Effective January 1, 2023, there will be a revised Joint Commission Sentinel Event definition. Specifically, TJC is revising the definition of sexual abuse/assault within the Sentinel Event Policy.

Current Joint Commission Sentinel Event Definition

The current definition of sexual abuse/assault in the Sentinel Event Policy is as follows:

“Nonconsensual sexual contact, including oral, vaginal, or anal penetration or fondling of the individual’s sex organ(s) by another individual. One or more of the following must be present to determine that the incident is a sentinel event:

• Any staff-witnessed sexual contact as described above
• Admission by the perpetrator that sexual contact, as described above, occurred on the organization’s premises
• Sufficient clinical evidence obtained by the health care organization to support allegations of unconsented sexual contact”

Revised Joint Commission Sentinel Event Definition

The revised definition of sexual abuse/assault in the Sentinel Event Policy will be as follows:

“Nonconsensual sexual contact of any type with an individual. Sexual abuse includes, but is not limited to, the following:

• Unwanted intimate touching of any kind, especially of the breasts, buttocks, or perineal area
• All types of sexual assault or battery, such as rape, sodomy, and coerced nudity (partial or complete)
• Forced observation of masturbation and/or sexually explicit images, including pornography, texts, or social media
• Taking sexually explicit photographs and/or audio/video recordings of an individual and maintaining and/or distributing them (for example, posting on social media); this would include, but is not limited to, nudity, fondling, and/or intercourse involving an individual

Generally, sexual contact is nonconsensual in the following situations:

• When the individual lacks the cognitive or legal ability to consent even though appearing to want the contact to occur
• When the individual does not want the contact to occur

Other examples of nonconsensual sexual contact may include but are not limited to situations where an individual is sedated, is temporarily unconscious, or is in a coma. An individual’s apparent consent to engage in sexual activity is not valid if it is obtained from the individual lacking the capacity to consent, or consent is obtained through intimidation, coercion, or fear, whether it is expressed by the individual or suspected by staff. Any forced, coerced, or extorted sexual activity with an individual, regardless of the existence of a preexisting or current sexual relationship, is considered to be sexual abuse.”

Why the Change in Definition?

So, what’s the background on this change? First, TJC developed the original sentinel event definition over 11 years ago. That was prior to the wide popularity of social media which is often a factor in sexual abuse/assault events.

Next, the new definition aligns with the CMS definition of sexual abuse which is “non-consensual sexual contact of any type with a resident.” Last, TJC aims to provide a clearer definition of these events so organizations can determine if they indeed constitute a sentinel event.

Implications for Behavioral Health Settings

Incidents of alleged sexual contact are fairly common in 24-hour behavioral health settings. Investigating these incidents and determining the facts can be challenging. So, what are the implications of this new definition in those circumstances?

Frequently, an organization will be in the position of needing to investigate if the sexual contact was “nonconsensual” and thus meets the definition of a sentinel event. We recently posed a question to TJC’s Standards Interpretation Group on this topic.

Specifically, we asked if an organization can proceed to do this investigation before they label the incident as a sentinel event. Their response was “Absolutely, it would be reasonable to obtain facts and understanding to determine whether the event is sentinel.”

If the incident meets the Joint Commission Sentinel Event definition, the organization must conduct a root cause analysis (RCA.) TJC highly encourages reporting sentinel events to their Office of Quality and Patient Safety. However, per the Sentinel Event Policy, reporting is still voluntary.

What to Do Next

First, we recommend you brush up on the 2023 Joint Commission Sentinel Event Policy. Aside from the new definition of sexual abuse/assault, it provides guidance about determining if an incident is a sentinel event. In addition, it gives specific instructions on the requirements for conducting an RCA.

Next, review your internal Sentinel Event Policy. Be sure it conforms to TJC’s 2023 Sentinel Event Policy and includes the new definition of sexual abuse/assault.

Also, consider whether your internal Incident Reporting Policy needs revision to align with the new definition of sexual abuse/assault. Last, be sure to communicate your updated policy to all your key stakeholders.

Relationship to the Survey Process

So, how will this change play out during 2023 surveys? We’ll keep a close eye on that as we analyze survey reports and share findings with you as they develop. Meanwhile, remember a few important points about the survey process and the topic of sentinel events.

Most importantly, TJC instructs surveyors not to search for or investigate sentinel events during an accreditation survey. Surveyors are also not to inquire about sentinel events the organization has reported to TJC.

Sentinel Event Resources

TJC offers several helpful resources on the subject of sentinel events. One we’ve found particularly helpful is RCA2: Improving Root Cause Analyses and Actions to Prevent Harm. It includes forms, tools, and a podcast about conducting RCAs and Action Plans in follow-up to a sentinel event.

Barrins & Associates Consultation

We’ll be incorporating this change to the Sentinel Event Policy into our 2023 Mock Surveys and Customized Survey Preparation.

As always, we’re prepared to support your ongoing survey readiness and best practices for regulatory compliance.