Joint Committee

Legal Bug in Medical Records/Health Data Management

Sally Beahan , in Practical Guide to Clinical Computing Systems (Second Edition), 2015

iv.3 Monitoring

The Joint Commission performs random unannounced surveys that typically occur every 2–3 years. It is wise for hospitals to form committees that address the standards of compliance on a regular footing so there is connected readiness in the effect of an unannounced survey. Furthermore, information technology is in the best interests for patient prophylactic and quality when hospitals are continuously implementing processes in guild to comply with The Joint Commission standards. The Joint Committee has made great strides in how they handle the survey process, equally in the past hospitals knew when to expect the surveys and would substantially cram for the test. The current method encourages hospitals to attain ongoing compliance.

The Joint Commission has a method by which they charge per unit hospitals and give timeframes depending on the severity of the non-compliance for the infirmary to evidence they are meeting standards. Hospitals are at gamble for losing their accreditation if they are not able to achieve and maintain compliance with Joint Commission standards. Losing accreditation could ultimately result in a hospital losing their ability to bill federal payers, creating large financial implications for the institution. Maintaining Articulation Committee accreditation is essential for the viability of the institution and the safety of its patients.

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Areas of College Risk

Tony West. York , Don MacAlister , in Hospital and Healthcare Security (Sixth Edition), 2015

Drills and exercises

Articulation Commission standards and elements of performance practice not require infant/child abduction drills. The standards do require that the arrangement identifies and implements security procedures that address handling of an infant or pediatric abduction, every bit applicative. An infant abduction exercise is one method to evaluate the effectiveness of the procedures and processes in this area. It is upwards to the organization to determine the appropriate actions to ensure successful implementation of security procedures. xiii

Infant/pediatric abduction drills should exist conducted on a schedule that includes personnel who work days, evenings, weekends, and/or nontraditional shifts, in addition to testing the response of the pediatric care areas. Drills should never be viewed as a "success" or "failure" for the sole reason that the mock abductor is able to successfully behave out the exercise without being stopped. The goal for each practise should be to teach and test, using a mixture of announced and unannounced exercises. Never should an inpatient female parent unknowingly be involved in a drill. As a effect, an important safeguard in the infant security plan is not tested and the simulation modified. However, engaging a existent mother in activating the Code (but not utilizing their infant) is a useful tool to engage staff participation. Obtaining the mother's knowledge of her role in her infant's security in the critique, provides a snapshot of the effectiveness of the parental education provided.

Evaluations should include a review of the responses of unit staff, security, PBX announcement, and the facility-wide response, to include the time taken to initiate the response. Monitoring the fourth dimension information technology takes from the initial call for a Lawmaking Pink and the time it takes for the hospital operator to announce overhead are of import functioning indicators in beingness able to engage staff hospital-wide.

A sample infant abduction evaluation form/report menu is demonstrated in Figure 21-four.

FIGURE 21-4. Sample infant abduction drill evaluation form adopted from Kelly Dahl, Managing director of Safety at The Medical Center of Aurora.

Prior to conducting the practice, the baby abduction drill should have the "mock abductor" visit and call the unit of measurement prior to the actual drill. This pre-sentinel methodology is a useful tool as it allows the mock abductor to obtain data on department layout and the security measures in place, programme the escape route based on data obtained, determine how much information on a patient can be gathered, and evaluate staff response to an individual asking questions and demonstrating traits of the "typical abductor."

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Electronic Security Arrangement Integration

Tony W. York , Don MacAlister , in Hospital and Healthcare Security (Sixth Edition), 2015

TJC Surveyor Identification

With The Joint Committee now conducting all regular surveys in the U.S., imposters take turned up in a number of hospitals challenge to exist Joint Commission surveyors. The reasons for attempted entry into the healthcare system are many and range from the unscrupulous to the criminal—gaining faster access to care or faster access to a family fellow member, to stealing prescription drugs. As news reports of these events accept shown, such events can take dire consequences for patients and compromise public trust. 34

Joint Commission surveyors follow established procedures when visiting an organization to conduct an unannounced accreditation survey, and are trained to expect hospital personnel to make inquiries to verify their identity. Surveyors volition study to either the front desk-bound or to infirmary security upon their arrival and will voluntarily present identification. To confirm authenticity of the badge that surveyors article of clothing when they visit a facility for survey, organizations may compare it to a sample posted on The Joint Commission extranet site. 35 Box 19-one demonstrates actions to exist taken to verify surveyor identity.

Box 19-one

TJC Surveyor Identity Verification

(Courtesy of Joseph Cappiello, vice president for Accreditation Field Operations at The Joint Committee)

TJC Surveyor Identity Verification Checklist

•

Asking to see The Joint Commission Surveyor badge

•

Compare the badge present to the sample bluecoat on the TJC extranet

•

Verify survey appointment on the extranet

•

Verify assigned surveyors on the extranet

•

Ensure employees know what actions they should take if they have concerns about someone entering the system

•

Direct questions about the veracity of a surveyor to Joint Committee business relationship representative at 630-792-3007

In Canada, Accreditation Canada surveys are never unannounced, and then the organization, and security, will know in advance of the surveyor's attendance at a site.

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Preventing and Managing Healthcare Assailment and Violence

Tony Westward. York , Don MacAlister , in Hospital and Healthcare Security (Sixth Edition), 2015

The Joint Commission has been tracking major violent events in healthcare since 1995. Their database (which it says contains a significantly lower number of fierce episodes than the bodily number, due to underreporting by healthcare institutions) found that since 1995, in that location have been 256 assaults, rapes or homicides at hospitals and healthcare facilities. Of those, 110 have occurred since 2007. The accrediting body has identified half dozen reoccurring causes for variety of violent episodes that the healthcare industry has dealt with:

1.

Bug in leadership were noted in 62% of the events, most notably problems in the areas of policy and procedure development and implementation.

2.

Human resource-related factors were noted in sixty% of events, such as the increased demand for staff educational activity and competency assessment processes.

3.

Assessment issues, noted in 58% of events, particularly in the areas of flawed patient observation protocols, inadequate assessment tools, and lack of psychiatric assessment.

iv.

Communication failures, noted in 53% of the events, in terms of deficiencies in general safety of the environment and security procedures and practices.

5.

Physical environment problems, noted in 36% of the events, in terms of deficiencies in general rubber of the environment and security procedures and practices.

half dozen.

Issues in care planning, information management, and patient education were other causal factors identified less frequently. 1

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Designing for medication safety

Sadaf Kazi , ... Nicole L. Mollenkopf , in Design for Health, 2020

Medication reconciliation

The Joint Commission (2006) defines medication reconciliation every bit assembling the "best possible medication history, and using this listing to provide right medication to the patient at all points of care." The medication reconciliation process consists of (1) gathering a patient'southward "home" list of medications currently beingness taken, (2) comparing that list to the medications that are currently prescribed for that patient at the transition point, and (3) utilizing medication data to inform prescribing at the electric current betoken in fourth dimension, equally well every bit in the future.

The list of home medications informs subsequent parts of the medication reconciliation procedure. "Home" may refer to the patient's home, or any setting in which the patient receives care prior to the transition. In the inpatient setting, transitions could include hospital admission, transfer between dissimilar levels of care (e.yard., critical intendance and intermediate care) or care provider teams, and hospital discharge. In the customs setting, patients may transition between a variety of provider types (e.g., primary care provider and specialist), setting types (e.g., outpatient surgery center), or even multiple pharmacies.

Assembling the medication list from home and the current setting of care requires specialized skills. This responsibility has historically fallen to the prescribing physician. However, because gathering this information tin can exist hard and fourth dimension-consuming, there is at present greater involvement of nonphysician providers with varying levels of medication knowledge, such as nurses, medical assistants, pharmacy technicians, and pharmacists, in obtaining the dwelling house medication list. In inpatient settings, nursing involvement at error-prone stages during care transitions, including gathering the medication list at access (White et al., 2011) and verifying the medication list at discharge (Pronovost et al., 2003), has translated to improved rates of medication reconciliation.

It is noteworthy that involving pharmacists and pharmacy technicians not only improves the completion charge per unit of medication reconciliation but also, more chiefly, the completeness and quality of the medication history elicited from the patient (Pevnick et al., 2018; Varkey et al., 2007), and doing so is cost constructive (Karnon, Campbell, & Czoski-Murray, 2009). These improvements tin can be attributed to the specialized medication cognition of pharmacy staff and the substantial time spent in collecting medication histories. Depending on the report, this fourth dimension may range between 20 and twoscore   minutes, but collecting the medication histories of medically circuitous patients tin likewise be equally high every bit nearly fourscore   minutes (Pevnick et al., 2018).

The final step of medication reconciliation is prescribing medications to meet the current and future needs of the patient. This entails resolving differences, if they be, between medication lists, prescribing advisable medications based on current illnesses and patient-related factors (due east.g., physiologic and pathophysiologic parameters, adherence to medication, medication toll, and access to pharmacy), updating the medication listing, and communicating the updated medication listing with the patient.

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Protecting a Healing Surroundings

Tony W. York , Don MacAlister , in Infirmary and Healthcare Security (Sixth Edition), 2015

The Joint Committee

The primary Joint Commission security standards are contained inside the functional chapter entitled "Management of the Surround of Care" in the Security/Safety Management section.

As office of its Emergency Operations Program requirements for hospitals, internal prophylactic and security standards during an emergency are also institute in the Emergency Management (EM) department. These include making advanced preparations, identifying the part of community security agencies (law, sheriff, National Guard) and analogous their security activities during an emergency. The controlled entrance into and out of the facility, the movements of individuals within the facility, and the command of vehicles accessing the facility during an emergency are as well addressed.

In add-on, there are other standards that have a direct bearing on security in terms of action and compliance requirements. These standards are considered "whole business firm," applicable to all hospital staff, and are principally found in the capacity on Human Resource (60 minutes), Leadership (LD), Improving Organization Performance Standards (PI), and Management of Data (IM). The healthcare security ambassador must coordinate with other departments and functions to determine specific action items and compliance oversight regarding security standards.

In the surface area of security, this touch on is, however, beginning to erode equally The Articulation Commission in 2009 combined the rubber and security standards inside the Management of the Environment of Care. This has not improved safety and security but served only to dilute the protection measures used to make our healing environments safe. The disciplines of rubber and security should be carve up to promote a safer and more secure surroundings. As the body of noesis continues to evolve for each of these disciplines, the educational offerings available will remain split up. There are very few college education institutions that combine these ii disciplines in the same caste program.

In 2010, Sentry Event Alert issue #45 (SEA 45) was issued on preventing violence in the healthcare setting. Information technology specifically addresses assault, rape or homicide of patients and visitors equally perpetrated by staff, visitors, other patients and intruders to the institution. The majority of SEA 45 is focused on traditional workplace violence scenarios and offers important foundational recommendations for healthcare facilities. Withal, the majority of violence to which healthcare is exposed today is patient-to-staff generated violence. We must protect our patients and Ocean 45 has laid out a solid baseline for that. Simply what TJC apparently does not fully comprehend is the violence being perpetrated by patients against our intendance providers, security officers, and others who piece of work in and effectually the emergency department.

Since the issuance of Sea 45, surveyors are placing greater emphasis on the issue of violence in healthcare, specifically the security risk assessment for determining the potential for violence and the response plan through the use of focused "violence" tracers.

The Joint Commission Resource (JCR) is the official publisher and educator of TJC. They work with healthcare organizations, ministries of health and governmental bodies around the world providing accreditation preparation and advocating for patient rubber strategies in the areas of infection prevention, medication safety, and the surround of intendance.

References to the various TJC security standards will be made in the subsequent give-and-take on specific elements of the healthcare security program. Figure 2-2 provides an overview of how TJC Environment of Care standards have evolved since 1990.

FIGURE 2-2. TJC Environment of Care standards fourth dimension line.

 (Reprinted with permission from Health Facilities Management Magazine.)

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A Primer for Healthcare Executives

Tony W. York , Don MacAlister , in Hospital and Healthcare Security (6th Edition), 2015

Where Should Security Report?

An expectation of The Articulation Committee and the required Security Management Programme is to clearly specify the position that has the responsibility for security of the organization and has a clearly divers reporting level for this position. The hierarchical level in the organisation to which security reports reflects the importance that the administrative squad places on the security part and the organization's responsibility of protecting persons and property. The important aspect of the security reporting level is it must provide the organizational authority necessary to properly carry out its mission. A practical consideration is security should report to an individual who has both the time and interest in the security function. In brusque, there must be proper authoritative support for a security plan to be effective and productive. A common reporting level for security is the vice president (or manager) of facilities or the adventure management administrator who, as a generality, seems to fit the foundation criteria for a successful program.

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The Healthcare Environment

Tony W. York , Don MacAlister , in Hospital and Healthcare Security (Sixth Edition), 2015

The Sentinel Event

Patient safety is at the core of TJC's standards and policies related to sentry events (whatever unexpected occurrences involving death or serious physical or psychological injury, or chance thereof). The term "spotter event" is a very broad term utilized past TJC in relation to their accreditation process. TJC's Sentinel Result Policy calls for every accredited organization to identify, voluntarily report, evaluate and evoke sentinel result prevention strategies. The policy requires organizations to investigate the root causes of adverse events, implement appropriate strategies to prevent reoccurrence, monitor the effectiveness of these strategies, and advise the afflicted patients and families of errors or unexpected outcomes and the steps taken to correct them.

The picket event not simply relates to protection, but to a wide array of adverse patient outcomes. Such events are called "spotter" because they point the need for immediate investigation and response. 21

There are four principal goals for the Joint Commission sentinel outcome policy:

1)

To have a positive bear on in the improvement of patient care.

2)

To focus arrangement attending on the event to provide an understanding of the underlying cause, and to make changes in systems and procedures to reduce the probability of such an event in the time to come.

three)

To increase the general knowledge about spotter events, their causes, and preventive strategies.

4)

To maintain the conviction of the public in the commission accreditation process.

There are ii bones categories of the spotter outcome relative to the investigation and reporting of such incidents. The offset is the event referred to every bit "reviewable" by The Joint Commission. The second is an event that is handled internally within the organization. In the latter event, the organization is required to have a policy regarding a review process that meets The Articulation Commission criteria, but the event does not need to be reported.

The subsets of sentinel events that are subject to Joint Commission review at the time of occurrence and that are security-related consist of: (1) an event resulting in an unanticipated death or major permanent loss of function, not related to the natural course of the patients' illness or underlying condition, or (2) the outcome is one specified by The Articulation Committee and the outcome is not decease or major permanent loss of part. This 2nd category specifically includes security incidents of infant abduction or discharge to the wrong family, or rape.

The Articulation Commission is not very clear regarding its definition of an infant or the distinction of an abduction (stranger to stranger versus domestic custody). There is a vast difference in these two categories of baby abduction incidents.

The rape of a patient is a reviewable lookout man event. The decision of rape is to be based on the organisation's definition, consistent with applicative law and regulation. An allegation of rape is not reviewable under Articulation Commission policy. Applicability of the policy is established when a determination is made that a rape has actually occurred.

Reported sentinel events are compiled into a database, which currently contains over 9,980 cases reviewed by The Joint Commission from 1995 through June of 2013. 22 As noted in Figure ane-2, the number of sentinel events has increased dramatically since 1995. This vast knowledge base of operations of adverse outcomes helps inform and improve The Joint Commission's standards and policies, and provides "lessons learned" information to healthcare organizations to support their condom improvement efforts.

FIGURE 1-2. Total watch events reviewed by year. 23

The terms "spotter event" and "medical fault" are non synonymous; events are called "sentinel" because they signal the need for firsthand investigation and response. For the healthcare security administrator, examples of reviewable and nonreviewable sentry events nether The Joint Commission'southward Picket Upshot Policy include:

one.

Suicide of whatever patient receiving care, treatment and services

2.

Abduction of whatever patient receiving care, treatment, and services

3.

Discharge of an infant to the wrong family unit

four.

Whatever elopement, that is, unauthorized departure, of a patient from an around-the-clock care setting resulting in a temporally related death (suicide, accidental death, or homicide) or major permanent loss of function

5.

Rape, set on (to include sexual corruption), or homicide of any patient receiving care, treatment, and services

6.

Rape, assail (to include sexual corruption), or homicide of a staff fellow member, licensed independent practitioner, visitor, or vendor while on site at the healthcare organization. 24

Figure i-3 shows the number of reported assaults, rape and homicide by yr since 1995. Figure 1-4 shows the number of reviewed elopement-related events resulting in death or permanent loss of role.

Effigy i-iii. Sentry events past year: Assault, rape, homicide. 23

Figure ane-4. Sentinel events by year: Elopement-related events resulting in death or permanent loss of office. 23

The Joint Commission encourages accredited organizations to report all reviewable sentinel events. Information technology should be noted the reporting of almost sentinel events is voluntary and The Joint Commission believes it represents just a small proportion of actual events. The Joint Commission may also get aware of a reviewable sentinel event through patient contact, family, media, or a staff member. Regardless of how the accrediting trunk is fabricated aware of the event, the organization is expected to prepare a root cause analysis study and action plan inside 45 calendar days of the consequence or of becoming aware of the event. The analysis and action plans are to then exist forwarded to The Joint Commission. Upon receipt of the data, they volition determine the acceptability of the analysis and action plan.

An system that does non submit an acceptable analysis or action plan within the 45-twenty-four hours period may be put on Accreditation Watch. This designation is considered to be public data. The Accreditation Picket is not an accreditation status; rather, information technology is an aspect of the organization's official accreditation.

The removal of an Accreditation Sentinel is a determination of The Joint Commission'due south Accreditation Commission. The decision to remove this accreditation attribute generates an Official Accreditation Decision Report. This written report will assign an appropriate follow-upward activity for the facility, typically a written progress report or follow-up visit to exist conducted inside a specified menstruation of time.

Accreditation Canada does not fulfill the sentinel event reporting mandate described for The Articulation Commission. While sentinel events of course practice occur in all countries (sometimes called adverse events), responsibility for follow-up and investigation usually rests with the organization in which the upshot occurred. Oversight for this process is usually provided by the government entity with responsibleness for the health organization—usually the Ministry of Wellness in Canada's provinces.

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Patient Intendance Involvement and Intervention

Tony Due west. York , Don MacAlister , in Hospital and Healthcare Security (6th Edition), 2015

Patients with Suicidal Ideation

In 2012, Eric Smith, CPP, manager of security for Exempla Health, shared an account of a patient who presented to one of their emergency departments with suicidal ideations, and was placed on a mental wellness hold and asked to be watched by a security officeholder. She was completely cooperative, Smith pointed out, and did not brand any threats either towards staff or nearly her own well-beingness, and she was placed on a bed in an overflow expanse. During the sentinel, the patient asked the officer to move abroad because she felt uncomfortable with him nearby. The officer complied and backed off a brusque distance; maintaining a clear line of sight. The patient moved around in the bed, so her head was near the foot of the bed, and and then rolled over with her dorsum towards the hall and the officer. After realizing her hands were out of sight and in front of her, the officer found the patient had taken a hose off of a piece of equipment left in the hall, used in the care of some other patient, and had twisted the hose around her neck twice and pulled information technology tight. She was essentially unconscious. Fortunately, the officer was alert to the state of affairs and was able to loosen the hose and notify staff. A short fourth dimension later, she was moved to a room where the surround could be meliorate controlled.

Co-ordinate to The Joint Committee Sentinel Event Database, more 14% of reported suicides occur in nonbehavioral health units—suicides can happen in medical/surgical suites, intensive care units, oncology units and telemetry units; viii% of reported suicides occur in emergency departments, 21 like the attempted suicide noted above. Complicating matters further is the design of these units: they are rarely designed to mitigate suicide risks and admission to potentially dangerous items. Some specific ways of suicide that are readily available in the general hospital setting include bell cords, bandages, sheets, restraint belts, plastic bags, elastic tubing and oxygen tubing. 22

To help hospitals improve safe of their patients, The Articulation Commission released Lookout man Event Alert #46 that focuses on preventing suicide in the ED and medical/surgical units. I of the primary recommendations of SEA #46 involves designing a suicide screening and assessment procedure. In add-on to thoroughly screening patients for suicide risk, several other strategies tin be incorporated to minimize the risks of patient suicide. 21

•

Assess the room. Looking at the entire room, a comprehensive assessment should exist performed to place potential risks and decide possible mitigation strategies. Examples include shatter-proof and tamper-resistant light covers, ligature-resistant door handles, sink fixtures and shower heads, tamper-resistant shower defunction, so forth. A checklist for assessing the environmental risks for suicide can be found in Figure xiii-7.

Figure 13-seven. A checklist for assessing the environmental risks for suicide.

 (Courtesy of Surroundings of Intendance News, reprinted with permission.)
•

Minimize medical equipment in the room. Most handling rooms contain a host of equipment and supplies that present hazards, and not every patient will require all the equipment and supplies housed in the room. When treating patients at risk for suicide, an organization should minimize the equipment in the room, and include only that which is absolutely necessary for the patient. Although all equipment and supplies cannot be removed for storage and other reasons, some organizations have equipped rooms with a roll-down door or like device, that hides medical equipment and covers the medical gas outlets in the treatment room. Photos of such doors are noted in Figure 13-8.

Effigy 13-eight. Examples of scroll-downward doors used in an emergency department room.

 (Courtesy of Presbyterian-St. Luke's Medical Heart, Denver, Colorado.)
•

Cheque for contraband. In add-on to equipment and supplies found in the room, patients may bring items that can exist used in a suicide attempt, such as knives, needles, and weapons. A reasonable search of person and property should be conducted when a patient is screened for possible suicide risk. The facility should have a policy that covers what a reasonable search entails, when it should occur, and who should perform information technology.

•

One-to-One Observation. Having a trained person sitting with the patient effectually the clock, whether a security officer or sitter, is an important mitigation strategy. The individual should be able to identify when the patient's behavior is escalating, and know how and when to seek help. Those charged with watching patients must fight confronting the routine and boredom, watching every activeness by the patient. The officeholder in the case noted at Exempla Wellness certainly saved the life of the patient past being mindful of the inherent risks surrounding suicidal ideations.

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Training and Development

Tony Due west. York , Don MacAlister , in Infirmary and Healthcare Security (6th Edition), 2015

Forensic (Prisoner) patients

Patient-prisoners pose unique safety and security challenges for healthcare organizations. The Joint Commission standard Hr.2.ten EP10 requires the organization to "orient and educate forensic staff to include how to collaborate with patients; procedures for responding to unusual clinical events and incidents; the hospital's channels of clinical, security, and authoritative communication; and distinctions between administrative and clinical seclusion and restraint." This function is often performed by the healthcare system's security staff, and tracked meticulously.

Clear direction and guidance helps keep everyone safe during the commitment of forensic healthcare. With the safety of patients and personnel as a priority, defining the security officeholder role in the treatment of inmates and arrestees is especially important, but is all too often missing in the security officer training program. If security staff are summoned for assistance, what can exist provided? Does the arrangement allow for security staff to provide bath breaks or spell law enforcement officials in their duty to watch the patient? CMS differentiates in the use of handcuffs or other restrictive devices applied past law enforcement officials. 11 If security staff are expected to render assistance to police enforcement officials, are there modifications to the use-of-force continuum that the officer must be trained on?

A challenging upshot for security staff is a clear understanding of what patient information can or cannot be disclosed. All too frequently, police enforcement officials practice a "drop and run" technique. The patient, known to take broken the law, is not arrested or formally charged. The police force enforcement officer leaves the healthcare facility with a mandate for the security officer to notify them prior to discharge. This effect is the subject of many heated discussions in the healthcare customs. Tin can the security officer legally notify the government? The respond is that information technology depends on the healthcare system's policy and their interpretation of HIPPA.

Some healthcare organizations release this data freely to law enforcement, interpreting that the police officeholder has "a need to know," while other organizations view the discharge of a patient every bit confidential medical data that cannot be readily shared. This is a precarious situation for the security officer who needs specialized training on HIPPA rules and regulations and how to maintain collegial relationships and liaison efforts with law enforcement.

Internationally, while the term "forensic" is not universally used to describe prisoners every bit patients, the same challenges be for healthcare organizations and the need for security training and their engagement in the prisoner management procedure cannot be disputed.

More detailed data almost the interrelationship of security with forensic patients is discussed in Affiliate 13, "Patient Intendance Involvement and Intervention."

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