WORKPLACE VIOLENCE PREVENTION

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WORKPLACE VIOLENCE PREVENTION

• Long Term Care Worker Protection Program

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Objectives

• 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.

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Definitions
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.
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Workplace includes

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

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Types of Workplace Violence

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

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Types of Workplace Violence

• 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.

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Types of Workplace Violence

• 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.

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Most Common Type in LTC?

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

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Statistics on Workplace Violence

• 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 Americas
  workplaces.
• Bureau of Labor Statistics, U.S. Department of
  Labor, News Release, August 25, 2011.

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Impact on the Employees

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

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Economic Impact

• 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.

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Risk Factors in Long Term Care Settings

• Working with unstable or volatile people in a
  health care setting.
• Working alone or in very small numbers.

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Additional Risk Factors

• Working late at night or in the early morning
  hours.
• Working in community based settings.

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Risk Factors (contd)

• 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.

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Risk Factors (contd)

• 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.

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Risk Factors (contd)

• 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.

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Guidelines on Workplace Violence

• 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.

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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.
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OSHA General Duty Clause
OSHA will rely on Section 5 (a)(1) of the OSH Act
for enforcement authority.
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Elements of a General Duty Clause Citation

• 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/certifi
  cation.
• Past complaints
• Employee interviews
• Documentation that the workplace violence
  hazard was reasonably foreseeable by the employer.

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General Duty Clause Violation

• 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.

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General Duty Clause Violation

• 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.

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General Duty Clause Violation

• 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.

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Inspection Procedure

• 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 records
• Closing Conference

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Recent Incidents

• March 29, 2009 Carthage, NC nursing home
• 6 killed, 3 injured
• December 8, 2009 Hazard, KY
• 1 physician killed at rural medical
  clinic
• March 2, 2010 Danbury, CT, hospital
• 1 nurse shot by elderly patient, medical
  unit
• Summer, 2010 Valley Stream, NY
• 1 nurse severely injured by patient in a
  group therapy session

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Workplace Violence Prevention Program Elements

• Management Commitment and Employee Involvement
• Worksite Analysis
• Hazard Prevention and Control Potential
  Abatement Methods
• Employee Education
• Recordkeeping and Evaluation of Program

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Management Commitment Employee Involvement

• 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.

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Management Commitment

• 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.

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Management Commitment (contd)

• 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.

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Management Commitment (contd)

• 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.

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Employee Involvement

• 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.

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Worksite Analysis

• 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.

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Worksite Hazard Analysis

• 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.

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Worksite Analysis Recommended Program

• 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.

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Abatement Methods Hazard Prevention and
Control

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

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Engineering Controls

• 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

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Administrative Work Practice Controls

• 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.

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Administrative and Work Practice Controls

• Provide management support during emergencies.
• Respond to all complaints/reports of workplace
  violence.

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Workplace Prevention Program

• 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.

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Post-Incident Response
Provide comprehensive treatment for victimized
employees and employees who will be traumatized
by witnessing a workplace violence incident.
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Post-Incident Response

• 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.

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Employee Education

• 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.

Workplace Violence Prevention Program
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Employee Education

• 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.

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Topics for this Education

• 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.

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Key Concepts

• 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.

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Recordkeeping and Evaluation

• 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.

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Recordkeeping

• 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.

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Evaluation

• 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
  facilitys plan.

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Under reporting is often due to

• Unclear policies and procedures.
• Supervisors not responsive to incidents.
• Victim fear of retaliation or loss of job.
• No obvious physical injury sustained.

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Strategies to help Reporting

• 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 its just part
  of the job perspective.

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Resources

• 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

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Secure a Safe Work Environment Prevent Workplace
Violence
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Summary

• 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!

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Outcome Measurement

• 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!

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Thanks for Participating!

• Contact Information tmckenna_at_uta.edu