The Joint Commission typically issues Sentinel Event Alerts when a situation occurs that may put patients at risk of severe injury, illness or death. It is a tool used to raise awareness about the most dangerous conditions, putting healthcare facilities on notice that action must be taken to prevent severely adverse outcomes. Sentinel Event Alerts are rarely issued when healthcare workers’ health or safety is at stake. However, the rate of violence against healthcare workers has reached a critical level, and the Joint Commission has responded by issuing Sentinel Event Alert #59: Physical and verbal violence against healthcare workers. The alert was issued on April 16, 2018.

Violence on the rise

According to the Occupation Safety and Health Administration (OSHA), approximately 75% of violent workplace assaults in the U.S. occur in healthcare and social service settings. Workers in healthcare settings are four times more likely to be victims of violence than workers in all other private industries. As appalling as these numbers are, the actual number of workplace violence incidents is likely to be much higher, as healthcare workers often do not officially report these incidents. Lack of reporting may be due to the belief that the assailant was not responsible for his or her actions due to mental illness, dementia, extreme emotional stress or because those who’ve been assaulted do not believe management will take any action.

While violence has traditionally been most common in emergency departments and behavioral health settings, it has become increasingly frequent in other areas such as labor and delivery, medical-surgical units, long-term care/residential facilities and even pediatric departments.

Risk factors and recommendations

The Sentinel Alert lists the following factors that are related to workplace violence in the healthcare setting:

• Alcohol and drug abuse
• Stressful conditions such as long wait times, overcrowding, being given bad news
• Lack of training regarding recognition and de-escalation of hostile and abusive behaviors
• Gang activity
• Domestic violence
• Presence of firearms and other weapons
• Inadequate security and mental health personnel on site
• Understaffing
• Staff working in isolation or in situations in which they can be trapped without an escape route
• Poor lighting and other factors restricting vision both within and outside the facility
• No access to emergency communication devices (cell phone, panic buttons, etc.)
• Unrestricted public access
• Lack of community mental healthcare

The Sentinel Alert recommends the following actions to decrease the risk of violence:

1. Clearly define workplace violence and put systems into place across the organization that enable staff to report workplace violence instances, including verbal abuse.
2. Recognize that data come from several sources. Capture, track and trend all reports of workplace violence—including verbal abuse and attempted assaults when no harm occurred.
3. Provide appropriate follow-up and support to victims, witnesses and others affected by workplace violence, including psychological counseling and trauma-informed care if necessary.
4. Review each case of workplace violence to determine contributing factors. Analyze data related to workplace violence and worksite conditions to determine priority situations for intervention.
5. Develop quality improvement initiatives to reduce incidents of workplace violence, including changes to the physical environment and changes to work practices or administrative procedures.
6. Train all staff, including security, in de-escalation, self-defense and response to emergency codes.
7. Evaluate workplace violence reduction initiatives.

The Sentinel Alert acknowledges that to effectively reduce workplace violence there must be leadership commitment and employee involvement. NYSNA agrees that frontline worker involvement at each step of hazard analysis and development of methods to control the risk of violence is key to a successful workplace violence prevention program.

The full Sentinel Event Alert can be found at www.jointcommission.org/sea_issue_59/.

Violence can be controlled

NYSNA believes that no worker, under any circumstances, should be subject to physical or verbal abuse. For more information on the best methods to prevent violence in the healthcare setting, attend a NYSNA workplace violence workshop. For specific questions or concerns, contact your union rep or the NYSNA Health & Safety Representatives at healthandsafety@nysna.org.

Excerpt from the Joint Commission’s “Take a stand: No more violence to health care workers.”