Workplace Violence Prevention Sandra Williams Director of Environmental Health & Safety Alameda Health System September 6, 2017
Focus & Objectives Focus: Session is designed to provide an overview of the new requirements for healthcare facilities to identify, track, log, mitigate and report injuries. Objectives Understand the environmental threats and examine a response protocol. Recognition of unsafe practices and conditions in the healthcare environment.
Polling Question #1 How many of you are responsible for: A. Staff Safety B. Patient Safety C. Visitor Safety D. Environmental Safety
Shared Responsibility 4
Shared Common Goal All healthcare organizations share the same common goal for workplace safety. We want staff to be: Safe while performing their duties Protected in their work environment Free from the potential of harm and violence Secure in healthy workplaces Prepared to respond to safety events 5
Benefits of a Safe Environment
Background Snapshot of the Workplace Violence timeline reported by Cal OSHA. June 2014: OSHASB grants petitions and asks CAL/OSHA to convene advisory committee. September 2014: Senate Bill 1299 was passed/signed for Workplace Violence Prevention plans for hospitals. October 2016: OSHASB adopts the proposed regulation April 2017: Hospitals must have violent incident logs, recordkeeping and reporting in place. July 2017: Hospitals began reporting to CAL OSHA. April 2018: Workplace Violence must be fully operational. 7
Injury and Illness Plan Components 8
Definition of Workplace Violence Workplace violence means any act of violence or threat of violence that occurs at the work site. The term workplace violence shall not include lawful acts of self-defense or defense of others. Workplace violence includes the following: (A) The threat or use of physical force against an employee that results in, or has a high likelihood of resulting in, injury, psychological trauma, or stress, regardless of whether the employee sustains an injury; (B) An incident involving the threat or use of a firearm or other dangerous weapon, including the use of common objects as weapons, regardless of whether the employee sustains an injury; 9
Types of Violence Type 1 violence (unknown/criminal intent) means workplace violence committed by a person who has no legitimate business at the work site, and includes violent acts by anyone who enters the workplace with the intent to commit a crime. Type 2 violence (clients/patients/those accompanying) means workplace violence directed at employees by customers, clients, patients, students, inmates, or visitors or other individuals accompanying a patient. Type 3 violence (employee to employee) means workplace violence against an employee by a present or former employee, supervisor, or manager. Type 4 violence (personal relationship) means workplace violence committed in the workplace by someone who does not work there, but has or is known to have had a personal relationship with an employee.
Useful Data Analyze the existing data that is reported at the hospital to establish a baseline for the number, frequency, and location of potential and real incidents. Code Gray or Silver activity reports Security Reports/Daily Summaries CrimeCast/CAP Report Employee Injury Logs Occurrence Reports 11
Examples These are examples of familiar plans and policies that may exist. Compare and use documents to foster further development of the Workplace Violence Plan. Illness and Injury Plan Workplace Violence Prevention Zero Tolerance for Violence Assaultive Behavior Disruptive Behavior Security Management Employee Assistance 12
WPV: Direct Impact 13
Violence Data
Polling Question #2 How many resources does your organization use to care for an injured employee? A. 0 to 5 B. 6 to 10 C.11 to 15 D.16 >
Care for Injured Staff 1. Unit/Department 2. Manager/Leader 3. House Supervisor 4. Front Line Staff 5. Emergency Department 6. Employee Health 7. Workers Compensation 8. Risk Management 9. Safety Management 10. Benefits Department 11. Labor Relations 12. Payroll Department 13. Human Resources 14. Security/Law Enforcement 15. Employee Assistance Department 16. Senior Leadership
WPVP Building Blocks 17
WPVP Implementation Timeline Establish a timeline to develop and meet the requirements of the regulation
WPVP Multi-Disciplinary Committee Potential Key Stakeholders Staff from high risk areas/departments Human Resources Workers Compensation Employee Relations Safety Officer Licensing and Accreditation Social Worker Staff Developer Contracting Vendor Management Labor Unions Environmental Health and Safety Security Risk Management Nursing Leaders Behavior Care Home Health Pharmacy Business office/registration Social Services Pharmacy Imaging Laboratory Patient Affairs/Client Services 19
WPVP Annual Assessments Requirements Annual Plan content Annual Plan review or when changes occur Address corrective actions Reporting WPV incidents Contacting law enforcement Identify harm risks Provide counseling Post incident debriefing Provide staff training Environmental Assessment Parking Lot High Risk Areas Remote Locations Escape Routes Exterior Lighting Employee Entryways Harmful Objects Valuables 20
Training Curricula Initial training requirements: Identified workplace violence hazards in facility Workplace Violence Prevention Plan Recognition of potential violence Avoiding potential harm and factors of escalation Strategies to avoid physical harm Recognizing alerts, alarms or other warnings Role of private security Reporting of private security Reporting violent incidents to law enforcement Resources available for coping with incidents of violence Opportunity for interactive questions 21
Special Training Considerations Staff who will require special training include assignments that cover: Responding to alarms Notifications of violent incidents Controlling persons with aggressive or violent behavior Training will include: Aggression Violence predicting factors Assault cycle Maneuvers to defuse and prevent violence Restraining techniques 22
BrØset Violence Checklist (BVC) The BVC assesses the presence of six observable predictive patient behaviors that help staff determine whether the patient is: confused irritable boisterous verbally threatening physically threatening attacking objects https://laeringsportalen.helse-sorost.no/mohiverepository/content/77190dfc- 072f-4f4b-9fc0-ae80f417a0de/course/asset/main.html 23
BrØset Tool 25
Screening Considerations Examine screening indicators that staff may use to determine risk factors for violence. Examples: Risk for Violence Substance Abuse History Trauma History Treatment History 26
Persons Accompanying Patient Assess policies and practices that restrict persons that refuse to adhere to the hospital s Zero Tolerance for Violence policy. The policy may prohibit: Abusive Language Aggressive Behavior Violent Behavior Influence of drugs and alcohol Consider developing a clear understanding for behavior expectations for both patients and those accompanying patients. 27
Response Policy Use alerting systems to summons response teams when de-escalation measures are ineffective. Response from designated staff to defuse or use safety maneuvers to control the situation. Recognize staff s right to contact law enforcement when an assault occurs. Refer staff for care and treatment for injuries. 28
Response (cont d) Notify Leader/WPVP team members. Investigation is conducted, reports are generated, and document the incident. Provide staff with information and access to Employee Assistance Program (EAP) Counseling services. Schedule incident debriefing. Conduct plan assessment for effectiveness.
Incident Mapping Aggressive Behavior Patient /Person Accompanying Patient WPV Act (Violence or Weapon) In Progress Code Gray/Law Enforcement Response Use Safety Strategies/ Team Responds Incident Neutralized Escalate/Communicate Activate Response Protocol Track whether Team Member(s) Treated onsite or transported Generate Internal Report/Conduct Preliminary Investigation Document Incident on WPV Log Comply with CAL/OSHA Time Sensitive Reporting Requirements 24 hours vs.. 72 hours Initiate Post Incident Debrief Process Schedule Organizational Debrief Assess Effectiveness of WPV Plan 30
Cal/OSHA Reporting Event Types Biting by aggressor Choking Grabbing Hair pulling Kicking Punching/slapping Pushing/pulling Scratching Shooting Spitting at/on Stabbing Striking Rape/attempted rape Unwanted physical sexual contact Type of physical force not listed above Use of firearm or other dangerous weapon: Gun Knife Furniture/furnishings (e.g., lamp) Medical equipment Other weapon
Cal/OSHA Reporting Injury Types Death Amputation Asphyxiation/suffocation Burns Bruising/abrasion Cut/puncture Dislocation/fracture Head injury Internal injury Open wound Sprain/strain Stress/psychological impairment Injury type not listed above Injury type unknown by the hospital at this time N/A No known injured employees at this time (Restriction: if checked,no other boxes can be checked)
Reporting Other Employers Employees N/A No employees of other employers affected Contractor providing services to the hospital If known: Company name Company phone number (not required) Emergency services or medical transport personnel If known: Company name Company phone number (not required) Licensed independent provider If known Company name Company phone number (not required) Vendor If known: Other If known: Company name Company phone number (not required) Company name Company phone number (not required) Don t know the type of employer
Communication Template for Staff To: From: Date: Subject: Workplace Violence Incident Staff Communication Brief description of the Incident, Date, and Location: What you should know: Describe safety Measures Implemented for unit staff, or staff not assigned to unit/department. What are the known behavior triggers? Who to call to report a Workplace Violence Incident? Describe safety measures established or visitors. List Employee Assistance Program (EAP) Contact Number
Exercise Big Orange Caution: This video is graphic used only to demonstrate the need for staff training on screening criterion, situational awareness, environmental hazards, and deescalation techniques
Polling Question #3 How many errors or high risk safety practices were you able to identify? A. 0 to 3 B. 4 to 7 C. 8 to 9 D. 10 or >
Identified Risks in Video Triage desk under staffed. Staff frustration noticeable. Staff had no empathy for patients. Staff had no situational awareness. Staff ignored patient attacking objects. Patient walking down hallway behind staff. Room not prepared for patient attacking objects. Safety measures not used. Ineffective communication between staff members. Patient left unattended in fully stocked room. Employee failed to use AIDET. Team respond without coordination.
Employee Satisfaction Zero Tolerance Employee Protection Employee Satisfaction Employee Safety
Questions
Thank You Contact Information Sandra Williams Director of Environmental Health and Safety Alameda Health System swilliams@alamedahealthsystem.org
References California Code of Regulations, Title 8, Section 3342, Violence Prevention in Healthcare. (December 8, 2016) California Hospital Association, Healthcare Workplace Violence Prevention How to comply with the Cal/OSHA Regulations. (2017) United States Government Accountability Office. Workplace Safety and Health: Additional Efforts Needed to Help Protect Health Care Workers from Workplace Violence, Report to Congressional Requesters. (March 2016). Occupational Safety & Health Administration (December 2015) Caring for our Caregivers. Retrieved, February 26, 2017 https://www.osha.gov/publications/osha3827.pdf Centers for Disease Control (2013). The Public Health Approach to Violence Prevention retrieved February 27, 2017. https://www.cdc.gov/violenceprevention/overview/publichealthapproach.html TeamHealth Patient Safety Fables. (2013). Big Orange. Retrieved February 24, 2017 https://www.youtube.com/watch?v=8rzkcw-kdmo https://www.youtube.com/watch?v=ztv2o-alk7u&feature=youtu.be Linaker & Bush Iversen (1995). Almvik & Woods (2000). Behavior Violence Checklist Retrieved March 1, 2017. http://riskassessment.no/files/bvc-english-version.pdf Tuti Iryani Mohad Daud, MD, Violence, Aggression, and Mental Illness. National University of Malaysia Medical Centre. Retrieved March 5, 2017 https://www.slideshare.net/tutimd/managing-aggression-part-1 Harvard Health Publications. Mental Illness and Violence. Harvard Medical School. (January 2011). Retrieved March 8, 2017. http://www.health.harvard.edu/newsletter_article/mental-illness-and-violence American Psychology Association. Mental Illness is Not Usually Linked to Crime Research Finds. (April 2014). Retrieved March 8, 2017 h
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