Presented by: September 17, 2015 Nickole Winnett, Esq. Jackson Lewis P.C. (703) 483-8313 nickole.winnett@jacksonlewis.com Copyright 2015 Jackson Lewis P.C. New OSHA Enforcement Memorandum (June 25, 2015). All inspections of hospitals, nursing homes, rehabilitation and social service facilities will include the review of all of these potential hazards: o Musculoskeletal disorders (MSD) related to patient handling; o Bloodborne pathogens; o Workplace violence; o Tuberculosis; and o Slips, trips and falls. 2 1
High Rate of Injuries! o Healthcare and social assistance industry has reported more injury and illness cases than any other private industry sector over the last several years. o Considered by OSHA to be one of the most dangerous industries. o Slips, trips, and falls, patient handling, and workplace violence contribute the most to high injuries. 3 It's time for us to start doing some enforcement to make sure fewer workers are hurt. "A lot of hospitals still believe this old myth that hospitals are safe places to work. Dr. David Michaels, Assistant Secretary of Labor for Occupational Safety and Health Some hospitals are at risk for serious penalties we'll go in, we'll issue penalties, and that will tell the industry to change things. As quoted in National Public Radio s multi-part series on hospital workplace injuries. 4 2
OSHA defines Workplace Violence as an assault, intimidating act, or threatening conduct which occurs in or is related to the workplace. In healthcare, OSHA considers resident/patient to caregiver/nurse violence as workplace violence that must be protected against even when the individual does not have the necessary intent. o Examples include: biting, hitting, kicking, spitting, stabbing, pushing, threatening to hurt, etc. Check out OSHA s new Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers! 5 General Duty Clause -- 5(a)(1) of the OSH Act -- Employers are required to provide a safe and healthful work environment. OSHA has recognized that workplace violence is an occupational hazard in some industries and environments, which can be avoided or minimized if employers take appropriate precautions. Employers may be found in violation of the general duty clause if they fail to reduce or eliminate recognized workplace violence hazards that cause or are likely to cause death or serious physical harm to employees when there is a feasible method to abate the hazard. 6 3
California, Connecticut, Illinois, Maryland, New Jersey, New York and Oregon have laws requiring workplace violence-prevention programs for health-care employees. 7 OSHA issued $70,000 general duty clause citation against hospital when evidence that employees were stabbed in neck with a metal fork, shoved and pushed, kicked, punched, chocked, bitten, spat upon and threatened with death. Evidence of poor engineering controls patients were allowed to roam freely, no audible alarms, secluded areas that prevented others from hearing cries for help, use of metal cutlery and glassware, medication cart that blocked doorways when they were pushed into patients rooms. 8 4
OSHA s suggested abatement: o personal pendant wireless alarms carried by staff, o private walkie-talkies, o security cameras, o alarm systems, o metal detectors, o additional lighting in alcoves, curved mirrors, o furniture mounted to walls and floors, o plastic cutlery and glassware, o intercom call buttons placed onto walls above beds, o safe rooms and swipe card-enabled doors. 9 Also included: o management commitment, o input solicited from employees, o policies to allow staff to impose physical control measures, o a strong liaison with local police, o hands-on exercises and practice drills, o medical and emotional treatment, o root cause analysis for each assault. 10 5
Create an anti-violence program that : o Includes an anti-violence statement that covers all workers, patients, clients, visitors and anyone else who may come in contact with personnel. o Identifies potential outcomes taken if the policy is violated, including discipline of employees, law enforcement contacted, or removal of visitors and residents. o Encourages prompt reporting and investigation of all incidents. o Records incidents to assess risk and to measure progress. 11 Clearly define what will be considered violence in the workplace from employees, visitors, and residents or patients: o Screaming and kicking o Biting o Pushing and shoving o Insults and practical jokes o Threats of physical violence o Physical or mental intimidation 12 6
Complete a workplace violence hazard assessment: o Identify residents and patients with the greatest risk of provoking violence, as well as actions that could put employees at risk of assault, including how often and when. o Perform resident/patient assessments. Determine the behavioral history of new and transferred residents/patients to learn about past violent or aggressive behavior. Communicate with staff! o The assessment should consider whether certain physical changes or administrative controls can reduce employee vulnerability to violent incidents. 13 Employers are encouraged to perform job analysis to identify specific tasks or positions that may put employees at risk for workplace violence o Identify jobs or locations with the greatest risk of violence psychology ward, emergency rooms, o Priority should be given to jobs that require: administering medicine providing intimate care activities transferring patients or residents 14 7
Working directly with: o Patients and residents with a history of violence. o Patients and residents with cognitive disabilities or impairments. o Patients and residents with certain psychological disorders. o Patients and residents who have abused drugs or alcohol. o The public or with relatives of patients and residents. Lack of emergency communication devices or ability to get help. Long waits for care and services. Overcrowded or uncomfortable waiting and emergency rooms. 15 Survey employees before and after making job or worksite changes, or installing security measures or new systems to determine their effectiveness. Survey employees periodically to learn if they experience hostile or threatening situations that are not being reported. Ask employees for suggestions on how to improve program and evaluate effectiveness of program! 16 8
Sample questions that could be asked: o What daily activities, if any expose you to the greatest risk of violence? o What, if any, work activities make you feel unprepared to respond to a violent action? o Can you recommend any changes or additions to the workplace violence prevention training you received? o Can you describe how a change in a patient s daily routine affected the precautions you take to address? 17 Analyze previous incidents and include an account of what happened before and during the incident, and the relevant details of the situation and its outcome. Identify patterns of workplace violence and near misses, organized by departments, work areas, job titles, and activities being performed at time to occurrence time of day Use this information to assist in identifying trends and patterns of occurrence. Good examples in OSHA s guidelines! 18 9
Implement Feasible Engineering Controls, such as: o Arrange furniture and medical carts to prevent entrapment of staff. o Tie down furniture and use plastic silverware o Use glass panels for doors or walls for better monitoring behavior. o Install security cameras, additional lighting or curved mirrors in common or high-risk areas. o Install and regularly maintain alarm systems and other security devices, such as panic buttons, hand-held alarms or noise devices. 19 Implement Feasible Administrative Controls, such as: o Supervise the movement of residents/patients throughout the facility. o Implement log-in/log-out procedures for employees. o Implement sign-in procedures for visitors and guests. o Communicate with residents/patients about what you will do before you do it and ask permission before touching them. o Re-approach when residents/patients act out. o Use case management conferences to discuss behaviors and ways to effectively treat potentially violent residents/patients. 20 10
Implement Feasible Administrative Controls, such as: o Use the buddy system when person safety may be threatened. o Provide responsive, timely information to those in waiting rooms or waiting for care. o Use properly trained security officers and counselors to respond to aggressive behavior. o Prepare contingency plans to treat clients who are acting out or making verbal or physical attacks or threats. 21 Develop a method for communicating that a resident or patient has a history of violence with caregivers. Develop a method for notifying caregivers when a resident is acting out or has engaged in violent behavior. Develop a method for identifying controls that should be used for residents and patients after assessment. Notify caregivers what they should do if they believe violence is imminent. 22 11
Require employees to report all acts or threats of violence to a supervisor or manager promptly including from residents and patients. Define the ways in which an employee can raise a complaint, including who they can complain to and what responsibilities that person will have when a complaint is received. Include an anti-retaliation provision and make sure that employees know that they will not be retaliated against for bringing a complaint of violence or bullying to management s attention or for participating in an investigation. 23 Investigate all complaints of violence in the workplace and develop a plan of action once findings are issued. Define the investigation procedures: o Who will be responsible for investigating a complaint? o Will the supervisor be responsible or Administrator? o When will claims be investigated? o How will the results of the investigation be communicated? 24 12
Perform post-incident investigation after each incident. o Identify the root cause of the incident to assist in preventing future occurrences. o Interview employees, witnesses and even residents (when possible) on what occurred. o Ask why the patient acted and why the employee responded in a certain way in order to uncover the reason behind the actions. Look beyond employee misconduct or unforeseeable accident to determine reason. o Once you know the why, act to reduce! Retraining may be a good response to an incident. 25 OSHA recommends that employers provide at no charge to employee prompt medical treatment and psychological evaluation regardless of severity of assault. Trauma-crisis counseling, critical-incident stress debriefing or employee assistance programs also suggested. 26 13
Conduct mandatory and annual training for employees to learn: o How to recognize the earliest stages of a possible assault. o How to avoid or mitigate potential violent encounters, including how to protect oneself. o How to seek refuge and/or assistance if violence appears imminent. o How to report and document incidents of violence or aggressive behavior. o How to locate and operate safety devices, such as panic alarms. 27 Have a workplace violent safety committee! Review reports and minutes from staff meetings on safety and security issues. Routinely evaluate administrative and work practice changes to determine how well they work to prevent workplace violence. Keeping abreast of new strategies available to prevent and respond to violence. Maintain accurate records of incidents. Track and trend results to identify patterns! 28 14
Nickole Winnett Jackson Lewis P.C. nickole.winnett@jacksonlewis.com (703) 483-8313 29 30 15