OSHA Inspection: CHEYENNE MESA

Issued

Jan 10, 1995

Abate by

Feb 12, 1995

Penalty

Initial $3,500

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 were likely to cause death or serious physical harm
to employees in that
employees were exposed to:
a)  Cheyenne Mesa, located in Colorado Springs, Colorado, exposed
employees involved in physical holds/escorts and other Special Treatment
Procedures (STP's) of violent and/or aggressive adolescent patients to
serious
physical injury.  Employees have sustained torn ligaments and cartilage,
fractured facial bones, head injuries, severe strains of torso and lower
body
muscles, and contusions as a result of punching and kicking.  Employees are
exposed to patients that have a previous history of acting out and violent
behavior, and are generally suffering from conduct disorders requiring
therapeutic treatment.
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 physical restraints or
seclusion.
2.  Provide in depth training for all personnel required to perform
physical restraint and
seclusion duties, including extensive hands-on training and supervised
on-the-job training
prior to being required to perform any type of restraint or seclusion.
3.  Develop procedures for, and implement use of, a crisis intervention
"team" to respond to
escalating situations where physical restraint may be necessary and to
perform all required
restraint procedures during crisis interventions.
4.  Provide separate restraint/seclusion areas where patients can be
placed which are secure
from the rest of the facility, without the need for constant interaction
with employees (i.e.
locked "time-out room" doors).
5.  Provide an emergency notification system for use by the employees if
an escalating
situation is occurring and assistance is needed.  This system should be
immediately accessible
to all employees, and may include personal alarms as well as a central
alarm system.
Reliance on patients to participate in the notification system is not
acceptable.
6.  Provide additional seclusion areas or rooms so that employees or
crisis management team
members have an adequate number of places to de-escalate patients who may
be acting out
and are in need of physical restraint or seclusion.
7.  Prohibit the use of any physical restraint procedures if fewer than
three staff members are
present in the immediate area of the patient that is in need of such
intervention.  Also
prohibit the use of one-person restraints under any circumstances.
8.  Provide some mechanical means of restraining or disabling a patient
who may be using atool or other object as a weapon (i.e. in the leisure
crafts
area where sharp crafts tools are
used by the patients).  This may include foam pads large enough to cover
the patient's torso
and legs with in order to facilitate the recovery of the instrument
without injury to
employees.
9.  Institute the use of critical incident stress debriefing sessions, to
include interpersonal
support techniques after a critical incident.  These sessions should
include the use of an
outside consulting therapist or physician if requested by the employee.
10.  Provide for ease and flexibility in increasing the staff to patient
ratio to adjust for patient
acuity in the facility (both residential and day-treatment).
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.  Provide for immediate transfer of a patient that has seriously
assaulted a staff member
or another patient.
13.  Ensure that all areas of the facility have means immediately
available for contact of
other staff members in the event of an escalating situation or crisis
(i.e. the downstairs
gymnasium area, the OT area, the parking lot and outside recreation area,
the hallway
outside of the "time-out" room in the day-treatment building, and the
residential building
floors, stairwells and restrooms).
14.  Repair the lights in the parking lot, and prohibit less than two
employees from escorting
patients in this area, to ensure employees have adequate visual contact
with patients and other
staff.