OSHA Inspection: THE ACADIA HOSPITAL

Issued

Jan 25, 2011

Abate by

Jun 15, 2011

Penalty

Initial $6,300 · Current $6,300

General-duty citation text

including response
teams, security, adequate and appropriately trained staff to restrain
patients; 3) Adequate staffing
during times of greatest risk including during patient transfers,
emergency responses, meal
times, and at night; 4) Establishment of policies for when employees are
not allowed to work
alone; 5) Use of case management conferences with employees and management
to discuss ways
Section 5(a)(1) of the Occupational Safety and Health Act of 1970:  The
to treat potential violence patients effectively; and 6) Use of security
escorts or the buddy system
in circumstances considered to be high risk such as during transport in
elevators or stairways.
iv)  Institution of a recordkeeping system designed to report any violent
incidents.  The reports
must be in writing and maintained for program review. Records must include
medical records,
safety meetings, OSHA 300 Logs, insurance records, police and law
enforecement records,
employer did not
incidence reports, and records of near misses.
v)  Development of a workplace violence training program that includes a
written
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 physical assaults by violent psychiatric patients:
Facility-wideFrom January 1, 2008 through December 31, 2010 there have been
at least 115 hospital employees identified in the OSHA 300 LOG that have
been assaulted on the
outline or
lesson plan.  Workplace violence training includes: 1) The Acadia Hospital
Workplace Violelnce
Program; 2) Risk Factors that cause or contribute to assaults; 3) Early
recognition of escalating
behavior or recognition of warning signs or situations that may lead to
assaults; 4) Ways to
prevent or diffuse violent situations including the availability of
assistance, response to alarm
job by violent psychiatric patients resulting in approximately 1741
systems, and communication procedures; 6) Ways to deal with hostile people
other than patients
and clients, such as relatives and visitors; 7) Progressive behavior
control methods and safe
methods to apply restraints; 8) Ways to protect oneself and coworkers,
including use of the"buddy system"; 9) Policies and procedures for
reporting and recordkeeping; 10) Information
on multicultural diversity to increase staff sensitivity to racial and
ethnic issues and differences;
and 11) Policies and procedures for obtaining medical care, counseling,
restricted duty days and
worker compensation,
and legal assistance after a violent episode or injury.
vi)  Annual review of the workplace violence prevention program, which
should
be updated as
necessary.  Such review and updates shall set forth any mitigating steps
taken in response to any
workplace violence incidents.
around 570 days away from work as well as at least 76 non-recordable cases
resulting in broken
teeth, prescription glasses broken in physical assaults, contusions, human
bites, being punched
in the face,or being hit and kicked by violent psychiatric patients.
During the current reporting
year there were at least five instances of particular severity.  On April
30, 2010 a psychiatrist
in admissions was choked and beaten by a patient.  The next day, May 1,
2010 the same violent
patient choked, beat, pulled hair, and pounded a nurse's head into a wall.
On July 8, and
August 7, 2010 psychiatric technicians were aggressively  assaulted by
different violent patients
resulting in a severe kick to the pubic area of one and a smashed face in
the other technician.
Some feasible and acceptable means to abate the hazard of workplace
violence in the Acadia
Hospital include but are not limited to:
1.  Ensure that all patients are screened for potential violence before
being
admitted to the
hospital.  In addition, consider using hand-held metal detecting wands to
discover concealed
weapons and consider using closed circuit TV and other surveillance
systems in order to discover
workplace violence quickly.
2. Conduct extensive training  so that all effected employees are aware of
what the hospital's
workplace violence  plan is, and where the 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
or violent behavior and techniques for timely deescalating that behavior.
Workplace violence training includes 1) The Acadia Hospital Workplace
Violence Program; 2)
Risk Factors that cause or contribute to assaults; 3) Early recognition of
escalating behavior or
recognition of warning signs or situations that may lead to assaults; 4)
Ways to prevent or
diffuse volatile situations or aggressive behavior; 5) The standard
response plan for violent
situations including the availablity of assistance, response to alarm
systems and communication
procedures; 6) Ways to deal with hostile people other than patients and
clients, such as relatives
and visitors; 7) Progressive behavior control methods and safe methods to
apply restraints; 8)
Ways to protect oneself and coworkers including use of the"buddy system";
9) Policies and
procedures for reporting and record keeping; 10) Information on
multicultural diversity to
increase staff sensitivity to racial and ethnic issues and differences;
and 11) Policies and
procedures for obtaining medical care, counseling, worker compensation,
and legal assistance
after a violent episode or injury.
Training on escalating behavior includes, but not limited to : 1)
Recognize warning signs sucha
s confusion, frustration, blame, anger, and hostility; 2) Use methods to
de-escalate violent and
excalating behavior such as listening to concerns, using clarifying
questions, giving factual
information, relocating to a quiet setting, reassuring, making a sincere
effort to clarify concerns,
disingaging, and bringing to help; 3) Respond to violence and potential
violence by using venting
techniques, preparing to evaluate, and contacting supervisors and
security; 4) Use personal
conduct to minimize violence such as projecting calmness, moving slowly,
speaking slowly,
listening empathetically, having relaxed but attentive posture,
establishing ground rules with
consequences, and using delaying tactics to allow the person to calm down.
3)  Use a system such as flagging a 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
a patient, so that emloyees who might not have access to the patient's
chart would be aware of
a previous act of aggression or violence.
4)  Ensure that adequate numbers of properly trained security people (such
as
"Response Teams"
or Security Department) are readily and immediately available to render
assistance in the event
of an incident of workplace violence and ensure that security has the
specialized training to deal
with aggressive and violent behavior.  In addition, develop a good working
relationship with the
local police department in order to keep abreast of the rise and fall of
criminal activity in the
community.
5)  Configure the workplace in such a way to maximize the ability of an
employee to escape in
the event of workplace violence.  Ensure that work areas have two exits
and that furniture is
arranged to prevent entrapment.  Ensure that articles in the patient areas
that may be used as
weapons are removed or properly secured.
6)  Limit employees from working alone or in secluded places with
patients, including stairways
and elevators.  Use a buddy system where appropriate.
7)  Develop and implement the specific actions employees are to take for
an incident of
workplace violence in the hospital.  For example, specify a specific
workplace violence alarm
system and a specific, reliable response to that system.  Be very clear
regarding the specific
actions that the employees are to take for a workplace violence situation
such as a
"Green Code" or a "Silver Code" as described in the Acadia Hospital
Interdepartmental
Directive titled: "Overhead Paging System" dated October 16, 2008 and
revised on August 31,
2010.
Alarm systems may include use of panic buttons, beepers, cellular phones,
surveillance cameras,
and publc address alarms.  The response to the system must be reliable and
may include
response teams, security teams, security guards, or local law enforcement.
The response system
must also include medical assistance for injured employees or other
injured persons. Finally,
develop and implement the specific reporting requirements for an incident
of
workplace violence.
8)  Develop and implement specific procudures for reporting incidents of
workplace violence
including both reporting to hospital management as well as reporting to
law enforcement for
assistance and/or filing charges.
9)  Create a stand alone written Workplace Violence Prevention Program for
the hospital which
includes the following elements:
i)  A policy statement regarding violence in the workplace including a
Zero-tolerance policy for
workplace violence and assignment of oversight and prevention
responsibilities.
ii)  A workplace violence hazard assessment and security analysis,
including a list of the risk
factors identified in the assessment and how the employer will address the
specific hazards
identified in the assessment and how employer will address the specific
hazards identified.  A
step by step complete assessment includes analysis and tracking of
records,
monitoring of trends,
analysis of incidents, conducting employee screeing surveys, and analysis
of security.
iii)  Development of workplace violence controls including, administrative
and engineering
controls and methods used to prevent potential workplace incidents.
Engineering controls may
include 1) alarm systems, panic buttons, hand-held alarms, noise devices,
cellular phones,
radios, and reliable response to those alarms; 2) Installed and hand-held
metal detectors; 3)
Closed circuit video; 4) Curved mirrors at hallway intersections; 5)
Employee "Safe Rooms" for
use during emergencies; 6) "Time Out" or seclusion areas for patients who
"act out" and
separate rooms for criminal patients; 7) Arrangement of furniture and
rooms to prevent
entrapment; 8) Minimal furniture and objects in rooms that may be used as
weapons; and 9)
Bright effective lighting.  Administrative controls may include: 1) Clear
statement ot patients
and visitors that violence is not permitted or tolerated; 2) Adequate
staffing

Issued

Jan 25, 2011

Abate by

Jan 28, 2011

Penalty

Initial $900 · Current $900

Issued

Jan 25, 2011

Abate by

Feb 27, 2011

Penalty

Current $900

Issued

Jan 25, 2011

Abate by

Jan 28, 2011

Issued

Jan 25, 2011

Abate by

Feb 27, 2011

Issued

Jan 25, 2011

Abate by

Jan 28, 2011

Penalty

Current $900

Issued

Jan 25, 2011

Abate by

Jan 28, 2011