By Gary Evans, Medical Writer

The Joint Commission (TJC) recently issued a Sentinel Event Alert1 on violence in healthcare that identifies some key triggers and prevention measures.

Potentially violent patients may have underlying mental health issues or addiction problems when they present for care. In addition to caring for patients with these characteristics, other factors associated with violence include:

• stressful conditions, such as long wait times, crowding in the clinical environment, or being given “bad news” related to a diagnosis or prognosis;

• lack of organizational policies and training for security and staff to recognize and de-escalate hostile and assaultive behaviors from patients, clients, visitors, or staff;

• gang activity;

• domestic disputes among patients or visitors;

• the presence of firearms or other weapons;

• inadequate security and mental health personnel on site;

• understaffing, especially during mealtimes and visiting hours;

• staff working in isolation or in situations in which they can be trapped without an escape route;

• poor lighting or other factors restricting vision in corridors, rooms, parking lots, and other areas;

• no access to emergency communication, such as a cellphone or call bell;

• unrestricted public access to hospital rooms and clinics;

• lack of community mental healthcare.

Among other recommendations, TJC recommends the following measures to prevent violence in healthcare settings:

• Encourage conversations about workplace violence during daily unit huddles, including team leaders asking each day if any team members have been victims of physical or verbal abuse or if any patients or family situations may be prone to violence.

• Develop systems or tools to help staff identify the potential for violence, such as a checklist or questionnaire that asks if a patient is irritable, confused, or threatening.

• Develop a protocol, guidance, and training about the reporting required by the hospital safety team, OSHA, police, and state authorities.

• Remove all impediments to staff reporting incidents of violence toward workers, such as retribution or disapproval of supervisors or co-workers, and a lack of follow-up or positive recognition from leadership.

• Capture, track, and trend all reports of workplace violence, including verbal abuse and attempted assaults when no harm occurred.

• Gather this information from all hospital databases, including those used for OSHA, insurance, security, human resources, complaints, employee surveys, legal or risk management purposes, and from change of shift reports or huddles.

• Regularly distribute workplace violence reports throughout the facility.


1. The Joint Commission. Physical and verbal violence against health care workers. Sentinel Event Alert 59: April 16, 2018. Available at: