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

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.