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Workplace Violence in Healthcare

Disclaimer

The content and information presented in this program is intended to be used for general information and is not intended to be legal advice. Consult a licensed attorney-at-law to assist with specific situations that require legal advice or counseling.

The Big Picture

Workers in hospitals, nursing homes, and other healthcare settings face significant risks of workplace violence.

Forms of violence to health care workers

• Biting• Kicking• Punching• Pushing• Pinching• Shoving• Scratching• Spitting• Name Calling

Joint Commission. Sentinel Event Alert. Issue 59, April 17, 2018. Jointcommission.org

• Intimidating• Threatening• Yelling• Harassing• Stalking• Beating• Choking• Stabbing • Killing

Prevalence in Health Care

• A 2014 survey on hospital crime attributed 75% of aggravated assaults and 93% of all assaults against health care workers to patients or customers.

• According to OSHA, approximately 75% of nearly 25,000 workplace assaults reported annually occurred in health care and social service settings.

• Workers in health care are four times more likely to be victims than workers in private industry.

• The National Crime Victimization Survey showed health care workers have a 20% higher chance of being the victim of workplace violence than other workers.

Prevalence in Health Care

• Incidences are underreported

• Only 30% of nurses report incidences of WPV

• 26% of emergency department physicians report WPV

• Scope of WPV is difficult to recognize because of reporting mechanisms

The Joint Commission

• Emergency departments, behavioral health care settings, extending care facilities, and inpatient psychiatric units

• Common root cause of violence-lack of or inadequate behavioral health assessment to identify aggressive tendencies in patients.

• Sentinel event data show 68 incidences homicide, assault or rape of hospital staff workers over an eight-year period.

• Worker-to-worker as well as patient-health care worker verbal abuse is common

The Joint Commission Perspectives. Workplace Violence Prevention: Screening for the Early Detection of Risk of Harm to Self or Others. http://www.jointcommission.org

Unique Challenges

• Difficult to mitigate or prevent due to lack of information• “Do no harm”• Patient population• “Part of the job” mentality• Employees must react to unpredictable events with split-

second decisions• Compromises patient care

The faces of perpetrators

Most Common Characteristics

• Altered mental status– Dementia– Delirium– Substance intoxication– Decompensated mental illness

• Patients in police custody• Providing care for potentially violent individuals

Other factors

• Stressful situations• Lack of organizational policies and training• Gang activity• Domestic disputes• Presence of firearms or other weapons• Inadequate security • Long wait times or crowding

Other factors

• Understaffing• Staff working in isolation or areas without an escape• Poor lighting or factors restricting vision• No access to emergency communication• Unrestricted public access • Lack of community mental health care

Physician Practice Incident

• Parent and physician• Negative reviews• Response• Future care

WPV comes with a high cost

• Harms workers-physically and emotionally• Workman’s comp $$• Replacement cost in overtime, temporary staffing, recruiting

and training a replacement• Higher turnover• Deterioration of productivity and morale• Compromised patient care• Regulatory and accreditation requirements

• “The organizational culture, principles, methods, and tools for creating safety are the same, regardless of the population whose safety is the focus.”– The Joint Commission. Improving Patient and Worker Safety: Opportunities

for Synergy, Collaboration and Innovation.• Sentinel Event Alert 40: Behaviors that undermine a culture of safety• Sentinel Event Alert 57: The essential role of leadership in developing a safety

culture• Sentinel Event Alert 59: Physical and verbal violence against health care

workers

• Numerous standards that relate directly or indirectly to workplace violence.

• Leadership (LD) and Rights and Responsibilities of the Individual (RI)– Establish the framework for safety and security of all persons in the

organization• Provision of Care, Treatment and Services (PC)

– Provide guidance addressing patient assessment interventions• Environment of Care (EC)

– Address the physical environment and practices that enhance safety• Emergency Management (EM)

– Address planning for more extreme risks of workplace violence• Active shooters, community unrest and terrorist attack

• Det Norske Veritas Germanischer Lloyd (DNV-GL) quality management standards require accredited hospitals to "maintain safe and secure facilities that are designed and maintained in accordance with national and local laws, hospital policy, regulations and guidelines."

• Standards further specify that "the Security Management System shall address issues related to abduction, elopement, visitors, workplace violence, and investigation of property losses and [shall] be proportional to the risk." (DNV-GL, PE 4, SR 3)

Occupational Safety and Health Administration

• No specific standard on the prevention of workplace violence• General duty to “furnish to each of his employees employment and a

place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees.”

• Section 5(a)(1) of the Occupational and Health Act of 1970 (OSH Act)• Section 11(c) of the OSH Act provides protection for employees who

exercise a variety of rights under the Act

Occupational Safety and Health Administration: Workplace Violence Prevention and Related Goals. OSHA 3828-12/2015. www.osha.gov.

OSHA Issues Largest Workplace Violence Citation in 2017

Confined Space. OSHA Issues Largest Workplace Violence Citation in its History. Good Indication for the Future? http://jordanbarab.com/confinedspace/2017/08/22/workplace-violence-citation/

• $207,690 failure to abate citation and fine against UHS of Westwood Pembroke, Inc.-doing business as Lowell Treatment Center

• Failed to comply with multiple terms of a formal settlement to resolve violations identified in a 2015 inspection

• Follow-up inspection after hospital failed to provide documentation to show it had implemented a workplace violence program

OSHA-Citation for Violations and Notification of Penalty

Among other methods, feasible abatement measures include, but are not limited to the following:• Evaluation and modification to the workplace violence policy;• Review workplace violence incidents;• Develop reporting structure for WPV concerns• Provide employees with readily available means of communication;• Perform a workplace hazard assessment;• Develop a recordkeeping system designed to report any violent incident;

Time frame for response 15 days

It’s not a matter of if…it’s a matter of when

Comprehensive Workplace Violence Prevention Programs: Building Blocks

1. Management commitment and employee participation2. Worksite analysis and hazard identification3. Hazard prevention and control4. Safety and health training5. Recordkeeping and program evaluation

Building Block #1: Management Commitment and Employee Participation

1. Commitment by management

2. Environment of trust

3. Create a written WPV policy and post it visibly-include verbal abuse

4. Joint management-employee committee

5. Address employee’s safety concerns in a timely mannerOccupational Safety and Health Administration: Caring for Our Caregivers. Preventing Workplace Violence: A Road Map for Healthcare Facilities. OSHA 3827 12/2015. www.osha.gov.Joint Commission. Sentinel Event Alert. Issue 59, April 17, 2018. Jointcommission.org

Building Block #2: Worksite Analysis and Hazard Identification

1. Risk factorsa) Patients, clients and settingsb) Organizational

2. Reviewing records, procedures and employee inputa) Anonymous employee surveysb) Work-related injury logsc) Incident reports (include near misses)

Occupational Safety and Health Administration: Caring for Our Caregivers. Preventing Workplace Violence: A Road Map for Healthcare Facilities. OSHA 3827 12/2015. www.osha.gov.Joint Commission. Sentinel Event Alert. Issue 59, April 17, 2018. Jointcommission.org

Building Block #2: Worksite Analysis and Hazard Identification

d) Procedurese) Look for trends or “hot spots”

3. Patient input4. Walk through assessment5. Include all locations

Building Block #3: Hazard Prevention and Control

Engineering Controls:• Improve sightlines for staff• Changing floor plans• Improving lighting in remote areas or outdoor spaces for better visibility• Installing mirrors• Controlling access • Enclosing areas or installing deep counters

Building Block #3: Hazard Prevention and Control

Administrative and work practice controls:• Procedures/tools for assessing and reassessing patients for violent behavior• Communicating information regarding patient behavior• Adequate staffing• Training on de-escalation• Emergency procedures

Building Block #4: Safety and Health Training

• Objectives– Increased confidence among workers in de-escalating aggressive

behavior and in managing aggressive behavior when it occurs• Topics

– Review of workplace violence policy– Risk factors that cause or contribute to assaults– Location, operation and coverage of safety devices/alarm

systems.Occupational Safety and Health Administration: Caring for Our Caregivers. Preventing Workplace Violence: A Road Map for Healthcare Facilities. OSHA 3827 12/2015. www.osha.gov.Joint Commission. Sentinel Event Alert. Issue 59, April 17, 2018. Jointcommission.org

• Topics– Proper use of safe rooms– Self-defense procedures when appropriate– Importance of early assistance– Progressive behavior control methods

• Who– Nurses and other direct caregivers– ED staff– Support staff– Security personnel– Supervisors and managers

• Format and frequency– Classroom plus hands-on instruction– Just-in-time training– Web-based training– Blended

• Evaluation and improving training programs

Building Block #5: Recordkeeping and Program Evaluation

• Reporting– Internal– External

• Injury Tracking Application-OSHA• https://www.osha.gov/injuryreporting/

• Recordkeeping

• Program evaluationOccupational Safety and Health Administration: Caring for Our Caregivers. Preventing Workplace Violence: A Road Map for Healthcare Facilities. OSHA 3827 12/2015. www.osha.gov.Joint Commission. Sentinel Event Alert. Issue 59, April 17, 2018. Jointcommission.org

Tools and Resources

ASHRM Workplace Violence Toolkit – www.ASHRM.org

ECRI InstituteViolence in Health Care Facilitieshttps://www.ecri.org/components/HRC/Pages/SafSec3.aspx

ENA Workplace Violence Toolkit– https://www.ena.org/docs/default-source/resource-library/practice-

resources/toolkits/workplaceviolencetoolkit.pdf?sfvrsn=6785bc04_28

Tools and Resources

How Safe is Your Hospital for Workers? • A Self-Assessment

– Total Case Incidence Rate (TCIR)– Days Away, Restricted, or Transferred (DART)– Injuries and Costs– Safety ProgramsOSHA 3690 www.osha.gov

Tools and Resources

OSHA Guidelines for Health Care– https://www.osha.gov/Publications/osha3148.pdf

Preventing Workplace Violence: A Road Map for Healthcare FacilitiesOSHA 3827 December 2015www.osha.gov

Sentinel Event Alert, Issue 59 includes actions suggested by TJC

Teresa Kelly Phillips, MSA, BSN, CPHRM, LHRMRisk and Patient Safety Consultant

tkelly@mmpsi.com(229)308-4885

References

Behnam M, et al. Violence in the emergency department: A national survey of emergency medicine residents and attending physicians. Journal of Emergency Medicine, 2011; 40(5): 565-79.

Centers for Disease Control and Prevention. National Institute for Occupational Safety and Health (NIOSH). Violence in the Workplace. DHHS (NIOSH) Publication Number 96-100, Current Intelligence Bulleting 578. Atlanta, GA: DOL, July 1996.

Confined Space. OSHA Issues Largest Workplace Violence Citation in its History. Good Indication for the Future? http://jordanbarab.com/confinedspace/2017/08/22/workplace-violence-citation/

Joint Commission. 2012. Improving Patient and Worker Safety: Opportunities for Synergy, Collaboration and Innovation. www.jointcommission.org/improving_Patient_Worker_Safety

Joint Commission Perspectives. Workplace Violence Prevention: Screening for the Early Detection of Risk of Harm to Self or Others. http://www.jointcommission.org

Occupational Safety and Health Administration: Caring for Our Caregivers. Preventing Workplace Violence: A Road Map for Healthcare Facilities. OSHA 3827 12/2015. www.osha.gov.

References

Occupational Safety and Health Administration. Guidelines for preventing workplace violence for healthcare and social service workers (OSHA, 3148-04R). Washington, DC: OSHA, 2015

Occupational Safety and Health Administration. Workplace Violence in Healthcare. (OSHA 3826). Washington, DC: OSHA, 2015.

Pompeii L, et al. Perpetrator, work and workplace characteristics associated with patient and visitor perpetrated violence (type II) on hospital workers: A review of the literature and existing occupational injury data. Journal of Safety Research. 2013; 44 (Feb): 57-64

Security Industry Association and International Association of Healthcare Security and Safety Foundation. Mitigating the risk ofworkplace violence in health care settings. Silver Spring, MD: Security Industry Association, August 2017.

Speroni KG, et al. Incidence and cost of nurse workplace violence perpetrated by hospital patients or patient visitors. Journal of Emergency Nursing, 2014; 40(3):218-28

U.S. Department of Labor. DOL Workplace Violence Program-Appendices. Definitions. Washington, D.C.: DOL, no date.

Vellani KH. The 2014 IHSSF crime survey. J Healthc Prot Manage. 2014;20(2):28-35

Workplace Violence in Healthcare › images › meeting › 042518 › gshrm... · – Review of...

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