OSHA Inspection: CHARTER BARCLAY HOSPITAL

Issued

Sep 22, 1993

Abate by

Oct 29, 1993

Penalty

Initial $5,000 · Current $2,500 Reduced

General-duty citation text

Section 5(a)(1) of the Occupational Safety and Health Act of 1970:
%%
The employer did not furnish employment and a place of employment
which were free from recognized hazards that were causing or likely
to cause death or serious physical harm to employees in that
employees were exposed to:
(a)  Charter Barclay Hospital, Chicago, exposed employees
involved in Code Yellow seclusion/restraint incidents
with violent psychiatric patients to serious physical
injury.  Employees have sustained fractures, torn
cartilage, bites, knee damage, head injury, and
contusions from punching and kicking.  Employees are
exposed to patients that are members of street gangs,
patients with a history of acting out and previous
violent behavior, patients with psychotic homicidal
ideation, and psychotic rage.  Patients have broken
doors, walls, windows, and plumbing fixtures.
Feasible methods of abatement include but are not limited to:
(1)  Development of crisis prevention management written
policies identifying risk factors for assaultive
behavior and emphasizing early intervention during
impending violent situations which would obviate the
need for the use of seclusion and restraint.
(2)  Development of mandatory training in crisis
prevention techniques for all clinical staff and any
other employees that participate in Code Yellow
situations such as maintenance, housekeeping and
security employees to be given at orientation and
before actual involvement with a Code Yellow.
(3)  Provide mandatory training in restraint/seclusion
procedures for all employees who participate in a
Code Yellow, including maintenance, security and
housekeeping employees.  Training shall be given at
orientation and before actual involvement with a
Code Yellow.
(4)  Institute the use of critical incident stress
debriefing sessions to include interpersonal support
techniques after a critical incident as outlined in
the Journal of Safe Management of Disruptive and
Assaultive Behavior.
(5)  Complete all sections of the employee incident
report, including supervisor's investigation and
Human Resource portions, such that causal factors,
weaknesses, and preventative measures can be
identified.
(6)  Complete the Code Yellow evaluation sheet in the
detail provided and after each Code Yellow to
identify problem areas, evaluate team performance,
and design an action plan to rectify problem areas
to prevent future occurrences of Code Yellows and
decrease the incidence of employee injuries.
(7)  Provide training on multicultural diversity to
develop sensitivity to racial/ethnic issues and
differences that may have causal connections with
violent behavior.
(8)  Emphasize the importance of treatment team
intercommunication so that staff members apprise
each other of patients' most current mental status
and any occurrences of threatening remarks,
behavior, etc. that may signify an impending violent
situation.
(9)  Provide receptiveness and sensitivity to clinical
staff input regarding patient/staff fears which
pertain to personal safety.
(10) Provide for ease and flexibility in increasing the
staff to patient ratio to adjust for patient acuity
on the ward.
(11) Increase the staff to patient ratio when necessary
to maintain a therapeutic (as opposed to custodial)
milieu to decrease the likelihood that violent
behavior is not used as a means of getting attention
because of the unavailability of staff time to
address individual patient needs.
(12) Identify patients with an increased potential for
violence, and assign them to staff members with the
expertise, and experience to deal effectively with
the clinical challenges presented.
(13) Increase staffing when patients with history of
assaultive behavior and/or gang activity are
admitted, or else develop a no-admit policy.
(14) Provide for transfer of a patient that has seriously
assaulted a staff member or another patient.
(15) Allow only personnel that have been trained in
crisis prevention techniques and restraint/seclusion
procedures to participate in a Code Yellow.
Restrict untrained employees and contract personnel
from assisting in a Code Yellow.
(16) Establish a policy that mandates a minimum of 5
staff members present before a Code Yellow is
attempted.
(17) Provide for the presence of a minimum of 2
physically qualified staff members before a Code
Yellow is attempted.
(18) Schedule staffing assignments such that an adequate
number of physically qualified staff members are
available on each unit on each shift to respond to
a Code Yellow.
(19) Establish a method of accounting for all metal
silverware which patients use in the cafeteria,
implement use of plastic utensils, and/or install
a metal detector.
(20) Increase structure, activities, and opportunity for
staff/patient interaction on the evening and weekend
shifts, which have a higher proportion of acting out
and Code Yellow

Issued

Sep 22, 1993

Abate by

Sep 28, 1993

Penalty

Initial $1,350 · Current $700 Reduced

Issued

Sep 22, 1993

Abate by

Sep 26, 1993

Penalty

Initial $2,250 · Current $1,500 Reduced

Issued

Sep 22, 1993

Abate by

Oct 5, 1993

Penalty

Initial $2,250

Issued

Sep 22, 1993

Abate by

Oct 5, 1993

Issued

Sep 22, 1993

Abate by

Sep 26, 1993

Penalty

Initial $2,250 · Current $1,300 Reduced

Issued

Sep 22, 1993

Abate by

Oct 5, 1993

Issued

Sep 22, 1993

Abate by

Sep 28, 1993

Issued

Sep 22, 1993

Abate by

Sep 26, 1993

Penalty

Initial $2,250 · Current $1,500 Reduced

Issued

Sep 22, 1993

Abate by

Sep 26, 1993

Issued

Sep 22, 1993

Abate by

Oct 22, 1993

Penalty

Initial $1,350 · Current $700 Reduced

Issued

Sep 22, 1993

Abate by

Oct 22, 1993

Issued

Sep 22, 1993

Abate by

Nov 1, 1993

Issued

Sep 22, 1993

Abate by

Oct 2, 1993

Issued

Sep 22, 1993

Abate by

Oct 22, 1993

Penalty

Initial $5,400 · Current $3,000 Reduced