According to the Bureau of Labor Statistics, roughly 75% of work-related assaults reported from 2011 to 2013 took place in a healthcare or social service setting, and 80% of the incidents reported in 2013, alone, were caused by patients. As gatekeepers to patients’ access into a facility, frontline staff are not only susceptible to such behavior, but are also in a unique position to identify and address disruptive conduct.
With this in mind, organizations might consider developing a policy to guide staff in the appropriate handling of disruptive patients, with the goal of maintaining a safe environment that is conducive to quality patient care. When reading through these considerations, HBI always recommends checking with an organizational compliance and legal team before implementing any process that deals with patient and staff safety, and HBI as an entity does not specialize in compliance or legal matters.
What is Disruptive Behavior?
One of the first steps to creating a policy is determining what behaviors qualify as disruptive. As a rule of thumb, any behavior that impedes a provider’s ability to administer care, obstructs communication, threatens the well-being of others, or causes damage to organizational property qualifies as disruptive. Examples include:
- Verbal threats or derogatory statements
- Excessive or repetitive noise
- Physical acts of violence or aggression
- Sexual comments or offensive gestures
- Possession and use of alcohol or illegal substances while on premises
- Throwing objects or tampering with property
- Knowingly providing staff with false or misleading information
Generally, the scope of such a policy may apply to patients who are competent and able to take responsibility for their actions, but behave inappropriately regardless. For cases where a patient’s better judgment may be compromised due to a psychiatric, physiological, or substance-abuse related condition, it is important to notify medical staff.
Strategically Managing Disruptions
The next step that could be helpful when developing a policy is to outline the steps staff take when addressing disruptive behavior, with the primary goal of maintaining a safe environment. As such, a strategy may be based on a zero-tolerance policy against behavior that threatens the safety and wellbeing of others. Language depicting this may be placed near the beginning of a policy, but the concept can be reinforced throughout by letting staff know that they may involve an internal security team or local law enforcement at their discretion.
In terms of handling disruptive patients who do not pose an immediate threat, it may be beneficial for staff to first attempt to de-escalate the situation by calmly asking the patient to stop, offering them a chance to explain their behavior, and explaining how it may affect their care. When this does not work, staff should involve a manager, who may issue the patient an informal warning by verbally notifying them that the behavior is unacceptable and must stop.
To address consecutive occurrences of disruptive behavior after an informal warning has been issued, a formal, written warning may be given to the patient. This document may clearly describe the behavior that has resulted in the issuance of a formal warning and inform the patient that their relationship with the organization may be suspended if their behavior persists. Within the policy, it is a good idea to establish the number of times a patient may receive formal warnings before suspension may be initiated.
Suspending Habitually Disruptive Patients
If a patient remains disruptive after having received the maximum number of warnings, an organization may consider initiating suspension. However, this does not come without risk. Unless proper precautions are taken, suspending a patient—even one that is habitually disruptive—may result in allegations of patient abandonment. As such, a policy could include the following steps to be taken prior to issuing a written notice of suspension:
- Involve risk management in decision to suspend patient
- Consult the patient’s physicians to determine their health status and ensure they receive the appropriate care—or find an alternate provider—before being suspended
- Ensure all interactions with the patient have been documented and recorded in the medical record
- Check state and health plan-specific regulations concerning patient suspension to ensure compliance
Once these steps have been completed, a written notice of suspension may be issued. It is important that the notice describes why the patient is being suspended and for how long, provides recommendations for continued care, authorizes the release of their medical records, and notifies the patient that they may receive emergent care for a period of 30 days after receiving the notice. While this final piece of information may help prevent a patient from utilizing the organization’s services after the 30-day notice is up, the organization cannot refuse a suspended patient’s care for urgent or emergent conditions.