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Violence Prevention in Health Care Settings

Violence Prevention in Health Care Settings. Background. Violence is escalating in health care Recent BLS data shows an annual rate of 8.3 assaults per 10,000 HCWs Compared to a rate of 2 per 10,000 for all private-sector industries.

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Violence Prevention in Health Care Settings

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  1. Violence Prevention in Health Care Settings

  2. Background • Violence is escalating in health care • Recent BLS data shows an annual rate of 8.3 assaults per 10,000 HCWs • Compared to a rate of 2 per 10,000 for all private-sector industries. • The actual incidence rate of violence in health care is likely to be greater due to lack of reporting

  3. Background • Risk factors • Working with volatile people • Working with those under the influence of alcohol or drugs • Working when understaffed • Transporting patients • Long waits for service • Overcrowded, uncomfortable waiting rooms • Working alone • Inadequate security • Lack of staff training

  4. Background • RCW 49.19 was passed in 1999. This law requires “health care settings” to develop and implement plans “to reasonably protect employees from violence.”

  5. Scope • Hospitals * • Home health • Hospice • Evaluation & treatment facilities • Community mental health programs • Psychiatric hospitals and long-term care facilities (i.e., nursing homes) not included. • State Psychiatric facilities covered under RCW 70.23

  6. “Violence” or “Violent Act” “Any physical assault or verbal threat of physical assault against an employee of a health care setting”

  7. Workplace Violence Plan “Each health care setting shall develop and implement a plan to reasonably prevent and protect employees from violence…”

  8. WPV Plan includes: • Security and Safety Assessment • Physical attributes of setting • Staffing (including security) • Personnel policies • First aid & emergency procedures • Reporting of violent acts • Education and training

  9. WPV Plan: security and safety assessment • Hazard assessment identifies causes and consequences of violent acts in preceding 5 years, or for length that records are available in home care/hospice • Guidelines from any appropriate agency may be used for assessment

  10. Training • Provided to all affected employees within 90 days of hire. • On a “regular basis” thereafter. • Temporary workers: employer must take into account “unique” circumstances. • May include classes, video, written materials as appropriate

  11. Training Contents* • General and personal safety procedures • Violence escalation cycle • Violence-predicting factors • Obtaining a patient history from a patient with violent behavior • Techniques to de-escalate violent acts • Strategies to avoid physical harm • elements included as appropriate

  12. Training Contents (as appropriate) • Restraining techniques • Appropriate use of physical and chemical restraints • Reporting of incidents • Debriefing procedures • Resources for employees for coping with violence • Facility’s WPV Plan

  13. Records • Records must be kept of any violent act against an employee, a patient, or a visitor: • Setting name & address • Date, time, specific location • Name, job title, department or ward, and staff id (if an employee) • Description of victim and perpetrator (i.e., patient, visitor, employee, other)

  14. Records (By July 1, 2000) • Description of violent act • Threat • Assault (with or without injury/death) • Body part injured • Weapon used • Number of employees in area • Actions taken by co-workers or facility in response to violent act • Records kept for 5 years and available to L&I upon request

  15. RCW 72.23: Violence Prevention in State Psychiatric Hospitals • WPV Plan must be updated annually • Training must be given prior to assignment • Training must be provided annually • List of training elements required for inclusion is expanded • except for removal of a reference to the use of medications as chemical restraints.

  16. Compliance • WISHA enforces RCWs • Citations will use: • Safe Place (WAC 296-24-020) • Accident Prevention Program (WAC 296-24-040) • Also see, WRD 5.05 Violence in the Workplace (1997). • http://www.lni.wa.gov/wisha/regs/wrds/ wrd505.htm

  17. Possible Citations (1) • Failure to develop violence prevention plan: Serious violations of WAC 296-24-040 where a related serious violation is cited or where a related serious hazard has been documented. Otherwise, cited as general.

  18. Possible Citations (2) • Failure to provide training as required: • Serious violations of WAC 296-24-020(1)(c), management responsibility to provide training, for failure to provide training necessary for safe job performance (referencing the statute) where a related serious hazard has been documented. Otherwise, cite general

  19. Possible Citations (3) • Failure to implement features of the violence prevention plan other than training: Serious violations of WAC 296-24-020(1)(b) where a related serious hazard has been documented. Otherwise, cite general.

  20. Possible Citations (4) • Citations for missing elements of the required plan will be handled in accordance with the description in Citation 1 - 3 above.

  21. Prevention Strategies • Environmental designs • Alarms, metal detectors, cameras • Administrative controls • Staffing patterns, restrict public movement • Behavior modifications • Training

  22. More Information • L&I Consultation Program • Check the blue government section of the white pages; or the LNI web page • Alan Lundeen • lund235@lni.wa.gov • 360.902.5154 • John Furman • furk235@lni.wa.gov • 360.902.5666

  23. More Information • WISHA/Policy and Technical Services Web Page on Violence Prevention: • http://www.lni.wa.gov/wisha/ • Chose Workplace Violence Prevention from the Topics List

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