Violence threatens patients, HCWs
Sentinel event alert urges action to reduce risk
Hospitals are not the "safe havens" they once were. That is the cautionary message of a recent Sentinel Event Alert by the Joint Commission accrediting body, which focuses on attacks on patients.
Hospitals report the assault, rape or homicide of patients as a sentinel event. Those reported events have increased significantly since 2004, with 36 incidents in 2007, 41 in 2008 and 33 in 2009, according to the Joint Commission.
Violence actually occurs much more often against hospital employees often by patients themselves. In 2008, 2,250 hospital workers had injuries from assaults that were serious enough to require days away from work or restricted days, according to the U.S. Bureau of Labor Statistics.
"What the Joint Commission is saying is that violence in health care is affecting quality of patient care. Hospitals need to be able to reduce this or mitigate it," says Russell Colling, MS, CPP, CHPA, a health care security consultant based in Salida, CO.
The Joint Commission issued recommendations, including risk assessment and prevention strategies. Already, the Sentinel Event Alert has led to an increased attention to security at hospitals, says Colling. And with the publication of the alert, surveyors are more likely to ask about actions hospitals have taken to prevent or respond to violent events, he says.
"The standard of care in security is a reasonable and prudent program to prevent events from occurring," he says.
There are several forces in health care and in the broader community that are raising the risk of violence, says Colling. Hospitals, and especially emergency departments, are overwhelmed with patient volume. Staffing has not kept up, and the result is long waits. "It just breeds stress. And stress breeds violence," Colling says.
Violence in the community also spills over into hospitals especially the Emergency Department, which treats victims of violence as well as patients who are substance abusers or under the influence of alcohol. Meanwhile, fewer inpatient psychiatric beds and the lack of mental health services in the community means that unstable psychiatric patients often end up in acute care hospitals, says Colling.
There are many steps that hospitals can take to reduce the risk of violence. Better staffing is the single most important element, says Colling.
But hospitals also can make the health care experience more comfortable for patients. For example, they can provide waiting areas with good lighting, adequate seating, and access to food and drinks. "We've got to improve the environment and we'll improve behaviors," he says.
Meanwhile, the hospital needs a system for providing communication to the patients' family and other visitors.
Security is one tool
For security reasons, hospitals need to manage access to the facility, especially late at night, and they need to restrict access to treatment areas, he says.
But while security is vital, it is just one tool in an overall effort to prevent workplace violence, says Jane Lipscomb, FAAN, PhD, RN, professor in the Schools of Nursing and Medicine and director of the Work and Health Research Center at the University of Maryland Baltimore.
"If security is the only control measure, then we're really talking about a prison kind of mentality," she says. "It takes a comprehensive 'H and S' program that focuses on violence."
Training of health care workers is an important component of violence prevention. But, again, that can't solve the problem alone, she says. "That's a very, very important component, but until you reduce the waiting times in a very busy emergency room, all the training in the world isn't going to make a difference," she says.
Hospitals are not the "safe havens" they once were. That is the cautionary message of a recent Sentinel Event Alert by the Joint Commission accrediting body, which focuses on attacks on patients.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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