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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  • 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


  • 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


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


  • 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


  • 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 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 Hospitals

  • 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).

    • wrd505.htm

Possible citations 1
Possible Citations (1) Hospitals

  • 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) Hospitals

  • 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) Hospitals

  • 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) Hospitals

  • 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 Hospitals

  • Environmental designs

    • Alarms, metal detectors, cameras

  • Administrative controls

    • Staffing patterns, restrict public movement

  • Behavior modifications

    • Training

More information
More Information Hospitals

  • L&I Consultation Program

    • Check the blue government section of the white pages; or the LNI web page

  • Alan Lundeen

    • [email protected]

    • 360.902.5154

  • John Furman

    • [email protected]

    • 360.902.5666

More information1
More Information Hospitals

  • WISHA/Policy and Technical Services Web Page on Violence Prevention:


    • Chose Workplace Violence Prevention from the Topics List