VIOLENCE: AN OSHA PERSPECTIVE FROM THE OFFICE OF OCCUPATIONAL MEDICINE AND NURSING

Transcription

1 VIOLENCE: AN OSHA PERSPECTIVE FROM THE OFFICE OF OCCUPATIONAL MEDICINE AND NURSING Michael J Hodgson, MD, MPH Chief Medical Officer and Director, Office of Occupational Medicine and Nursing

2 Background No explicit federal regulations address workplace violence OSHA uses the General Duty Clause [5(a)(1)] to enforce violence cases External interests Senators sent a letter In 2016 OSHA was petitioned for a standard by a coalition of labor unions GAO has been examining our performance Several states have local regulations that address workplace violence In 1994, California became the first state to pass a workplace violence law when it enacted the Workplace Violence Safety Act In 2005, Illinois enacted the Health Care Workplace Violence Prevention Act

3 States with Enhanced Penalties for Violence against Health Care Workers Source: Emergency Nurses Association (

4 OUTLINE Recent data BLS SIR Materials Guidelines CMS / OSHA iniative Recent OSHA activities Enforcement Evaluation of education programs Assessment of 5(a)(1) versus Hazard Alert Letter

5 25.0 ASSAULT RATES Cases per 10,000 workers C2011 C2012 C2013 C2014 Crop production Construction Hospitals Residential facilities All industry 5 Bureau of Labor Statistics 10 / 2016

6 INTENTIONAL INJURY BY ANOTHER PERSON Rate per 10,000 workers Y2011 Y2012 Y2013 Y2014 Natl HCW Educat Bureau of Labor Statistics 10 / 2016

7 ASSAULT RATES IN HEALTH CARE SECTORS Cases per 10,000 workers C2011 C2012 C2013 C2014 Offices of physicians Home health care General Hospitals Other Hospitals Residential Mental Health Other residential Care Failities Outpatient care centers Other ambulatory services Psychiatric Hospitals Nursing Care Community Elderly Facilities All Industry Bureau of Labor Statistics 10 /

8 Frequency of Healthcare Violence by Facility Type 4% 4% 8% 4% 4% 8% 8% 56% 4% General Hospitals Skilled nursing care Continuing care facilities Other individual family services Vocational Rehabilitation Psychiatric Hospitals Residential Substance abuse Assisted living Other community housing Severe Injury Reports through 4/2016

9 100 Workplace violence resulting in amputation Hospitalized Frequency Percent Yes

10 VIOLENCE PERPETRATORS IN VARIOUS INDUSTRIES Type 3 Type 2 Type Healthcare Trade All others

11 Frequency of workplace violence by industry Type 1 Type 2 Type 3

12 35.0 Workplace violence percentage by industry

13 Frequency Mechanism of workplace violence (n=25) Mechanism Severe Injury Reports through 4/2016

14 Category of healthcare violence (n=25) 8% 92% Type 1 (criminal intent) Type II (patient) Severe Injury Reports through 4/2016

15 Intent (%) for healthcare violence Severe Injury Reports through 4/2016

16 Inter rater agreement for forensics intent Predatory Affective Severe Injury Reports through 4/2016

17 OSHA VIOLENCE PREVENTION GUIDELINES FOR HEALTHCARE AND SOCIAL SERVICES 2015 CONTENTS 1. Management Commitment and Worker Participation Worksite Analysis and Hazard Identification Hazard Prevention and Control Safety and Health Training Recordkeeping and Program Evaluation CHECKLISTS Area Program

18 IMPLEMENTATION TOOLS Roadmap for violence prevention (OSHA/CMS) Examples for implementation List of OSHA tools and publications on violence prevention

19 OSHA INTERNAL ACTIVITIES Enforcement Program evaluations Investigation of 5(a)(1) v HAL

20 transportation security retail other health

21 DISTRIBUTION OF INDUSTRIES BY FISCAL YEAR OF EVENTS FY2004 FY2007 FY2010 FY2011 FY2012 FY2013 FY2014 FY2015 FY2016 health other retail security transportation

22 OUTCOME OF INSPECTION BY FISCAL 90 YEAR FY2004 FY2007 FY2010 FY2011 FY2012 FY2013 FY2014 FY2015 FY2016 No citation 5(a)(1) HAL Active

23 3.5 RATIO OF 5(a)(1) CITATIONS TO HAZARD ALERT LETTERS AND OF 5(a)(1) CITATIONS to NOTHING R1 R2 R3 R4 R5 R6 R7 R8 R9 R10 5a1:HAL 5a1:nothing

24 Frequency of enforcement visits by healthcare facility type Vocational Rehabilitation Other community housing Other individual family services Assisted living Continuing care facilities Residential Substance abuse Skilled nursing care Psychiatric Hospitals General Hospitals Field visit initiated No field visit initiated

25 Graphic Comparison of 12 Reviewed Programs to Review Criteria Facility policies 25% 17% 58% Facility specific risk factors 17% 8% 75% Early recognition 92% 0% 8% Teach de escalation 100% 0% Evasion/extrication 92% 0% 8% Restraints and holds 92% 0% 8% Yes signficant evidence Predatory violence Team approach 25% 0% 92% 75% 0% 8% Yes limited evidence Reporting violence 8% 8% 83% Multicultural info 25% 0% 75% Worker Follow up 17% 25% 58.30% Program evaluation 25% 33% 41.70% 0% 20% 40% 60% 80% 100%

26 Project Methods 1. Literature review on WPV and prevention programs 2. Identified 5 recent 5(a)(1) and 3 HALS on WPV 3. Modified existing checklist (2015 OSHA Guidelines) 4. Interviewed CSHOs who investigated the WPV cases 5. Collaborated with national violence prevention experts on modification of program evaluation checklists 6. Compared existing laws and programs for essential elements: modified checklists 7. New questions

27 Rate of Gaps Identified in Employers WPV Programs WPV Prevention Program Checklist Elements Five Total 5(a)(1) Citations Reviewed Three Total HALs Reviewed 1. Written WPV program 60% 67% 2. Management commitment/employee participation 3. Threat assessment and management 4. Hazard prevention and control 80% 67% 80% 67% 100% 33% 5. Training program 100% 67% 6. Data systems 100% 67%

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