-be­ing of em­ploy­ees as a top pri­or­ity and take se­ri­ously their re­spon­si­bil­i­ties to en­sure a safe work­place free of all forms of vi­o­lence— whether such vi­o­lence results from en­coun­ters be­tween staff and pa­tients and/or their fam­i­lies, staff-to-staff ag­gres­sion and ha­rass­ment or the in­tru­sion of com­mu­nity con­di­tions and com­mu­nity vi­o­lence into the work­place en­vi­ron­ment,” Melinda Hat­ton, the AHA’s se­nior vice pres­i­dent and gen­eral counsel, said in an emailed state­ment.

Not­ing that the AHA’s Hos­pi­tals Against Vi­o­lence ini­tia­tive is a tool avail­able to hos­pi­tals, Hat­ton said “the Joint Com­mis­sion’s new­est Sen­tinel Event Alert may pro­vide an ad­di­tional re­source for hos­pi­tals on ad­dress­ing work­place vi­o­lence, namely phys­i­cal and ver­bal vi­o­lence, and its im­pact on em­ployee mo­rale, re­ten­tion and well-be­ing.”

But un­til now, some pro­fes­sional as­so­ci­a­tions be­lieve they have been largely un­pro­tected.

Stiffer penal­ties at both the federal and state level are needed to curb the prob­lem, said Dr. Paul Kivela, pres­i­dent of the Amer­i­can Col­lege of Emer­gency Physi­cians. Cur­rently, le­gal penal­ties vary around the coun­try. For in­stance, in West Vir­ginia a per­son can face a felony charge and up to three years in jail de­pend­ing on the sever­ity of the at­tack against a health­care worker. In Cal­i­for­nia, an as­sault or bat­tery against a provider is viewed as a mis­de­meanor and is pun­ish­able by up to one year in jail for the most se­vere cases.

Kivela ar­gues that med­i­cal providers should be treated sim­i­larly to other front­line pro­fes­sion­als who reg­u­larly deal with com­bat­ive in­di­vid­u­als. “If a po­lice of­fi­cer or fire­man gets as­saulted, there are se­ri­ous ram­i­fi­ca­tions,” Kivela said. “The same thing should ap­ply to health­care providers.”

Na­tion­wide, the pun­ish­ment for as­sault­ing an of­fi­cer is con­sid­ered a felony and could carry up to three years in prison.

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