1. WORKPLACE VIOLENCE PREVENTION
Long Term Care Worker Protection Program

2. 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.

3. 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.

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

5. 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:

6. 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.

7. 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.

8. 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?

9. 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 America’s workplaces.*
* Bureau of Labor Statistics, U.S. Department of Labor, News Release, August 25, 2011.

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

12. 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….

13. 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.

14. Additional Risk Factors
Working late at night or in the early morning hours.
Working in community based settings.

15. Risk Factors (cont’d)
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.

16. Risk Factors (cont’d)
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.

17. Risk Factors (cont’d)
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.

18. 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 R 2004.
Violence: Occupational Hazards in Hospitals, Center for Disease Control and Prevention, National Institute for Occupational Health (2002), DHHS(NIOSH) Pub. No

19. 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.

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

21. 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/certification.
* Past complaints
* Employee interviews
* Documentation that the workplace violence hazard was reasonably foreseeable by the employer.

22. 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.

23. 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.

24. 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 ,
Effective Date: September 8, 2011,
Subject: Enforcement Procedures for Investigating or Inspecting Workplace Violence Incidents.

25. 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

26. 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

27. 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

28. 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.

29. 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.

30. Management Commitment (cont’d)
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.

31. Management Commitment (cont’d)
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.

32. 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.

33. 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.

34. 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.

35. 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.

36. Abatement Methods: Hazard Prevention and Control
Engineering controls and workplace adaptation.
Administrative and work practice controls.
Post incident response.

37. 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

38. 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.

39. Administrative and Work Practice Controls
Provide management support during emergencies.
Respond to all complaints/reports of workplace violence.

40. 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.

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

42. 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.

43. 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

44. 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.

45. 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.

46. 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.

47. 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.

48. 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.

49. 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 facility’s plan.

50. 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.

51. 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 “it’s just part of the job” perspective.

52. Resources http://osha.gov/SLTC/workplaceviolence/
OSHA Consultation Program
NIOSH (
Public Safety Officials
Local and state law enforcement agencies
Trade Associations
Unions and Insurers
Human Resource and Employee Assistance Professionals

53. Secure a Safe Work Environment: Prevent Workplace Violence

54. 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!

55. 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!

56. Thanks for Participating!
Contact Information: