PREVENTING WORKPLACE VIOLENCE67.132.127.103/inservice/Annual/CFCWorkplaceViolence.pdf · factors that may lead to violence and aggression, and how to take steps to keep you safe

PREVENTING WORKPLACE VIOLENCE

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Course Objectives

Once you complete this course you will:

Know the types of workplace violence

Understand the risk factors leading to workplace violence

Understand your facility’s workplace violence policy and be expected to comply with it

Be able to take measures to keep yourself safe

Know what to do in an armed intruder situation

This training is intended as an overview of our facility’s workplace violence prevention program. We offer more comprehensive training for topics such as behavior management, how to respond to armed intruders, and others as required by various regulatory agencies.

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What Is Workplace Violence

Workplace violence is any physical assault, threatening behavior, or verbal abuse occurring in the work setting.

A workplace is any location either permanent or temporary where an employee performs any work-related duty.

This includes, but is not limited to, all buildings, surrounding perimeters (including the parking lots), and locations where business occurs for our patients, employees, and visitors.

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Examples of Violence

Physical assault: attacks ranging from slapping, hitting, biting, to the use of any weapon which results in any degree of injury, from no injury to fatal injury

Threats (verbal or written): that express the intent to cause physical harm, including vague or covert threats which may be psychologically traumatic even if never carried out

Harassment/Intimidation: abusive or offensive language or gestures; stalking or harassment of any nature

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Types of Workplace Violence

There are four types of Workplace Violence. This training encompasses all of these types.

Most aggressive or violent events in healthcare facilities are caused by patients.

1. Violence by patients/clients or visitors

2. Violence by strangers (intended criminal activity)

3. Violence by co-workers

4. Violence by personal relations

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Risk Factors for Violence

Public’s access to handguns and other weapons

Patients with a history of criminal activity, substance abuse or certain psychosis

Availability of drugs and money at hospitals

Unrestricted public access and movement in/on our property

Working in high crime areas or alone in remote locations

Distraught family members

Long wait times for service/overcrowded waiting rooms

Disgruntled former or current employees

Targeted employees or patients (domestic violence)

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Universal Precautions for Violence

Violence should be expected but can be avoided or managed through planning. This is known as “universal precautions for violence”.

This facility has established protocols to keep you aware of risk factors that may lead to violence and aggression, and how to take steps to keep you safe.

You also have a responsibility for taking measures to keep yourself safe. Comply with our facility’s protocols at all times.

If you have a question, ask your supervisor.

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Universal Precautions In Practice

Be alert for situations that may lead to potential violence such

as escalating anger or distress.

Evaluate each situation when you enter a room or interact with a patient, visitor, or someone unknown to us.

Stay vigilant throughout the encounter.

Do not isolate yourself with a potentially violent person.

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Workplace Violence Prevention

The prevention protocols of our program that we will review:

Training & Competency--Behavior Management

Identifying, Reporting, and Addressing violent behavior

Contraband Prevention

Safe Patient Transport

Surveillance & Security

Safety Measures for Working Alone or in Remote Areas

Armed Intruder Situations

How We Evaluate/Review our Program

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Workplace Violence Policy

Our Workplace Violence Policy helps protect our patients and staff

The Policy’s Key Components:

Zero Tolerance Statement

Identifying Potentially Dangerous Individuals

Reporting Threats of Violence or Acts of Violence

Investigating and Addressing Threats or Acts of Violence

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Zero Tolerance for Workplace Violence

This facility has a zero tolerance for violence of any kind

We are committed to providing an environment free from all forms of violence including but not limited to harassment, intimidation, verbal, written and physical threats or acts of physical assault

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Zero Tolerance for Weapons

Weapons of any kind (e.g. firearms, knives, TASERS, etc.) are not permitted onto our facility’s premises (with the exception of law enforcement when/if needed)

A permit to carry a weapon does not supersede this policy (unless allowed by state law)

This policy applies to employees, patients, physicians, consulting staff, volunteers, vendors/contractors, and all visitors.

The State of Utah does permit an employee to store a weapon in their vehicle. If you do so, please ensure that it is stored in a place where it is not visible to anyone looking into your vehicle.

If you have questions about this policy, please ask your supervisor

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Identifying Violent Individuals

Our Human Resources department conducts employment references, drug tests and criminal background checks on all newly hired employees to reduce the risk of hiring individuals with a history of violent behavior

Supervisors report unusual behaviors of employees or other individuals whose behaviors may pose a potential threat

Some examples:

Overt signs of extreme stress, resentment, anger or hostility

Direct or indirect threats or threatening remarks

Destruction of property

Reports of fear from employees

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Your Role in Reporting Violence Violence

Notify your supervisor and the HR department:

Of any individual suspected of violent tendencies or violent behavior. This includes co-workers and those that do not work for our facility

If you are a victim of violence or witness an act of violence (including harassment, intimidation, or verbal abuse)

If you are injured during an assault, complete the necessary paperwork and participate willingly in any investigations

Retaliation/discrimination against victims or employees who report is not tolerated by this facility

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Addressing Workplace Violence

All reports of violence will be treated seriously, confidentially, and will be investigated promptly and fully

An employee found to have committed any act of violence either at this facility or while engaged in facility business, will be subject to corrective action up to and including termination of employment

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Warning Signs for Aggression

Be aware of verbal and behavioral cues that may lead to aggression and violence.

Examples:

Verbal cues: speaking loudly or yelling; swearing, threatening language

Behavioral cues: fixed stare; pacing or heavy breathing; clenched fists; arms held tight across the chest

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Most aggressive or violent events are caused by patients.

Proper patient interactions can prevent or help diffuse or de-escalate anger and potential violence

We cannot provide all the specific steps to avoid patient aggression during this training session

We provide comprehensive training (“Handle with Care”) which will increase your skill in de-escalating aggressive behaviors

Should you have any questions regarding our facility-specific training, please ask your supervisor

Patient To Staff Aggression

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Tips to Avoid Violent Behavior

Present a calm, caring attitude

Give immediate attention to any agitated person

Acknowledge the person’s feelings (“ I know you are frustrated”)

Do not match the threats (speak softly if a person is loud and belligerent)

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More Tips…

Avoid power struggles with the individual. Identify what the request is and attempt to accommodate where possible

Avoid “Why” questions. They may be perceived as a personal attack

Tell the person “I can’t help if you threaten me”

Provide options, not ultimatums

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Ordinary Items As Contraband

Consider these every day items as potential weapons which can injure. We call this unintentional contraband. A partial list:

Your dress—scarfs, dangling jewelry, name tags, keys, long hair

Unsecured sharps of any kind (i.e. scissors, pens, razors, nails, screws)

Cleaning chemicals on laundry carts

Small unsecured objects that can be thrown

Outside—rocks, glass, landscaping material

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Security--Surveillance

Everyone can participate in improving our facility’s safety and security. Please be vigilant about our surroundings.

Please report any concerns to your supervisor.

Some examples:

Broken locks that may allow unauthorized access

Someone lurking around the area with no reason to be there

Lighting out or lighting needed

Cars that are parked in unauthorized spots near the building

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Security—Parking Lots

Consider exposures indoors and out.

Plan ahead. Think about where you park and what conditions will be like at the end of your shift. If your shift will end after dark, move your vehicle into well-lit areas of the parking lot closer to the buildings.

Have your keys in hand and ready BEFORE you leave the building.

Don’t make yourself an easy target. Be aware of opportunities for concealment along walkways and around parking lots.

Avoid walking alone. Take advantage of security personnel as escorts, when/if available.

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Personal Safety Measures

Practice Universal Precautions for Violence—be alert for situations that may lead to potential violence

Dress safely and for safety

Know your patient’s potential for violence and how to manage aggressive behavior

Remove potential weapons, consider everyday items as potential weapons

Report any safety or security concerns to your supervisor

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More Personal Safety Measures

Report all situations of violence to your supervisor

Practice the behavior management techniques covered in your required training

Ask questions if you are not sure of how to manage aggressive behaviors

If you need a refresher, contact HR for a schedule of courses

Participate in any investigation if you are a victim of violence or have witnessed violence

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Safety While Working Alone

Be aware of your surroundings when working alone

Inform others where you are and who you are with

Know how to call for assistance when necessary

Always have a method to communicate in an emergency (i.e. cell phone)

Know your facility’s policy regarding precautions to take for your own safety when entering private homes

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Safety During Patient Transport

Comprehensive training is offered elsewhere. A few reminders :

Know your patient’s potential for violence and how to manage aggressive behaviors

Advise your supervisor of your planned route and expected return time

Secure patients’ belongings away from patient access

Address escalating agitation and verbal fights/threats as soon as possible

Pull the van over immediately when safe to do so. You cannot safely manage driving and de-escalation interventions

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Profile of an Armed Intruder

The chance of this situation occurring is remote, but consequences could be catastrophic. We must be prepared both mentally and physically to deal with this crisis situation.

There is no one profile of an armed intruder/active shooter

A shooter could be an ex-employee, a relative of a colleague, or someone we do not know

The individual is in extreme crisis, and therefore their behavior is very unpredictable

Situations involving an armed person change quickly

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Armed Intruder Situations

Stay calm. Do not challenge or approach the person.

Take note of the two nearest exits to you.

If you are in an office or patient room, stay there and barricade the door.

If you are in a hallway or common area, find the closest secure area to hide or barricade.

Follow facility’s protocol/code to alert others to stay away from the area.

When/if safe, call 911 (police) and provide as many details as possible.

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Post-Incident Review

Incident reports are reviewed on an ongoing basis to identify any issues which may lead to future violent events.

An investigation (root cause analysis) is completed after any incidence of violence. This is done to identify improvements that can be taken to prevent future events.

Our investigation also confirms procedures and staff responses that were effective to de-escalate the violence.

Findings are shared with our senior management, corrective actions are addressed in safety committee and followed up/completed by appropriate staff.

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This Training Discussed

Workplace Violence Policy—Zero Tolerance for Violence

Risk factors that cause or contribute to violence

Early reporting of escalating behavior or warning signs

Managing aggressive behavior

Standard response action plan for hostile situations

Steps you can take to keep yourself safe

How you can participate in improving our facility’s safety and security

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References

OSHA (Occupational Safety and Health Administration) Guidelines for Preventing Workplace Violence for Healthcare & Social Service Workers, publication OSHA 3148-01R 2004 www.osha.gov

CDC (Centers for Disease Control and Prevention) and NIOSH (National Institute for Occupational Safety and Health) VIOLENCE—Occupational Hazards in Hospitals, publication 2002-101 www.cdc.gov/niosh

ECRI Institute, Healthcare Risk Control, Violence in Healthcare Facilities, Safety and Security 3, Publication Volume 2, March 2011 www.ecri.org

U.S. Department of Homeland Security, Active Shooter How to Respond, www.dhs.gov

MARSH, Addressing the Risk of an Active Shooter, July 2014.

http://www.osha.gov/

http://www.cdc.gov/niosh

http://www.ecri.org/

http://www.dhs.gov/

Documents

PREVENTING WORKPLACE VIOLENCE67.132.127.103/inservice/Annual/CFCWorkplaceViolence.pdf · factors that may lead to violence and aggression, and how to take steps to keep you safe