OSHA Inspection: DANBURY HOSPITAL

Issued

Jul 1, 2010

Abate by

Aug 17, 2010

Penalty

Initial $6,300 · Current $6,300

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 fatal or serious physical
injuries from violent patients.
Danbury Hospital: Employees were exposed to the hazard of being assaulted
by violent patients causing fatal
or serious physical injuries while working in the psychiatric ward,
emergency department's behavioral care
unit, and the general medical floors. Within the past five years there
have been approximately 25 cases which
have resulted in 212 restricted duty days and 399 days away from work as
well as 119 non-recordable cases as
a result of gunshot wounds; serious fractures; contusions; bites; head
injuries; being punched in the face;
being hit and kicked by violent patients in the psychiatric ward,
emergency department and the general
medical floors. Some of the contraband patients have been successful in
bringing into the hospital include: a
gun; box cutters; knives; razor blades; lighters; and drug paraphernalia.
On or about March 23, 2010 a nurse was kicked by a patient while security
was trying to hold down the
patient in the psychiatric ward.
On or about March 2, 2010 a elderly man shot a nurse three times in 8
tower west.
On or about October 11, 2009, a patient struck a nurse  in the jaw causing
her to fall down and break her hip
in the psychiatric ward.
On or about May 18, 2009, a security guard was beaten up in the behavioral
care unit.
On or about December 31, 2008, a patient lunged at a nurse striking her in
the arm in the psychiatric ward.
Among other methods, feasible and acceptable means to abate the hazard of
workplace violence in Danbury
Hospital include:
1) Create a stand alone written Workplace Violence Prevention Program for
the
entire hospital which includes
the following elements:
A Workplace Violence Policy Statement including responsibilities of all
staff
Hazard/Threat Assessment including records review, inspection of the
worksite, and employee survey
Implementation of Workplace Controls and Prevention Strategies
Training and Education of all Staff
Incident Reporting and Investigation
Periodic review of the program;
2) Ensure that the program addresses the specific actions employees are to
take for an incidence of workplace
violence in the hospital, as well as the proper procedures to report those
incidences;
3)  Ensure that security staff members are readily and immediately
available to render assistance in the event
of an incidence of workplace violence and that security has had
specialized training to deal with aggressive
behavior.
4) Conduct more extensive training so that all employees are aware of what
the hospital's workplace violence
policy is, and where that information can be found.  In addition, train
all employees to state clearly to
patients, clients, and employees that violence is not permitted or
tolerated.  Further train all employees on
recognizing when a patient is exhibiting aggressive behavior and
techniques for de-escalating that behavior.
5) Ensure that all patients who receive a psychiatric consultation are
screened for potential history of violence
before being admitted to the hospital.  In addition, consider using hand
held metal detecting wands to detect
weapons that may be concealed by the patient.
6) Use a system to flag the patient's chart anytime there is a history or
act of violence and train staff to
understand the flagging system.  Put procedures in place that would allow
communication of any incident of
workplace violence to the staff that might come in contact with that
patient, so that employees who might not
have access to a patient's chart would be aware of a previous act of
aggression or violence.
7)  In the psychiatric ward, the optimal abatement would be to make the
psychiatric ward a one floor unit so
that employees are not alone with patients on the floor.  In lieu of
creating a one floor unit, administrativecontrols should be put in place
to prevent employees from being alone with patients.  In particular,
employees
should not be transporting potentially violent patients alone in
stairwells or in elevators.  Security should be
present and available immediately in the event of an incidence of violence.