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The prevention of workplace violence has emerged as an important safety issue in
today's workplace. Workplace violence is any physical assault, threatening behavior, or
verbal abuse occurring in the workplace. The workplace may be any location either
permanent or temporary where an employee performs any work-related duty.
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on the area for more specific information.

Common safety and health topics:
Additional Information:
Violence
Prevention Plan
In 1993,
Bureau of Labor Statistics showed more assaults occurred in the health care and social
services industries than in any other:
- 64% of the nonfatal assaults occurred in nursing homes, hospitals,
and establishments providing residential care and other social services.
- 27%
of these injuries occurred in nursing homes.
- The cause of injury in 45% of these cases was the health care patient.
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Hazard
Exposure to workplace violence because no violence prevention program
was in place to
help reduce
hazards.
Example
Controls
OSHA recommends
that employers establish and maintain a violence prevention program as part of their
facility's
safety
and health program. The prevention program should:
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Be made
available to all employees, including managers and supervisors; and
all employees should receive specific training concerning its content
and implementation.
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Track their progress in reducing work-related assaults,
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reduce the severity of injuries sustained by
employees,
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decrease the threat to worker safety.
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Reflect the
level and nature of threat faced by employees.
The main components that should be
included in a facility's Violence Prevention Program are:
Violence
Prevention Written Plan: To prevent workplace violence a written program
should incorporate the above areas
and state clear goals and objectives suitable to the size and complexity of the given
workplace.
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Although not every incident can be prevented, many
can be, and the severity of injuries sustained by employees reduced
by following a violence
prevention plan.
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"Universal Precautions" for violence,
states that violence should be expected but can be avoided or mitigated through
preparation.
A violence prevention written plan:
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Creates and disseminates a clear policy that
violence, verbal and nonverbal threats, and related actions, will not be tolerated.
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Ensures that no reprisals are taken against
employees who report or experience workplace violence.
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Encourages prompt reporting of all violent incidents
and recordkeeping of incidents to assess risk and to measure progress.
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Establishes a plan for maintaining security in the
workplace which includes law enforcement officials and other specialists.
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OSHA Workplace
Violence Awareness Prevention Program provides a:
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Management and Employee Commitment
Management and employee commitment are complementary and essential elements of an
effective violence prevention program. |
Hazard
Exposure to
workplace violence because of lack of management support and
employee involvement.
Example
Controls
It is
recommended that management
and employees work together to reduce workplace
violence.
Management Commitment: Provides the motivation and resources
to deal effectively with workplace violence and should include: A policy
that violence,
threats, harassment, intimidations, and other disruptive behavior in our workplace will
not be tolerated; that is all reports of incidents will be taken seriously and will be
dealt with appropriately. Management should to be committed to:
- Emotional as well as physical health of the
employee.
- Appropriate allocation of authority and resources to responsible
parties.
- Equal commitment to worker safety and health and
patient/client safety.
- A system of accountability for involved managers
and employees.
- A comprehensive program of medical and
psychological counseling for employees experiencing or witnessing violent
incidents.
- No employee reprisals for reporting incidents.
Employee Involvement
Employees should:
- Understand, support, and comply with the established
workplace violence program.
- Participate in employee complaint or suggestions sessions.
- Provide prompt and accurate reporting of all workplace
violence incidents.
Employees should understand that:
- Reporting violence will benefit them, and
enable management to identify, address, and solve problems.
- No reprisals will be taken by management or employer.
Employees often do not report
violent incidents because:
- Of lack of administrative reporting policies, or procedures.
- They are afraid employer will think they can't handle the
job effectively.
- Of misperception that violence is part of the job.
- Of fear of employer reprisals.
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Worksite Analysis,
Hazard
Prevention and Control |
Hazard
Exposure to workplace violence because:
Example
Controls
Complete
a worksite analysis: It is recommended that a worksite analysis
be completed by an appointed Threat Assessment Team or similar task
force, or coordinator. This "team" analyzes records, trends,
workplace security, and gives screening surveys to staff to help
identify hazards. OSHA has provided the following surveys to assist employers in
identifying hazards.
Taken from: Guidelines for Preventing
Workplace Violence for Health Care and Social Service Workers. OSHA Publication
3148 (1998).
Identify
potential reasons why nursing homes may be hazardous, such as:
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The availability of drugs or money in the pharmacy
area, making them likely robbery targets.
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Overall prevalence of firearms.
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low staffing levels, high turnover rates.
- Hazard of exposure to violent, confused
or mentally unstable patients.
- Dealing with combative, disoriented, uncooperative patients.
- Mentally unstable patients, that are possibly
dangerous, being released to nursing homes for care.
- Exposure to workplace violence in
rooms not prepared for violent patients:
- Moveable furniture that could be used as weapons,
or to entrap employees.
- Possible items on
countertops that could be thrown at worker.
Identify hazard prevention and
control: identify hazards found in the worksite analysis and
then provide administrative
and work practice controls to make nursing homes a safer workplace, for example:
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- Provide better visibility and good lighting, especially in
areas of high risk such as the pharmacy area, or in isolated treatment areas.
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- Implement safety measures to deter handguns inside
facility; for example using metal detectors.
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- Install plexi-glass in the
payment window in the pharmacy area.
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- Use of security devices such
as panic buttons, beepers, surveillance cameras,
alarm systems, two-way mirrors, card-key access systems, and security guards.
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- Place curved mirrors at hallway intersections or
concealed areas.
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- Control access to work areas.
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- Provide training for staff in recognizing and
managing hostile and assaultive behavior.
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- Provide adequate
experienced staffing even during night shifts.
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- Ensure accurate reporting of all violent behavior.
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- Make residents aware of zero tolerance
policy for violence.
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- Establish liaison with police authorities and
contact them when indicated.
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- Obtain previous records of patients to learn of
any past violent behaviors.
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- Carefully select/evaluate potential patients
to determine if appropriate to admit as patients in nursing home facility.
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- Establish a system to chart or track and evaluate
possible assaultive behaviors, including a way to pass on information from one shift
to another.
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- Implement a violence prevention plan to develop
strategies to deal with possibly violent patients.
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A safer
room for a possibly violent patient:
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- Has furniture arranged to prevent entrapment of
staff, furniture should be minimal, lightweight, without sharp corners, and/or affixed to
the floor.
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- Is free from clutter, nothing available on
countertops to throw at workers or use as weapons.
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- Is provided with a secondary door for escape in
case main door is blocked by patient.
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- Is one entered with a buddy, do not be alone with patient.
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Safety and Health Training
You can't always prevent violence, because it can be unpredictable,
but you can reduce the risk by planning ahead and being prepared to act swiftly to
deal
with threats, intimidation and other disruptive behavior at an early stage. |
Hazard
Increased risk of
violence because ineffective training of staff to deal with or identify
potential violence problems.
Example Controls
It is recommended that
facilities have a workplace violence
protection program in place that includes training of employees.
- Training is a critical component of any prevention strategy for staff, supervisors and other employees.
- Training could be conducted by a team of
individuals, police force, or others that have specialties in this area.
- Personally knowing team members responsible for
workplace safety programs encourages employees and supervisors to seek assistance from
them at a much earlier stage.
Training could include:
- An understanding of the
facility's workplace
violence policy and program.
- Encouragement and support to report incidents.
- Ways of preventing or diffusing volatile situations
or aggressive behavior, conflict resolution.
- The dynamics of violence.
- How to recognize and deal with hostile aggressive
persons, nonviolent responses.
- Managing anger.
- Techniques and skills to resolve conflicts.
- Stress management, relaxation techniques.
- Security procedures.
- Personal security measures, self defense.
- Techniques for victim support.
- The use of training tools such as:
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Post-Incident Response
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Hazard
Health care workers, given
inadequate support following a violent incident, may quit or be fearful to go back to work.
Example Controls
It is recommended that employers
provide a program of support for workers involved
in violent incidents and workers observing violent incidents.
- Set up trained response teams to respond to
emergencies, and provide post-incident response assistance to the worker
that includes:
- Prompt medical treatment and psychological evaluation
- Follow-up program in place to offer:
- counseling, support groups, stress debriefing,
trauma-crisis counseling, employee assistance programs
OSHA provides some sample
forms in: Guidelines for Preventing
Workplace Violence for Health Care and Social Service Workers. OSHA Publication
3148 (1998) to assist employers in developing their policies and
procedures following a violent incident.
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Evaluation and
Recordkeeping
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Hazard
Employers not evaluating their violence prevention programs:
- Overall effectiveness of the program is reduced
because of inablility to identify and correct problems.
No recordkeeping:
- Loss of records and information.
- Unable to evaluate trends in violence.
Example Controls
Implement adequate
evaluation and recordkeeping practices.
OSHA requires: entry on the OSHA Log of Injury and Illness (OSHA
200), for any injury that requires more than first aid, lost-time injury, modified
duty, or causes loss of consciousness. Injuries caused by assaults, which are otherwise
recordable, also must be entered on the log.
- A fatality or catastrophe that results in the
hospitalization of 3 or more employees must be reported to OSHA within 8 hours.
Recordkeeping is important to the success of a
workplace violence prevention program and can:
- Help to identify the severity of the problem,
evaluate methods of hazard control and identify training needs.
- Be useful for gathering or "pooling" data
for other applications.
It is recommended that other records
be considered such as:
- Medical reports of work injury.
- Incidents of abuse, (such as verbal abuse, or other
acts of aggression, that do not result in injury.
- Information on patients with a history of past
violence should be recorded on the patient's chart, and staff made aware of the possible
potential for aggression.
- Training records.
Evaluation
of a facility's violence prevention program is recommended for determining
it's
effectiveness. The evaluation:
- Identifies any problems or deficiencies that can
then be corrected.
- Allows for management to review program
effectiveness, and re-evaluate policies and procedures on a regular
basis.
- Helps management to analyze trends, measure
improvements, and keep abreast of new trends to reduce workplace
violence.
Additional Information
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