The Centers for Medicare & Medicaid Services (CMS) reminded hospitals of their responsibility to protect patients and healthcare workers alike from physical violence in the workplace.
In a memorandum released Monday, the agency highlighted Medicare-certified hospitals’ “regulatory obligation to care for patients in a safe setting,” which can range from patient environmental safety standards to protections for their physical and emotional health.
At the same time, CMS wrote that “healthcare workers have a right to provide care in a safe setting” and warned it “will continue to enforce the regulatory expectations” that healthcare settings prioritize the safety of both parties.
“CMS health and safety requirements do not preclude healthcare workers from taking appropriate action to protect themselves from workplace violence,” the agency wrote in the memo (PDF) to state surveyors. “However, it is incumbent on the leadership at these healthcare facilities to ensure they provide adequate training, sufficient staffing levels, and ongoing assessment of patients and residents for aggressive behavior and indicators to adapt their care interventions and environment appropriately.”
CMS’ memo instructed hospitals to have procedures in place to identify patients who are likely to harm either themselves or others. Hospitals should be able to demonstrate these processes and the steps they’re taking to minimize any potential safety risks.
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"All hospitals are expected to implement a patient risk assessment strategy, but it is up to the hospital to implement the appropriate strategies,” CMS wrote. “For example, a patient risk assessment strategy in a post-partum unit would most likely not be the same risk assessment strategy utilized in the emergency department.”
CMS said hospitals should have emergency preparedness plans that take these types of risks into account and that staff should have appropriate training on how to identify and mitigate risks.
The agency underscored its expectations by listing three previous cases in which hospitals were cited for falling short on their safety obligations.
These comprised a case where a nurse was sexually assaulted by a behavioral health patient in a unit with inadequate staffing, another in which a patient died when staff and law enforcement performed a takedown that cut off their breathing and an instance where an insufficient assessment and de-escalation led off-duty police officers to shoot a patient who was acting out.
“Exposure to workplace violence hazards come at a high cost; however, with appropriate controls in place, it can be addressed,” CMS wrote.
Workers across hospitals, nursing homes and other settings are at higher risk of workplace violence due in part to contact with individuals who may have behavioral issues, a history of aggressive behavior or are under the influence of drugs, CMS noted. Bureau of Labor Statistics data show healthcare workers accounted for nearly three-quarters of 2018’s reported nonfatal workplace injuries and illnesses due to violence.
Clinicians have also warned that these incidents have ramped up in recent months and years. Survey data released in September by the American College of Emergency Physicians outlined an increase in the number of ED workers who experienced or witnessed physical or verbal assaults. Press Ganey also recently estimated that about 57 assaults against nurses occur daily across the country.
2022 has also seen a handful of high-profile incidents of healthcare workplace violence and harassment, such as multiple-fatality shootings at Tulsa’s Saint Francis Hospital and Methodist Health System or campaigns of harassment targeting those working at children’s hospitals providing gender-related care.