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CMS Issues Memo on Violence in Hospitals, Expectations

A new memorandum from the Centers for Medicare & Medicaid Services (CMS) is reinforcing the agency’s role in enforcing regulatory expectations that patients and hospital staff have an environment that prioritizes their safety to ensure effective delivery of health care. The memo, from the directors of the Quality, Safety & Oversight and Survey & Operations groups, reminds hospitals of their responsibility, per Medicare’s conditions of participation, to provide adequate training, sufficient staffing levels, and ongoing assessment of patients and residents for aggressive behavior and indicators, with an overarching expectation that care interventions and environments are appropriately adapted. CMS notes that in the past, it has cited hospitals for failure to meet these obligations.

A Summary of the Memorandum include: 

  • Workers in hospitals, nursing homes, and other healthcare settings face risks of workplace violence. Many factors contribute to this risk, including working directly with people who have a history of aggressive behavior, behavioral issues, or may be under the influence of drugs.
  • An April 2020 Bureau of Labor Statistics Fact Sheet found that healthcare workers accounted for 73 percent of all nonfatal workplace injuries and illnesses due to violence in 2018. This number has been steadily growing since tracking of these specific events began in 2011.
  • Exposure to workplace violence hazards come at a high cost; however, with appropriate controls in place, it can be addressed.
  • CMS will continue to enforce the regulatory expectations that patient and staff have an environment that prioritizes their safety to ensure effective delivery of healthcare.

Questions about this memorandum should be addressed to

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