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Hospitals could be cited for failing to prevent violence, CMS says


The Centers for Medicare and Medicaid advise health systems about their responsibilities to protect staff and patients, and the agency says it will take action against those who aren’t doing enough.

Doctors and nurses are facing more violence in hospitals, and President Biden’s administration is advising health systems they could be cited if they don’t take sufficient steps to protect staff and patients.

The Centers for Medicare and Medicaid Services sent an advisory this week to hospitals and health systems stressing the importance of ensuring a safe environment.

“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,” the memo states.

The CMS said it would take action against hospitals that are falling short. The memo was first reported by Fierce Healthcare.

“CMS has cited hospitals in the past for failures to meet these obligations,” the agency said in the memo.

To illustrate the point, the CMS advisory cited instances where the agency has taken action, such as a nurse who was sexually assaulted by a behavioral health patient in a unit without adequate staffing. Other patients intervened to stop the assault.

CMS also cited a hospital when a patient was shot by off-duty police; the agency found that the hospital staff failed to properly assess the patient and didn’t do enough to calm the situation. The memo also points to a situation when hospital staff and law enforcement subdued a patient, who later died with a hospital custodian holding the patient on the floor with his knee on the patient’s back.

Hospitals must assess patients who may be at risk of harming themselves or others, CMS said in the memo.

“Although all risks cannot be eliminated, hospitals are expected to demonstrate how they identify patients at risk of self-harm or harm to others and steps they are taking to minimize those risks in accordance with nationally recognized standards and guidelines,” the memo stated.

Health systems must provide sufficient training in identifying patients who are at risk of hurting themselves or others, as well as mitigation strategies, the memo said.

Hospitals are also advised they need to devise different assessments and response plans for different units, noting that plans would be different in a maternity unit than in the emergency department.

Healthcare workers and leaders have said violence in hospitals has risen sharply since the COVID-19 pandemic.

Most emergency doctors say they have seen an increase in violence, according to a September poll by the American College of Emergency Physicians. In that poll, 85% of participants said there has been at least some increase in violence. At the same time, only 2% of those surveyed said hospitals were prosecuting attackers, and emergency room physicians say the lack of consequences is playing a factor in the increased violence.

About half of hospital nurses (48%) reported an increase in workplace violence, according to a survey released in the spring by National Nurses United.

Nursing leaders have said the violence, along with burnout, is driving some nurses to leave hospitals.

According to a poll by the American Association of Critical-Care Nurses, only 47% of nurses surveyed said they think their organization takes their health and safety seriously, down from 68% in a similar survey in 2018. In that same poll, two out of three nurses (67%) said they intend to leave their position within three years. Among those who said they were thinking about walking away,, 36% of those nurses said they would leave within the next year.

Nurses and other healthcare workers called for greater protections after a nurse and a social worker were fatally shot at Methodist Dallas Medical Center in October. They responded after a suspect was beating his partner in the maternity unit, police said.

Four people were killed in a shooting at a medical building on the campus of the Saint Francis Health System in Tulsa, Oklahoma, in June. Authorities said the suspect was upset because of postoperative pain. Two doctors, a receptionist and a patient were killed.

Lawmakers have also sponsored bills aimed at making hospitals safer.

U.S. Sen. Tammy Baldwin, D-Wisc., introduced legislation directing the U.S. Occupational Safety and Health Administration to require healthcare organizations to develop workplace violence prevention plans. More than 30 senators have co-sponsored the bill. The U.S. House of Representatives passed a similar bill sponsored by U.S. Rep. Joe Courtney, D-Conn., last year.

U.S. Reps. Madeleine Dean, a Pennsylvania Democrat and Larry Bucshon, an Indiana Republican and a doctor, introduced the Safety From Violence for Healthcare Employees (SAVE) Act in June. The legislation would impose tougher penalties on those who attack and intimidate health system employees.

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