Long Term Care Worker Protection Program

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.

The buildings and the surrounding areas, including parking lots, field locations, patients’ homes, and traveling to and from work assignments.

The classifications of workplace violence focuses on the relationship between the perpetrator and the target of the violence, as identified by OSHA:

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.

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.

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.

Type 2 – violence directed towards workers by customers, patients, or any others to whom they are providing a service.

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.

Injuries/Death Stress Fear – of losing their job, being hurt Avoidance of others Leaving their job and the organization.

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….

Working with unstable or volatile people in a health care setting.

Working alone or in very small numbers.

Working late at night or in the early morning hours.

Working in community based settings.

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.

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.

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.

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.

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 recordsClosing Conference

March 29, 2009 – Carthage, NC; nursing home * 6 killed, 3 injuredDecember 8, 2009 – Hazard, KY * 1 physician killed at rural medical clinicMarch 2, 2010 – Danbury, CT, hospital * 1 nurse shot by elderly patient, medical unitSummer, 2010 – Valley Stream, NY * 1 nurse severely injured by patient in a group therapy session

Management Commitment and Employee Involvement

Worksite Analysis Hazard Prevention and Control: Potential

Abatement Methods Employee Education Recordkeeping and Evaluation of Program

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.

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.

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.

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.

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.

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.

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.

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.

Engineering controls and workplace adaptation. Administrative and work practice controls. Post incident response.

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.

Safe rooms for staff use during emergencies

Enclose work stations, install deep service counters or bullet-resistant glass in reception area, triage, admitting

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.

Provide management support during emergencies.

Respond to all complaints/reports of workplace violence.

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.

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.

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.

WorkplaceViolence PreventionProgram

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.

Workplace violence prevention program

Risk factors in long term care

Early recognition of escalating behavior or warning signs

Ways to prevent volatile situations

Standard response action plan for potentially violent situations

Methods for accessing security assistance.

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.

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.

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.

Unclear policies and procedures.

Supervisors not responsive to incidents.

Victim fear of retaliation or loss of job.

No obvious physical injury sustained.

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.

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

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!

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.

Please help by taking the 4-5 minutes to complete and submit the survey!

Contact Information: tmckenna@uta.edu