Combined Assessment Program Summary Report— Management of Disruptive and Violent Behavior in Veterans Health Administration Facilities

Report Information

Issue Date
Report Number
17-04460-84
VA Office
Veterans Health Administration (VHA)
Report Author
Office of Healthcare Inspections
Report Type
Comprehensive Healthcare Inspection Program
Recommendations
4
Questioned Costs
$0
Better Use of Funds
$0
Congressionally Mandated
No

Summary

Summary
OIG completed a healthcare inspection of Management of Disruptive and Violent Behavior in Veterans Health Administration (VHA) facilities. The purpose of the evaluation was to determine whether facilities complied with selected VHA requirements. OIG conducted this review at 29 VHA medical facilities during Combined Assessment Program reviews performed across the country from October 1, 2016 through March 31, 2017. OIG noted high compliance in multiple areas, including that all facilities had implemented policies addressing prevention and management of disruptive/violent behavior and had conducted annual Workplace Behavioral Risk Assessments. However, Facility Directors needed to address employee-generated violence by establishing required Employee Threat Assessment Teams. Additionally, while facilities had established Disruptive Behavior Committees/Boards, Facility Directors need to ensure attendance at meetings by all required members. Patient Record Flags (PRF) in patients’ electronic health records communicate to clinicians that certain patients have exhibited disruptive/violent behavior. While most clinicians appropriately documented new flags, OIG found noncompliance with a requirement to inform patients about the PRFs and about the right to request to amend or appeal placement of the PRFs. OIG stressed the importance of informing patients for whom Orders of Behavioral Restriction (a type of therapeutic limit setting sometimes required to manage care for patients whose behavior is disruptive) were issued. Facilities had implemented training plans that used the official Prevention and Management of Disruptive Behavior training curriculum. However, facilities need to improve in providing newly hired employees with Level I Prevention and Management of Disruptive Behavior training and additional levels as indicated by the risk of the area assigned. VHA guidance focuses on managing patients who exhibit disruptive/violent behavior; ensuring a safe workplace would benefit from guidance concerning disruptive/violent behavior that involve non-patients as victims or perpetrators. We made four recommendations.

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
OIG recommended that the Executive in Charge, Office of the Under Secretary forHealth, in conjunction with Veterans Integrated Service Network senior managers, ensure Facility Directors establish Employee Threat Assessment Teams.
No. 2
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
OIG recommended that the Executive in Charge, Office of the Under Secretary forHealth, in conjunction with Veterans Integrated Service Network senior managers, ensure facility senior managers require attendance by VA Police Officers, Patient Safety and/or Risk Management Officials, and Patient Advocates at Disruptive Behavior Committee/Board meetings and monitor compliance.
No. 3
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
OIG recommended that the Executive in Charge, Office of the Under Secretary forHealth, in conjunction with Veterans Integrated Service Network and facility senior managers, ensure that when Chiefs of Staff (or designees) issue Orders for Behavioral Restriction, they document that they informed patients that the Orders were issued and of the right to appeal the decisions and that facility senior managers monitor compliance.
No. 4
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
OIG recommended that the Executive in Charge, Office of the Under Secretary forHealth, in conjunction with Veterans Integrated Service Network senior managers, ensure facility senior managers require that within 90 days of hire, all employees complete Level I Prevention and Management of Disruptive Behavior training and additional training levels based on the type and severity of risk for exposure to disruptive and unsafe behaviors and monitor compliance.