violence prevention in health care settings
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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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background
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
background1
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
background2
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.”
scope
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
violence or violent act
“Violence” or “Violent Act”

“Any physical assault or verbal threat

of physical assault against an employee of a health care setting”

workplace violence plan
Workplace Violence Plan

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

wpv plan includes
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
wpv plan security and safety assessment
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
training
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
training contents
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
training contents as appropriate
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
records
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)
records by july 1 2000
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
rcw 72 23 violence prevention in state psychiatric hospitals
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.
compliance
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
possible citations 1
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.

possible citations 2
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
possible citations 3
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.

possible citations 4
Possible Citations (4)
  • Citations for missing elements of the required plan will be handled in accordance with the description in Citation 1 - 3 above.
prevention strategies
Prevention Strategies
  • Environmental designs
    • Alarms, metal detectors, cameras
  • Administrative controls
    • Staffing patterns, restrict public movement
  • Behavior modifications
    • Training
more information
More Information
  • L&I Consultation Program
    • Check the blue government section of the white pages; or the LNI web page
  • Alan Lundeen
  • John Furman
more information1
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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