By Dean Samet, CHSP
In a June 3, 2010 News Release, The Joint Commission introduced Sentinel Event Alert Issue 45: Preventing violence in the health care setting. Health care facilities are confronted with and facing increased rates of violent crimes including assault, rape and homicide. TJC defines a sentinel event as “an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Serious injury specifically includes loss of limb or function. The phrase, “or the risk thereof,” includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome. Such events are called “sentinel” because they signal the need for immediate investigation and response.”
The Joint Commission’s SEA Issue 45 suggested actions follow:
1. 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.
2. Identify strengths and weaknesses and make improvements to the facility’s violence-prevention program.
3. 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).
4. Work with the HR department to make sure it thoroughly prescreens 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.
5. Confirm that the HR department ensures that procedures for disciplining and firing employees minimize the chance of provoking a violent reaction.
6. 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.
7. 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.
8. Encourage employees and other staff to report incidents of violent activity and any perceived threats of violence.
9. 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.
10. Ensure that counseling programs for employees who become victims of workplace crime or violence are in place.
11. 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. TJC is also urging controlling access to facilities, greater staff vigilance, and advising organizations to mandate the reporting of all real or perceived threats.
See also TJC Standard EC.02.01.01: “The hospital manages safety and security risks” as well as The Rationale for EC.02.01.01 which states, “Safety and security risks are present in most health care environments… Examples of security risks include workplace violence, theft, infant abduction, and unrestricted access to medications…Security incidents are caused by individuals from either outside or inside the hospital."
For the complete list and text of past issues of Sentinel Event Alert, go to The Joint Commission web site at http://www.jointcommission.org/.
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