The Centers for Medicare & Medicaid Services has issued a new memo reminding state surveyors of the importance of oversight of facility safety and security in the face of workplace violence, both from within and from outside threats. 

“CMS will continue to enforce the regulatory expectations that patient and staff have an environment that prioritizes their safety to ensure effective delivery of healthcare,” stated the Monday memo, which was meant for hospital surveyors but also noted standards for nursing homes.

There is no urgent enforcement change for nursing homes for now, but they would do well to heed new CMS messaging. The ongoing stress of working short-staffed, and even the holidays themselves, can make healthcare facilities an even more vulnerable environment, safety experts said this week.

Steve Wilder

Employee displeasure is a major factor in workplace violence, said Steve Wilder, president and founder of Sorensen, Wilder & Associates, a security and safety consulting firm.

“It’s almost an accepted mindset,” Wilder told McKnight’s Long-Term Care News. “Because the staffing shortages are so critical they’re developing a mindset with the clinical staff that it’s part of the job and that’s just not true.”

Wilder said not only does unhappiness lead to higher likelihood of confrontation on the job, the perception that safety worries are part of the job lead staff to not report incidents. Bad record keeping means the efficacy of a facility’s safety and security programs can’t be well measured.

Know your weaknesses

Good record keeping is one of the pillars of modern facility security, said Wilder. The others are assessment, de-escalation training, and controlling an attacker as a last resort.

“It always starts with a vulnerability assessment,” he said. “You have to know where the chinks in the armor are in your security management program that are allowing the incidents of violence to take place and are allowing them to escalate as opposed to just a verbal confrontation.”

Wilder describes an easy way to think about a security management program: P2T2. 

“People, programs, training, technology,” he said. “If any of the four have a deficiency, you’ve got a vulnerability.”

In Wilder’s de-escalation training, there are six ladder steps, from calm at the bottom to physical violence at the top. Each step is a change in behavior and must be recognized in order to be dealt with to bring the aggressor down to calm.

If the situation reaches the top step, staff have to control, not injure, Wilder said. There are also situational differences, for example, a drunk in an emergency room or a patient with dementia in a nursing home.

“We teach control techniques, not fighting techniques,” Wilder said. “Control until calm.”

Wilder said he’s hopeful for the future of workplace violation prevention because regulators such as CMS, the Joint Commission, and the Occupational Safety and Health Administration share a vision.

“There are enough major regulatory agencies addressing it. There’s no reason for healthcare facilities putting their heads in the sand and saying, ‘We didn’t know or we would have done that,’” said Wilder. “Sadly, we still hear that, though.”