Workplace violence. mehrdod ehteshami, do, mph

Transcription

1 Workplace violence mehrdod ehteshami, do, mph

2 objectives To obtain an understanding of workplace violence trends in healthcare To be able to identify risk factors for workplace violence To determine prevention strategies unique to different types of healthcare facilities

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4 we all have stories 2009: Kentucky physician shot and killed by patient for not prescribing narcotic pain medicine 2015: Brigham and Women s surgeon shot and killed by deceased patient s son 2017: Indiana FP shot and killed by patient s husband who was angry over not prescribing narcotic pain medicine

5 we re all scientists so Healthcare has highest incidence of workplace violence outside of law enforcement 24,000 75%

6 Some more numbers Prehospital setting: 80%/49% ED nurses: 100%/82.1% ED physicians: 78% Pediatric residents: 33% 154 shooting with injury between 2000 and 2011

7 Type II

8 risk factors Courtesy of OSHA AMS History of violence Working alone Poorly lit areas Lack of means of communication Prevalence of weapons in a community Unrestricted movement of the public Public perception of facility and tolerance Long wait times Crowding Inadequate food quality or amount

9 and the list goes on Still OSHA: Being given bad news Gang activity Patients in police custody High-volume urban Emergency Departments From personal experience: Race relations Rural medium sized ED, suburban ED, small rural ED

10 OSHA checklist Staffing Training Facility Design Security Measures Outside the Facility Workplace procedures

11 Osha guidelines and violence prevention program Management commitment and employee participation Worksite analysis Hazard prevention and control Safety and health training Record-keeping and program evaluation

12 management commitment and employee participation Acknowledgement Allocation of resources Assigning responsibility and authority Maintaining system of accountability Support of recommendations from staff Establishing program for post-assault Establishing policies ensuring proper reporting, recording, and monitoring

13 Worksite analysis Collected through records analysis, job hazard analysis, surveys (patient and employees)

14 hazard prevention and control Identify and evaluate control options for hazards Select effective and feasible controls Implement those controls Follow-up to be sure they are being followed Evaluate effectiveness

15 examples of controls Silenced alarm systems Exit routes Metal detectors Barrier protection Flagging patients with history of violence Workplace violence policies, transportation policies

16 Safety and training Necessary!

17 record keeping and evaluation Reporting incidents and how they were handled Analyzing trends Measuring improvement based on frequency and severity of violence Records of work practice changes Tracking recommendations Staying abreast on new recommendations and strategies Surveying employees Complying with OSHA and state requirements Requesting periodic law enforcement or outside consultation

18 prevention Lack of high quality research for what works 33%: number of hospitals that use hand-held metal detectors 7.5%: number of hospitals that use walk-through metal detectors

19 a couple of comments on strategies Training in aggression de-escalation and self defense Improve staffing of security personnel and staffing of hospital personnel

20 legal system

21 questions?

22 sources Phillips J. Workplace Violence against Health Care Workers in the United States. N Engl J Med 2016; 374: Occupational Safety and Health Administration. Guidelines for preventing workplace violence for healthcare and social service workers (OSHA, R). Washington, DC: OSHA, 2015 Peek-Asa C, Howard J, Vargas L, Kraus JF. Incidence of non-fatal workplace assault injuries determined from employer s reports in California. J Occup Environ Med 1997;39:44-50 May DD, Grubbs LM. The extent, nature, and precipitating factors of nurse assault among three groups of registered nurses in a regional medical center. J Emerg Nurs 2002;28:11-17 Behnam M, Tillotson RD, Davis SM, Hobbs GR. Violence in the emergency department: a national survey of emergency medicine residents and attending physicians. J Emerg Med 2011;40: Kelen GD, Catlett CL, Kubit JG, Hsieh YH. Hospital-based shootings in the United States: 2000 to Ann Emerg Med 2012;60(6): e1 Kowalenko T, Gates D, Gillespie GL, Succop P, Mentzel TK. Prospective study of violence against ED workers. Am J Emerg Med 2013;31: State issues. Chicago: Emergency Nurses Association ( Mohr DC, Warren N, Hodgson MJ, Drummond DJ. Assault rates and implementation of a workplace violence prevention program in the Veterans Health Care Administration. J Occup Environ Med 2011;53: