Preventing Violence in Hospitals: Applying the Learnings From Safety Data to Drive Change

Purpose:
Incidents of violence against nurses and other hospital staff are on the rise. To advance our knowledge on violence in hospitals to inform improvement efforts, UHC conducted an analysis of event reports involving patient assaults on staff and other patients.

Relevance/Significance:
Nurses are at high risk of injury from on-the-job assaults and violent acts and suffer the most nonfatal assaults resulting in injury. Emergency department nurses experience physical assaults at the highest rate of all nurses. Violence in the workplace can result in employee fear and low morale, stress symptoms, and declines in productivity, job satisfaction, and staff retention.

Strategy and Implementation:
The UHC Safety Intelligence® Patient Safety Organization conducted a retrospective review of safety data on assaults by patients in the hospital setting from 2011 to 2014 to identify common factors and opportunities for prevention. Data were obtained from more than 60 participating organizations. The analysis revealed 134 instances of patient violence directed at staff or other patients. In 63% of these violent events, staff or patients experienced emotional effects, temporary harm, or injury requiring treatment. The majority of events (60%) were reported in the ED; however, about 30% were reported in acute care medical/surgical and specialty units. Patient-on-patient assaults were common in emergency department holding areas where patients awaited services. Peaks in assaults occurred during mealtimes, when staffing levels may have been lower.

Evaluation:
The factors that nurse managers most commonly cited as contributing to assaultive behavior were lack of a safety culture and environmental factors such as overcrowding and noise. Other factors included inadequate assessment, patient observation, or response to warning signs; inadequate training, lack of assistance, or insufficient staffing; and failures in communication.

Implications for Practice:
This analysis highlights the need for hospital violence prevention programs that include policies and processes to address the culture of safety, staff training, an analysis of risks in the workplace, and improvements aimed at reducing identified risks.