Healthcare Workplace Violence Prevention:Implementation Challenges ofCal/OSHA’s Regulations

Caryn P. ThornburgS.E.M.S. OfficerValleyCare Health System

Scope of the Law and Standard

Covers all facilities under the hospitals licensure For ValleyCare, this includes:

General acute care hospital (Pleasanton) Level 2 NICU

Urgent care clinics ( Dublin and Pleasanton) Ambulatory surgery center (Livermore) Acute geriatric psych, (Livermore) DP/Skilled nursing facility (Livermore) Ancillary health care operations Chabot Student Health and Wellness Center - Hayward Las Positas Student Health and Wellness Center – Livermore,

CA

Who is Responsible for this Program?

Establishment of a multidisciplinary team Safety Officer/Director of Engineering Human Resources Employee Health 3rd Party Security – Guards Clinical Operations S.E.M.S. Officer Line-Level Staff Collective Bargaining Units

Who Does it Cover ?

“All health care workers, including temporary employees, working in the facility, unit, service, or operation”

Physicians Contracted Services Personnel

Challenge will be in getting our physicians and staff trained initially and annually there after

ACTION: Mandated training attendance tied to evaluations. Attend class during 60-day window prior to evaluation – monthly class schedule

Assessment of Risks

Requires assessment procedures to identify and evaluate environmental risk factors, including community-based risk factors

Review of all workplace violence incidents Challenges Disparate systems – paper and electronic No central point of collection, pieces go to different

depts. ACTION: Hired an outside consultant to do the

assessment since we don’t have the expertise to do this in-house to identify our gaps Third party gives us a fresh set of eyes to look at

the organization and our processes

Unfunded Mandate

Cost are involved with the assessment, training, engineering challenges based on identified hazards –construction/OSHPD, new ADA compliance requirements, equipment, and staff to support program

ACTION: Executive leadership support Physician champion Cost projections for next fiscal year Training estimates alone over 500K for 1500 staff

Identify costs associated with sustainability

Implementation Date

AB 1299 requires the Occupational Safety and Health Standards Board, no later than July 1, 2016, to adopt standards developed by the Division of Occupational Safety and Health that require specified types of hospitals, to adopt a workplace violence prevention plan as a part of the hospital’s injury and illness prevention plan to protect health care workers and other facility personnel from aggressive and violent behavior

October 1, 2016 as the implementation date, tentatively ACTION: Despite final standards not being completed,

moving forward with current information and developing a road map.

Training Requirements

Initial training Interactive questions and answers with a person

knowledgeable about the employer’s workplace violence prevention plan Face-to-face vs. online or computer based training

Employees performing patient contact activities and supervisors provided refresher training at least annually

Employees responding to alarms or violent incidents or duties involved with confronting/controlling person exhibiting aggressive/violent behavior –hands-on restraining techniques

Training Requirements (cont.)

Method Man

Material Machine

Provide training to all employees in the facility, unit,

service or operation,

including temporary employees

Large amount of staff need to be trained, who gets trained

Annual training plan (staff time, prior to eval.,

CI Care: Service Recovery vs DAB

Class Plan (hybrid, length, contents etc

Training Records prioritized departments need training first e.g. ED, Legends, M/C.

AV equipment: projector, laptop, dvd?, screen

Drive to store files and video

Space for Large Class with interactive

Standardize training materials

Train the trainer sessions

Getting new hires trained Hospital Roll out

Cost center for program e.g. staff time, training materials, equip.

Class Materials handouts

Communication

HR communicating regarding evaluation time. Annual requirements

Communicate Workplace Violence Plan and related policies

Communication about Class

Communication about Resources

Workplace Violence Prevention Training

Training Requirements (cont.)

ACTION: Develop hospital-specific training program – CPI/ProACT-based

1. Identify instructors2. Class registration process3. Develop course curriculum4. Train – the – Trainer (incl. line level staff)5. Restraint policy review and four-person

take down – not part of any training currently6. Communication to all staff aggressive

patient“Color It Orange or Orange is the New Black”

In-Patient Screening

MS4 Screening - Nursing In-Patient

Kim, S., Ideker, K., and Todicheeney-Mannes, D. (2012). Usefulness of aggressive behaviour risk assessment tool for prospectively identifying violent patients in medical and surgical units. Journal of Advanced Nursing, 68(2), 349-357.

doi:10.1111/j.1365-2648.2011.05744.x34

S.T.A.M.P. – Out-Patient Areas

Luck, L., Jackson, D., and Usher, K. (2007). STAMP: components of observable behaviour that indicate potential for patient violence in emergency departments. Journal of Advanced Nursing, 59(1), 11-19. doi:10.1111/j.1365-2648.2007.04308.x

Communication Tools for Staff

If patient has screened positive as a risk for violent behavior there will be:

– An orange magnetic dot is placed outside on the patient’s door frame,

– The patients unique identifier (NO Names) is entered on the tracking board will be in orange,

– The chart back will have an orange label.– When transporting patient -communicated on

“ticket to ride”

All staff must check in first at Nurses station prior toentering a patient room when there is an orange dot!

Patient Record Flags (PRF)Across the Continuum of Care

Working on a PRF alert is assigned by a VCHS employee to patients whose behavior, medical status, or characteristics may pose an immediate threat either to that patient’s safety, the safety of other patients or employees, or may otherwise compromise the delivery of safe health care in the initial moments of the patient encounter. PRF enhance both the right of all patients to receive confidential, safe, and appropriate health care, as well as the right of employees to a safe work environment.

Modeling after Veterans Administration PRF

Documentation and Reporting

Violent Incident Log Record every incident, post-incident response, and

workplace violence injury investigation Duplication of OSHA 300 Log entries Reporting to the Division within:

□ 24 hours for a injury, use of a firearm, dangerous weapon, or urgent, emergent threat to the welfare, health and safety of hospital personnel

□ 72 hours all others Term “violent” – preventing placement of patients ACTION: Evaluate current systems and leverage

resources and possible personnel. Using the word aggressive in patient care areas and for clinical documentation purposes

Customer Satisfaction

Possible impacts to patients and visitors Increased screening – metal detectors

Don’t want it to be like TSA at the airport Prevent unauthorized transport firearms and weapons into

the facility – patients, staff, visitors What to do when we find one Handling of weapon Securing weapons

Must check in and out at a central point for elevator access Reduce number of access points (doors) to the facility Security threats – overhead paging using plain languageACTION: Find a balance between safety and customer satisfaction and communication regarding changes

Privacy of Information

Staff reporting – Cal/OSHA desperate system from hospital Incident Logs Reports to Cal/OSHA, January 1, 2017, and annually thereafter, to post a report on its

Internet website containing specified information regarding violent incidents at hospitals. Concerns on hospital identification to the public What will they do with the information

ACTION: Partnering with CHA to provide input to Cal/OSHA regarding concerns Education of employees on mandated reporting requirements and

incident log Develop WPV incident log for internal use Additional staff time for data input – who will do this

CalOSHA - only will have one hospital person authorized to input

Sustainability

Regulations require annual assessments and training of staff since we do not have dedicated teams to respond on all shifts

Remediation of new risk identified ACTION: Considerations of program manager and

dedicated training staff or staff development educators DAB students as instructors via T-T-T program Trainers from line-level staff are partnered with

experienced instructor with psych/behavioral health background. Need large pool with up to 15 classes/month

Class size limited to 25 per two instructors due to hands-on component for release and restraining techniques

Questions?

Thank you

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Caryn Thornburg, LVN, BS, MSSafety, Emergency Management and Security OfficerValleyCare Health Systemcthornbu@valleycare.com