# Presentation: 329181

## WORKPLACE VIOLENCE PREVENTION

- Health Care and Social Service Workers

## Definition

- _Definition_

- Workplace violence is any physical assault, threatening behavior, or verbal abuse occurring in the work setting
- A workplace may be any location either permanent or temporary where an employee performs any work-related duty

## Definition Cont’d

- _Definition Cont’d_

- This includes, but is not limited to, the buildings  and the surrounding perimeters, including the parking lots, field locations, clients’ homes and traveling to and from work assignments

## Workplace Violence Includes:

- _Workplace Violence Includes_:

- Beatings
- Stabbings
- Suicides
- Shootings
- Rapes
- Near-suicides
- Psychological traumas

- Threats or obscene phone calls
- Intimidation
- Harassment of  any nature
- Being  followed, sworn or shouted at

## Examples

- _Examples_

- Verbal threats to inflict bodily harm; including vague or covert threats
- Attempting to cause physical harm; striking, pushing and other  aggressive physical acts against another person

## Examples

- _Examples_

- Verbal harassment; abusive or offensive language, gestures or other discourteous conduct towards supervisors, fellow employees, or the public
- Disorderly conduct, such as shouting, throwing or pushing objects, punching walls, and slamming doors

## Examples

- _Examples_

- Making false, malicious or unfounded statements against coworkers, supervisors, or subordinates which tend to damage their reputations or undermine their authority

## Examples

- _Examples_

- Inappropriate remarks, such as making delusional statements
- Fascination with guns or other weapons, bringing weapons into the workplace

## Types of Workplace Violence

- _Types of Workplace Violence_

- Violence by strangers
- Violence by customers or clients

- Violence by co-workers
- Violence by personal relations

## Statistics on Workplace Violence

- _Statistics on Workplace Violence_

- Homicide is the second leading cause of death in the workplace
- In 1997, there were 856 homicides in America’s workplaces
- Assaults and threats of violence number almost 2 million a year

## Statistics

- _Statistics_

- Most common was simple assaults: 1.5 million a year
- Aggravated assaults: 396,000
- Rapes and sexual assaults: 51,000
- Robberies: 84,000
- Homicides: nearly 1,000

## Assaults and Homicides

- _Assaults and Homicides_

## Economic Impact of Workplace  Violence 

- _Economic Impact of __Workplace  Violence _

- Cost 500,000 employees 1,175,100 lost work days each year
- Lost wages: $55 million annually
- Lost productivity, legal expenses, property damage, diminished public image, increased security: $ billions $

## Prevalence of handguns and other  weapons among patients, their families, or friends
Increasing use of hospitals by the criminal justice system for criminal holds and  the  care of acutely disturbed, violent individuals

- Prevalence of handguns and other  weapons among patients, their families, or friends
- Increasing use of hospitals by the criminal justice system for criminal holds and  the  care of acutely disturbed, violent individuals

- _Risk Factors_

## Risk Factors (cont’d)

- _Risk Factors (cont’d)_

- Increasing number of acute and chronically mentally ill patients being released from hospitals without follow-up care, who now have the right to refuse medicine and who can no longer be hospitalized involuntarily unless they pose a threat to themselves or others

## Risk Factors (cont’d)

- _Risk Factors (cont’d)_

- Availability of drugs and money at hospitals, clinics and pharmacies, making them likely robbery targets
- Unrestricted movement of the public in clinics and hospitals

## Risk Factors (cont’d)

- _Risk Factors (cont’d)_

- Presence of gang members, drug/alcohol abusers, trauma patients, distraught family members
- Low staffing levels during times of increased activity such as meal and visiting times, transporting of patients

## Risk Factors (cont’d)

- _Risk Factors (cont’d)_

- Isolated work with clients during exams or treatment
- Solo work, often in remote locations, high crime settings with no back-up or means of obtaining assistance such as communication devices or alarm systems

## Risk Factors (cont’d)

- _Risk Factors (cont’d)_

- Lack of training in recognizing and managing escalating hostile and aggressive behavior
- Poorly-lighted parking areas

## OSHA’s Commitment

- _OSHA’s Commitment_

## OSHA has developed guidelines to    provide information to assist employers in meeting their responsibilities under the OSH Act.

- OSHA has developed guidelines to    provide information to assist employers in meeting their responsibilities under the OSH Act.

## OSHA Guidelines

- _OSHA Guidelines_

- Not a new standard or regulation
- Advisory in nature and informational in content
- Intended for use by employers who are seeking to provide a safe and healthful workplace through effective workplace violence programs

## OSHA Guidelines

- _OSHA Guidelines_

-    Based on OSHA’s Safety and Health Program Management Guidelines published in 1989

## OSHA GENERAL DUTY CLAUSE:  SECTION 5(a)(1)

- _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

## OSHA General Duty Clause (cont’d)

- _OSHA General Duty Clause (cont’d)_

- OSHA will rely on Section 5 (a)(1) of the OSH Act for enforcement authority

## Workplace Violence Prevention  Program Elements

- _Workplace Violence__ Prevention  Program Elements_

- Management Commitment and Employee Involvement
- Worksite Analysis
- Hazard Prevention and Control
- Training and Education
- Recordkeeping and Evaluation of Program

## Management Commitment and Employee  Involvement

- _Management Commitment __and Employee  Involvement_

- Complementary and essential
- Management commitment provides the motivating force to deal effectively with workplace violence
- Employee involvement and feedback-enable workers to develop and express their commitment to safety and health

## Management Commitment

- _Management Commitment_

- Organizational concern for employee emotional and physical safety and health
- Equal commitment to worker safety and health and patient/client safety
- System of accountability for involved managers, and employees

## Management Commitment (cont’d)

- _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 incidents
- Encourage employees to promptly report incidents and suggest ways to reduce or eliminate risks

## Management Commitment (cont’d)

- _Management Commitment (cont’d)_

- Outline a comprehensive plan for maintaining security in the workplace
- Assign responsibility and authority for program to individuals with appropriate training and skills
- Affirm management commitment to worker supportive environment
- Set up company briefings as part of the initial effort to address safety issues

## Employee Involvement

- _Employee Involvement_

- Understand and comply with the workplace violence prevention program and other safety and security measures
- Participate in employee complaints or suggestion procedures covering safety and security concerns
- Prompt and accurate reporting of violent incidents

## Worksite Analysis

- _Worksite Analysis_

- Step-by-step look at the workplace, to find existing or potential hazards for workplace violence

## Worksite Analysis (cont’d)

- _Worksite Analysis (cont’d)_

- A “Threat assessment Team”, Patient Assault Team, or similar task force may assess the vulnerability to workplace violence and determine appropriate actions

## Worksite Analysis Recommended Program

- _Worksite Analysis __Recommended Program_

- Analyzing and tracking records
- Monitoring trends and analyzing incidents
- Screening surveys
- Analyzing workplace security

## Hazard Prevention and Control

- _Hazard Prevention and Control_

- Engineering controls and workplace adaptation
- Administrative and work practice controls
- Post incident response

## Engineering Controls

- _Engineering Controls_

- Alarm systems and other security devices
- Metal detectors
- Closed-circuit video recording for high-risk areas

- Safe rooms for use during emergencies
- Enclose nurses’ station, install deep service counters or bullet-resistant glass in reception area, triage, admitting

## Administrative and Work Practice Controls

- _Administrative and __Work Practice Controls_

- State clearly to patients, clients, and employees that violence will not be tolerated or permitted
- Establish liaison with local police and state prosecutors
- Require employees to report all assaults and threats
- Set up trained response teams to respond to emergencies

## Post-Incident Response

- _Post-Incident Response_

- Provide comprehensive treatment for victimized employees and employees who may be traumatized by witnessing a workplace violence incident

## Post-Incident Response

- _Post-Incident Response_

- Trauma-crisis counseling
- Critical incident stress debriefing
- Employee assistance programs to assist victims

## Training and Education

- _Training and Education_

- Ensure that all staff are aware of potential security hazards and ways of protecting themselves

- Workplace
- Violence
- Program

## Training and Education

- _Training and 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 designated emergency response team or security personnel are available

## Training and Education

- _Training and Education_

- Training program should involve all employees, including supervisors and managers

## Training and Education

- _Training and Education_

- Workplace violence prevention policy
- Risk factors that cause or contribute to assaults
- Early recognition of escalating behavior or warning signs

- Ways to prevent volatile situations
- Standard response action plan for violent situations
- Location and operation of safety devices

## Recordkeeping and Evaluation

- _Recordkeeping and Evaluation_

- Recordkeeping and evaluation of the violence  prevention program are necessary too determine overall effectiveness and Identify deficiencies or changes that should be made

## Recordkeeping

- _Recordkeeping_

- OSHA Log of Injury and Illness (OSHA 300)
- Medical reports of work injuries assaults
- Incidents of abuse, verbal attacks, or aggressive behavior
- Information on patients with history of violence
- Minutes of safety meetings, records of hazard analyses, and corrective actions
- Records of all training programs

## Evaluation 

- _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
- Measure improvement based on lowering frequency and severity of workplace violence

## Sources of Assistance

- _Sources of Assistance_

- OSHA Consultation Program
- OSHA Internet Site www.osha.gov
- NIOSH
- Public Safety Officials
- Trade Associations
- Unions and Insurers
- Human Resource and Employee Assistance Professionals