Health Care

Comply with the Joint Commission Standard PC.01.02.09 on Victims of Abuse

 The Joint Commission on Accreditation of Healthcare Organizations (The Joint Commission) is an independent, not-for-profit organization and accredits and certifies more than 17,000 health care organizations and programs in the United States. The Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards.

In 2004, The Joint Commission instituted new standards for hospitals on how to respond to domestic abuse, neglect and exploitation and revised them in 2009. These recommendations are outlined below with links to on-line resources to help hospitals comply with the requirements.

The primary resource to help hospitals comply is Futures Without Violence, formerly Family Violence Prevention Fund’s National Consensus Guidelines on Identifying and Responding to Domestic Violence Victimization in Health Care Settings.

Acronyms

AHC – Ambulatory Health Care

BHC – Behavior Health Care

CAH – Critical Access Hospital

HAP – Hospital

LTC – Long Term Care

OBS – Office Based Surgery

OME – Home Care

 

Additional Standards for Victims of Abuse

Standard PC.01.02.09 – Applicable to AHC, CAH, HAP, LTC, OBS, OME
The [organization, critical access hospital, hospital, practice] assesses the [patient/resident] who may be a victim of possible abuse and neglect, [or exploitation – applicable to LTC and OME only]. 

 
Rationale for PC.01.02.09

Family violence and child and elder abuse are frequently reported. A study published by the Centers for Disease Control and Prevention (CDC) estimates that “intimate partner abuse” results each year in 2 million injuries to women and 600,000 injuries among men1. The National Center on Elder Abuse references a study that estimates that between 1 and 2 million Americans age 65 or older have been injured, exploited, or otherwise mistreated by someone on whom they depend for care or protection.        

Definition of domestic violence

National Consensus Guidelines on Identifying and Responding to Domestic Violence Victimization in Health Care Settings produced by Futures Without Violence points out that “most Americans are seen at some point by a health care provider, and the health care setting offers a critical opportunity for early identification and even the primary prevention of abuse.” People who are victims of abuse or neglect may come to an organization for a variety of reasons. Sometimes the reason a patient seeks health care is not connected to his or her experience with abuse or neglect. By assessing patients who may be possible victims of abuse or neglect, health care organizations fulfill an important role in helping to protect patients2

o   Learn which staff should be trained on domestic violence

o   Information on how to identify abuse

o   Information on how to conduct an assessment

o   Learn how to provide appropriate care to a patient once abuse is identified

                           
Elements of Performance for PC.01.02.09

1.   The [organization, critical access hospital, hospital, practice] has criteria to identify those [patients/residents] who may be victims in each of the following situations (for further information on any of these categories, click on the links below):

 
Physical assault

o   Futures Without Violence's National Consensus Guidelines on Identifying and Responding to Domestic Violence Victimization in Health Care Settings

o   American Medical Association Diagnostic and Treatment Guidelines on Domestic Violence

 

Sexual assault and Sexual Molestation

o   Pennsylvania Coalition Against Rape

o   Sexual Assault Nurse Examiner-Sexual Assault Response Team

o   International Association of Forensic Nurses

o   National Sexual Violence Resource Center

 
Domestic abuse

o   National Consensus Guidelines on Identifying and Responding to Domestic Violence Victimization in Health Care Settings

o   American Medical Association Diagnostic and Treatment Guidelines on Domestic Violence

 
Elder neglect or abuse

o   American Medical Association Diagnostic and Treatment Guidelines on Elder Abuse and Neglect

o   University of Main Center on Aging Elder Abuse Screening Protocol for Physicians

o   National Center on Elder Abuse’s Identifying Elder Abuse: Tools, Techniques and Guidelines for Screening and Assessment

 
Child neglect or abuse

o   Identifying and Responding to Domestic Violence: Consensus Recommendations for Child and Adolescent Health

o   American Medical Association Diagnostic and Treatment Guidelines on Child Physical Abuse and Neglect

o   For sample clinical tools see Appendix D & E of the National Consensus Guidelines on Identifying and Responding to Domestic Violence Victimization in Health Care Settings

Note: Criteria can be based on age, sex, and circumstance

2.   To assist with referrals of possible victims of abuse and neglect [or exploitation – applicable to LTC and OME only], the [organization, critical access hospital, hospital, practice] maintains a list of private and public community agencies that can provide or arrange for assessment and care. 

o   National referrals

o   State-specific referrals

 

3.   The [organization, critical access hospital, hospital, practice] educates staff about how to recognize signs of possible abuse and neglect [or exploitation – applicable to LTC and OME only] and about their roles in follow-up [including reporting – applicable to LTC only].

o   Workplace Education and Training on Domestic and Sexual Violence

o   More information on staff education

 

4.   AHC and OBS practices use their criteria to identify possible victims of abuse and neglect. CAH, HAP, and LTC [organization, critical access hospital, hospital] use their criteria to identify possible victims of abuse and neglect [and exploitation – applicable to LTC only] upon entry into the [organization, critical access hospital, hospital] and on an ongoing basis. OME organizations use their criteria to identify possible victims of abuse, neglect and exploitation at the time of contact. 

o   Information on developing criteria as to how often patients should be assessed

 

5.   The organization either assesses the [patient/resident] who meets criteria for possible abuse and neglect [and exploitation – applicable to LTC and OME only] or refers the [patient/resident] to a public or private community agency for assessment.  

o   Information on how to conduct an assessment and assessment tools

o   Information on how to refer patients

 

6.   The [organization, critical access hospital, hospital, practice] internally reports cases of possible abuse and neglect [and exploitation – applicable to LTC and OME only]. (See also RI.01.06.03, EP 3)

o   Learn how to document domestic violence

o   Information on photo documentation and forensic evidence collection

o   Further information on confidentiality

o   Further help in preparing your practice to address abuse

7.    The [organization, critical access hospital, hospital] reports cases of possible abuse and neglect [and exploitation – applicable to LTC and OME only] to external agencies, in accordance with law and regulation. (See also RI.01.06.03, EP 3)

 

State laws differ for child abuse, intimate partner violence and elder abuse. Some states have requirements to report current victimization to law enforcement, or social services. Providers should:

o   Learn applicable state statutes. View state codes specific to domestic violence.

o   If you practice in a state with a mandated reporting law, inform patients about any limits of confidentiality prior to conducting screening.

o   For information on child abuse reporting requirements, see Appendix G from theSummary of Evaluation Studies on Training of Health Care Professionals on Child Abuse and Neglect.


Standard PC.3.10 – Applicable to BHC
Individuals served who may be victims of abuse, neglect, or exploitation are assessed.

Rationale for PC.3.10

Victims of abuse or neglect may come to a hospital in a variety of ways. The patient may be unable or reluctant to speak of the abuse, and it may not be obvious to the casual observer. Staff needs to be able to identify abuse and neglect as well as the extent and circumstances of the abuse or neglect to give the patient appropriate care.

Criteria for identifying and assessing victims of abuse or neglect should be used throughout the organization. The assessment of the patient must be conducted within the context of the requirements of the law to preserve evidentiary materials and support future legal actions.

Elements of Performance for PC.3.10

1.   The organization develops or adopts criteria3 for identifying victims in each of the following situations:

o   Physical assault

o   Rape

o   Sexual molestation

o   Domestic abuse

o   Elder neglect or abuse

o   Child neglect or abuse

o   Exploitation

 

2.   Staff is educated about abuse and neglect and how to refer as appropriate.

Note: Staff should be able to screen for abuse and neglect as indicated by the needs or conditions of the individual served. The organization may define who conducts the full assessment for alleged or suspected abuse or neglect or may refer to another organization. 

o   Workplace Education and Training on Domestic and Sexual Violence

 

3.  A list of private and public community agencies that provide or arrange for assessment and care of abuse victims is maintained to facilitate appropriate referrals.

o   National referrals

o   State-specific referrals  

4.  Victims of abuse or neglect are identified using the criteria developed or adopted by the organization at entry into the system and on an ongoing basis.

o   Information on how to conduct an assessment

 

5.  The organization's staff refers appropriately or conducts the assessment of victims of abuse or neglect

o   Information on how to refer patients

 

6.  All cases of possible abuse, neglect, or exploitation are reported to appropriate agencies according to organization policy and law and regulation.

o   View state laws and regulations specific to domestic violence

 

7.  All cases of possible abuse, neglect, or exploitation are immediately reported in the organization.

o    Learn how to document domestic violence

o    Information on photo documentation and forensic evidence collection

 

 Standard RI.01.06.03 – Applicable to AHC, BHC, CAH, HAP, LTC, OME

The [patient/resident/individual served] has the right to be free from neglect; exploitation; and verbal, mental, physical, and sexual abuse. 

Elements of Performance for RI.01.06.03

1.   The [organization, critical access hospital, hospital] determines how it will protect the [patient, resident, individual served] from neglect, exploitation, and abuse that occur while [the patient, the resident, he or she] is receiving care, treatment or services.

2.   The [organization, critical access hospital, hospital] evaluates all allegations, observations, and suspected cases of neglect, exploitation, and abuse that occur within the [organization, critical access hospital, hospital]. 

3.   The [organization, critical access hospital, hospital] reports allegation, observations, suspected cases of neglect, exploitation, and abuse to appropriate authorities based on its evaluation of the suspected events.

 

1The Centers for Disease Control and Prevention: Adverse health conditions and health risk behaviors associated with intimate partner violence. Morbidity and Mortality Weekly Report, Feb. 8, 2008. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5705a1.htm

2National Research Council Panel to Review Risk and Prevalence of Elder Abuse and Neglect: Elder Mistreatment: Abuse, Neglect and Exploitation in an Aging America. Washington, DC: NRC, 2003. http://www.nap.edu/openbook.php?isbn=0309084342

3For further information, contact Futures Without Violence at health@futureswithoutviolence.org