Transcript Document 7142972

Long Term Care Worker Protection Program
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Define key terms related to workplace violence.
Identify the potential risk factors in long term care
settings.
Recognize the current OSHA guidelines as they
apply to protecting caregivers/workers from
violence.
Describe the basic inspection procedures OSHA
would follow for incidents of workplace violence.
Workplace violence: any physical assault,
threatening behavior, or verbal abuse occurring
in the work setting.
Workplace: any location either permanent or
temporary where an employee performs any
work-related duty.
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The buildings and the surrounding areas, including
parking lots, field locations, patients’ homes, and
traveling to and from work assignments.
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The classifications of workplace violence focuses
on the relationship between the perpetrator and
the target of the violence, as identified by OSHA:
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Type 1: Criminal Intent
Violent acts by people who enter the workplace
to commit robbery or other crime – or current or
former employee who enters the workplace with
the intent to commit a crime.
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Type 2: Customer/Client/Patients
Violence directed at employees by customers,
clients, patients, students, inmates or any others
to whom the employer provides a service.
Type 3: Co-worker
Violence against co-workers, supervisors, or
managers by a current or former employee,
supervisor, or manager.
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Type 4: Personal
Violence in the workplace by someone who
does not work there, but who is known to, or has a
personal relationships with, an employee.
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Type 2 – violence directed towards workers by
customers, patients, or any others to whom they
are providing a service.
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Examples?
Homicide is one of the leading causes of death in
the workplace and has been for over 15 years.
In 2010, there were 506 homicides in America’s
workplaces.*
* Bureau of Labor Statistics, U.S. Department of Labor, News
Release, August 25, 2011.
Manner in which fatal work injuries occurred, 2010*
Exposure to harmful
substances or
environments
(9%)
Fires and explosions
(4%)
Total = 4,547
Highway incidents
(21%)
Falls (14%)
Fall to lower level
(11%)
Contact with objects
and equipment (16%)
Struck by
object
(9%)
Transportation
incidents (39%)
Homicides
(11%)
Assaults and
violent acts (18%)
More fatal work injuries resulted from transportation incidents than from any other event. Highway
incidents alone accounted for more than one out of every five fatal work injuries in 2010.
*Data for 2010 are preliminary.
NOTE: Percentages may not add to totals because of rounding. Transportation counts are expected to rise when updated 2010 data are released in Spring 2012 because key
source documentation on specific transportation-related incidents has not yet been received.
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Injuries/Death
Stress
Fear – of losing their job, being hurt
Avoidance of others
Leaving their job and the organization.
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Cost: 500,000 employees with 1,175,100 lost work
days each year.
Lost wages: $55 million annually.
Lost productivity, legal expenses, property
damage, diminished public image, increased
security, turnover….
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Working with unstable or volatile people in a
health care setting.
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Working alone or in very small numbers.
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Working late at night or in the early morning hours.
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Working in community based settings.
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Increasing number of patients and residents
with a history of violent behavior and/or drug
or alcohol abuse being released from
hospitals without follow-up care.
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Availability of drugs and money at care
facilities/assisted living, clinics and pharmacies,
making them likely robbery targets.
Unrestricted movement of the public – open
access in many cases to long term care settings.
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Isolated work with residents during exams or
treatment.
Residents who may strike out, pull, punch.
Staff that have not received training in
identifying/managing potential escalating, violent
behaviors.
Poorly-lighted corridors, parking areas.
Staff feeling that some of the incidents are just
“part of the job”, leading to under-reporting.
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Guidelines for Preventing Workplace Violence for
Health Care and Social Service Workers, U.S.
Department of Labor, Occupational Safety and
Health Administration. OSHA 3148-01R 2004.
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Violence: Occupational Hazards in Hospitals,
Center for Disease Control and Prevention,
National Institute for Occupational Health (2002),
DHHS(NIOSH) Pub. No. 2002-101.
OSHA GENERAL DUTY CLAUSE:
SECTION 5(a)(1)
Each employer shall furnish to each of his
employees employment and a place of
employment which are free from recognized
hazards that are causing or likely to cause
death or serious physical harm.
This includes the prevention and control of
the hazard of workplace violence.
OSHA will rely on Section 5 (a)(1) of the
OSH Act for enforcement authority.
A. A serious workplace violence hazard exists and the
employer failed to keep its workplace free of hazards to
which employees were exposed: (ex of documentation):
* OSHA 300 Log and 301 forms from prior 5 years
* Injury reports, including reports generated as part of a
JCAHO accreditation/certification.
* Past complaints
* Employee interviews
* Documentation that the workplace violence hazard
was reasonably foreseeable by the employer.
B. Industry and Employer Recognition (examples):
* Documentation from the business
groups/associations affiliated with the employer (Example:
Joint Commission, Sentinel Event Alert Issue 45, June 3,
2010 “Preventing Violence in the Health Care Setting”.
* Journal articles/research
* NIOSH and OSHA publications
*State and local laws that address workplace violence
in healthcare facilities.
* Employer awareness of any prior incidents, injuries,
or close calls; interviews with employees/managers.
* Documentation of how the employer currently
addresses workplace violence including a security plan,
training, a prevention plan, etc.
C. The hazard caused or was likely to cause death
or serious physical harm.
* Documentation might include employee
interviews, injury and illness logs, and police
reports.
* Evidence of actual instances where employees
were threatened with physical harm or seriously
injured or killed as a a result of workplace violence.
D. There are feasible abatement methods available
to address the hazard.
* Follow OSHA Guidelines for possible
abatement methods.
* Violence Prevention Plan
Reference: OSHA Inspection,
Directive Number CPL 02-01-052,
Effective Date: September 8, 2011,
Subject: Enforcement Procedures for Investigating or
Inspecting Workplace Violence Incidents.
Opening Conference
* Explanation of reason for inspection
* Request for information on hazard
assessments/incidents
* Existence of a Workplace Violence Prevention
Program, including worker training
 Walkaround and Records Review
* Employee interviews
* Review of injury/illness records
Closing Conference
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March 29, 2009 – Carthage, NC; nursing home
* 6 killed, 3 injured
December 8, 2009 – Hazard, KY
* 1 physician killed at rural medical clinic
March 2, 2010 – Danbury, CT, hospital
* 1 nurse shot by elderly patient, medical unit
Summer, 2010 – Valley Stream, NY
* 1 nurse severely injured by patient in a group
therapy session
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Management Commitment and Employee
Involvement
Worksite Analysis
Hazard Prevention and Control: Potential
Abatement Methods
Employee Education
Recordkeeping and Evaluation of Program
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Complementary and essential.
Management commitment provides the
motivating force to recognize and deal
effectively with workplace violence.
Employee involvement and feedback-enable
workers to develop and express their
commitment to safety and health.
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Organizational concern for employee emotional
and physical safety and health.
Equal commitment to worker safety and health
and resident/client safety.
System of accountability for all managers,
supervisors, and employees.
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Create and disseminate a clear policy of zero
tolerance for workplace violence.
Ensure no reprisals are taken against employees
who report workplace violence incidents.
Encourage employees to promptly report any
workplace violence incidents and suggest ways to
reduce or eliminate risks.
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Outline a comprehensive plan for maintaining
security in the workplace.
Assess security response in your facility – what
is the procedure, who responds, etc.
Affirm management commitment to employee,
creating and sustaining a supportive
environment.
Set up staff information sessions/briefings as
part of the initial effort to address workplace
violence issues.
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Understand and comply with the workplace
violence prevention program and other safety
and security measures.
Actively participate in sharing information or
suggestions related to safety and security
concerns.
Prompt and accurate reporting of any violent
incidents.
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Step-by-step look at the long
term care setting/assisted living
site, the community, and the
industry to find existing or
potential hazards for workplace
violence.
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Conduct a workplace violence
hazard analysis to assess the
vulnerability of your
organization to workplace
violence and determine
appropriate abatement
methods and employee training
needs.
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Analyzing and tracking records or reports of any
workplace violence incidents.
Monitoring trends and analyzing incidents.
Review reports from external agencies, including
Joint Commission, OSHA, NIOSH etc.
Screening surveys with employees to assess their
concerns.
Analyzing workplace security.
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Engineering controls and workplace adaptation.
Administrative and work practice controls.
Post incident response.
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Alarm systems and
other security devices
Metal detectors
Closed-circuit video
recording for high-risk
areas
Curved mirrors at
hallway intersections.
Bright, effective
lighting –indoors and
outdoors.
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Safe rooms for staff use
during emergencies
Enclose work stations,
install deep service
counters or bullet-resistant
glass in reception area,
triage, admitting
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State clearly to patients/families, clients, and
employees that violence will not be tolerated or
permitted.
Establish liaison with local police and state
prosecutors.
Require employees/supervisors to report all
assaults and threats.
Set up trained response teams to respond to
emergencies.
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Provide management support during
emergencies.
Respond to all complaints/reports of workplace
violence.
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A written plan that is clear, comprehensive and
available to all staff.
Can be part of the Safety Plan.
Assign responsibilities and roles.
Hazard analysis.
Abatement methods in place.
Policy/procedure to follow in the event of a
workplace violence event.
Employee education.
Annual review of the program.
Provide comprehensive treatment for
victimized employees and employees who
will be traumatized by witnessing a
workplace violence incident.
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Security response: what is the procedure, who is
trained, who is available.
Trauma-crisis counseling.
Critical incident stress debriefing.
Employee assistance programs to assist victims.
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Workplace
Violence
Prevention
Program
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All employees aware of the Workplace
Violence Prevention Program.
Ensure that all staff are aware of
potential hazards and ways of protecting
themselves.
Awareness of potentially escalating
behaviors on the part of
patients/residents;
Education for managers and
supervisors.
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Employees should understand concept of “Universal
Precautions for Violence”, i.e., that violence should be
expected but can be avoided or mitigated through
preparation.
Employees should be instructed to limit physical
interventions in workplace altercations unless they are
part of a designated emergency response team or
security personnel.
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Workplace violence
prevention program
Risk factors in long term
care
Early recognition of
escalating behavior or
warning signs
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Ways to prevent volatile
situations
Standard response action
plan for potentially violent
situations
Methods for accessing
security assistance.
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What are the risk factors in the long term care
workplace?
Behaviors should they be alert to: pacing, change
in tone of voice, threatening gestures or
comments.
Keeping their voice low and controlled, not arguing
or disagreeing.
Use the “alert system” – code name or panic
buttons to get help.
Buddy system (with residents/visitors with history).
Stay as close to the door as possible.
Recordkeeping and evaluation of the violence
prevention program are necessary to determine
overall effectiveness and identify deficiencies
or changes that should be made.
Annual Review and with updates as necessary.
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OSHA Log of Injury and Illness (OSHA 300).
Medical reports of work injuries assaults.
Incidents of abuse, verbal attacks, or aggressive
behavior.
Minutes of safety meetings, records of hazard
analyses, and corrective actions.
Records of all education programs.
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Establish uniform violence reporting system and
regular review of reports.
Review reports of minutes from staff meetings
on safety issues.
Analyze trends and rates in illness/injury or
fatalities caused by violence.
Employee participation in education related to
workplace violence prevention/abatement and
the facility’s plan.
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Unclear policies and procedures.
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Supervisors not responsive to incidents.
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Victim fear of retaliation or loss of job.
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No obvious physical injury sustained.
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Talk to staff about workplace violence.
Listen to any “incidents” or examples they will
share.
Explain that there is no retribution if a report is
made.
Make reporting easy.
Supervisor accountability for reporting/supporting
employees.
Confidentiality of all reports.
Recognize and try to diminish the “it’s just part of
the job” perspective.
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http://osha.gov/SLTC/workplaceviolence/
OSHA Consultation Program
NIOSH (www.cdc.gov/niosh/docs/2002-101)
Public Safety Officials
Local and state law enforcement agencies
Trade Associations
Unions and Insurers
Human Resource and Employee Assistance
Professionals
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Importance of next steps…
Sharing the information with your colleagues and
staff.
Engaging all workers in helping to achieve and
sustain a safe and healthy work environment!
Your questions and evaluation are very welcome!
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In approximately 6 months you will receive an
electronic survey tool that will ask just a few
questions about this educational program – it is
totally anonymous, but really helps us to identify if
and how you were able to use this information.
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Please help by taking the 4-5 minutes to complete
and submit the survey!
Contact Information: [email protected]