This document discusses signs and prevention of different types of abuse including spousal abuse, child abuse, abuse of endangered adults, elder abuse, and abuse in healthcare settings. It notes that healthcare providers are mandated by law to report suspected cases of child abuse, abuse of endangered adults, and elder abuse. The document provides guidance on properly documenting any suspected abuse cases and protecting patients during an investigation.

1. Abuse and Neglect

2. Spousal Abuse
o Warning Signs:
• Unexplained trauma
• Accident history inconsistent with
injury
• Over protective spouse
• Absent from work
• Poor eye contact
• Poor self esteem/image

3. Spousal Abuse
o 1 out of 4 women experience domestic violence in their
lifetime
o The leading cause of serious injury in women ages 15 to
44 is domestic violence
o Healthcare workers are not mandated by law to report
domestic violence

4. Child Abuse
o 500,000 children are abused each year.
o Types:
• Verbal, Physical harm, Sexual, Incest, Emotional, Neglect
o Healthcare providers are mandated by law to report
suspected child abuse and neglect.

5. Abuse of Endangered Adults
o An endangered adult is any adult 18 years or older who is found to
be in a situation or condition which poses an imminent risk of
death or serious bodily harm to that person AND who
demonstrates a lack of capacity to comprehend the nature and
consequences of remaining in that situation or condition
o Types
• Physical abuse Neglect
• Sexual Abuse
• Emotional maltreatment
• Exploitation
o Health care providers are mandated by law to report suspected
abuse or neglect of endangered adults

6. Elder Abuse
o 560,000 elders are abused each
year
o Indicators are:
• Malnutrition
• Neglect
• Physical harm
• Dehydration
• Afraid/fear of caregiver
• Financial/material exploitation
o Healthcare providers are
mandated by law to report

7. Abuse Affects Everyone it Touches
o Assess your patients for signs of abuse
• Admission Assessment
• Listening
• Dietary status
• Psychosocial Assessment
• Skin Assessment
• Daily Assessment

8. Documentation
o It is very important to document any indicators of
abuse.
o Documentation should be made of any physical
findings, forensic evidence collection, and any
statements made by the patient or those
accompanying the patient.
o The word “victim” should never be used in the medical
record. We care for patients not victims, using the word
victim suggests that the care provider has already
decided the patient was abused.

9. Documentation
o Alleged is another legal term that should not appear in the
chart.
o Replace the word alleged with suspected or reported.
o Be sure to quote exactly the patient’s or family members’
statements.
o Report all suspicions of elder and child abuse to Social
Services and the Administrative Supervisor and document that
in the medical record.

10. Prevention and Investigation of
Abuse, Neglect
o WCMC takes all measures possible to prevent and investigate
all abuse, neglect or misappropriation of property. Any signs of
suspected abuse, neglect and or misappropriation of property
should be immediately reported.
o All patients and/or families will be given a copy of the patient’s
rights and responsibilities on admission.
o All associates are encouraged to look for events such as
suspicious bruising or multiple unexplained skin tears and
report to the Administrative supervisor or Administrator on call
immediately

11. Prevention and Investigation of
Abuse, Neglect
o All associates should look for any signs of physical
abuse, mental abuse, and/or sexual abuse.
o Mental Abuse can be defined as
humiliation, harassment, and/or threats of punishment.
o Physical Abuse can be defined as hitting, kicking, slapping, or
pinching.
o Sexual Abuse can be defined as sexual harassment, sexual
coercion, or sexual assault

12. Things to look for
o Demeaning statements o Misuse of restraints
o Failure to provide necessary
o Threats food, clean linens or daily care
o Intimidation o Medical neglect including not calling
a physician if necessary, not being
o Suspicious bruising and/or welts aware of side effects of
medications, or not taking action on
medical problems
o Multiple unexplained skin tears, or
abrasions o Personal property abuse including
theft or harm to a patient’s
glasses, dentures, clothing, or
jewelry

13. Reporting
o All associates of White County Medical Center are instructed to report any unusual
occurrence, treatment or medication error using the Occurrence Report
Management system
o Any patient or family complaint is reported using the Service Management Report
o In the event of suspicion of abuse, the associates must notify their immediate
supervisor or their designee.
o The supervisor should notify the administrator on call immediately (within 24 hrs)
and inform them of a possible abuse/neglect situation that is under investigation.
o The director, risk manager, or administrator designee should begin the investigation
by interviewing the patient.

14. Protect
o If credible allegations of abuse, neglect, or misappropriation of resident
property is made against an associate, that associate will immediately be
suspended or moved to another area of the facility.
o The associate will not be allowed to return to work until the associate is
cleared of any suspected violation through the required investigation.
o If another associate has reason to believe the patient has been subjected
to conditions or neglect should immediately notify the Administrative
Supervisor.
o The first act of the associate will be to remove the patient/family/associate
from harm.

15. Investigate
o The associate who received the initial complaint will fill out a
Service Management Report with all the facts known at that
time.
o The manager of the area and their Administrative
Representative will initiate a thorough review of all suspected
allegations.
o Appropriate communication is maintained with the associate in
question as well as the patient and/or family.
o The investigation should take no more than 3 working days.

16. Reporting/Response
o The Risk Manager or Hospital Administrative
Representative will notify the proper regulated agencies
as follows:
• Law Enforcement for alleged abuse.
• Arkansas Department of Health/Division of Health
Facility Services for violation of abuse, neglect, or
misappropriation of property.
o Upon full investigation, the counseling process as
deemed necessary, is completed regarding associate(s)
involved and is documented.

17. Prevention and Investigation of
Abuse, Neglect and Misappropriation of
property
o In additional to monitoring for signs of abuse upon
admission, WCMC also takes all measures possible to prevent
and investigate all abuse, neglect or misappropriation of
property that may occur while in our care. Any signs of these
are reported immediately to the supervisor.
o The supervisor will notify the administrator on call within 24
hours and inform them of a possible abuse/neglect situation
that is under investigation.
o The director, risk manager, or administrator designee should
begin the investigation by interviewing the patient.

18. Prevention
o Recognizing caregiver stress and burnout can be essential to
preventing patient abuse or neglect. Caregivers often are so
busy caring for others that they tend to neglect their own
emotional, physical, and spiritual health.
o The demands on a caregiver’s body, mind, and emotions can
easily seem overwhelming leading to fatigue and hopelessness
and ultimately, burnout.
o Signs of burnout to look for in health care workers can include
negative behavior, tardiness, absenteeism, physical
illness, and withdrawal from others. It is important to take care
of ourselves so we can take care of others.

19. Prevention
The following are some steps to prevent burnout:
o Find someone you trust such as a friend, family member, or
neighbor to talk to about your feelings and frustrations
o Develop new tools for coping and practice relaxation techniques
o Stay healthy by eating right, exercising, and getting enough sleep
o It is important to take care of yourself physically as well as
spiritually and emotionally
WCMC has an Employee Assistance Program (EAP) that can provide
counseling services to associates in need via self-referral. Contact
information is provided in the benefits packet available through
Human Resources

20. Observation
All associates will observe for any signs of physical abuse, mental
abuse, and/or sexual abuse
o Things to look for include
• Demeaning statements or insults
• Intimidation or threats
• Suspicious bruising and/or welts
• Multiple unexplained skin tears or abrasions
• Misuse of restraints
• Failure to provide necessary food, clean linens or daily care
• Medical neglect, not calling a physician or taking action on medical
problems
• Personal property abuse including theft or harm to a patient’s
glasses, dentures, clothing, or jewelry

21. Protect
o If credible allegations of abuse, neglect, or misappropriation of
resident property is made against an associate, that associate will
immediately be suspended or moved to another area of the facility.
o The associate will not be allowed to return to work until the
associate is cleared of any suspected violation through the
required investigation.
o If another associate has reason to believe the patient has been
subjected to conditions or neglect should immediately notify the
Administrative Supervisor.
o The first act of the associate will be to remove the
patient/family/associate from harm.

22. Investigate
o The associate who received the initial complaint will fill out a
Service Management Report with all the facts known at that
time.
o The manager of the area and their Administrative
Representative will initiate a thorough review of all suspected
allegations.
o Appropriate communication is maintained with the associate in
question as well as the patient and/or family.
o The investigation should take no more than 3 working days.

23. Reporting/Response
o The Risk Manager or Hospital Administrative Representative will
notify the proper regulated agencies as follows:
• Law Enforcement for alleged abuse.
• Arkansas Department of Health/Division of Health Facility
Services for violation of abuse, neglect, or misappropriation of
property
o Upon full investigation, the counseling process as deemed
necessary, is completed regarding associate(s) involved and is
documented