OSHA Inspection: FRANKLIN HOSPITAL MEDICAL CENTER/ NORTH SHORE LIJ

Issued

Mar 8, 2011

Abate by

Apr 22, 2011

Penalty

Initial $4,500 · Current $4,500

General-duty citation text

-Institution of a recordkeeping system designed to report any violent
incidents.  The
reports must be in writing and maintained for the program review.  Records
kept include
medical records, safety meetings, OSHA 300 logs, insurance records, police
and law
enforcement records, incident records, and records of near misses.
-Development of a workplace violence training program that includes a
written outline
Section 5(a)(1) of the Occupational Safety and Health Act of 1970: The
or lesson plan.  Workplace violence training includes 1) The Franklin
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 led to assaults;
4)  Ways to prevent or diffuse volatile situations or aggressive behavior;
5)  The standard
response plan for violent situations including the availability of
assistance, response to alarms
employer did not
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
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 the hazard of being assaulted by violent
patients causing fatal or
serious physical injuries while working in the psychiatric ward of the
hospital.
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, workers compensation, and legal assistance after a violent
episode or injury.
A.) On or about September 10, 2010 at North Shore Long Island Jewish
-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.
NOTE: IN ADDITION TO ABATEMENT CERTIFICATION, THE EMPLOYER IS
REQUIRED TO SUBMIT ABATEMENT DOCUMENTATION FOR THIS ITEM,
FAILURE TO COMPLY WILL RESULT IN AN ADDITIONAL PENALTY OF
$1,000.00 AS PER 29 CFR 1903.19
Health System /
Franklin Hospital, 900 Franklin Avenue, Valley Stream, NY 11580
A nurse was attacked and severely injured during performance of her
regularly assigned
duties such as, but not limited to providing group-therapy session for
psychiatric patients.
Employees are exposed to workplace violence hazards that are likely to
cause death or
serious physical harm. The employer failed to develop and/or implement
adequate
measures
to protect employees from assault in the workplace.
Feasible methods of abatement include:
1)  Screen for potential weapons at the facility.
2) 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.
3)  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 de-escalating that behavior.
Workplace violence training includes 1) The Franklin 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
led to assaults; 4)
Ways to prevent or diffuse volatile situations or aggressive behavior; 5)
The standard
response plan for violent situations including the availability of
assistance, response to
alarms 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, workers compensation, and legal assistance after a
violent episode or
injury.
Training on escalating behavior includes, but not limited to: 1)
Recognize warning signs
such as confusion, frustration, blame, anger and hostility; 2) Use methods
to de-escalate
violent and escalating 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, disengaging and bringing in help; 3)  Respond to
violence and potential
violence by using venting techniques, preparing to evacuate, 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.
4)  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 employees who might not have
access to the patient's
chart would be aware of a previous act of aggression or violence.
5)  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 of a good
working relationship with the local police department in order to keep
abreast of the rise or
fall of criminal activity in the community.
6)  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 patient areas
that may be used as
weapons are removed or properly secured.
7)  Limit employees from working alone or in secluded places with
patients, including
stairways and elevators.  Use a buddy system where appropriate.
8)  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 the employees are to take for a workplace violence
situation.
Alarm systems may include use of panic buttons, beepers, cellular phones,
surveillance
cameras, and public 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.
9)  Develop and implement specific procedures for reporting incidents of
workplace violence
including both reporting to hospital management as well as reporting to
the law enforcement
for assistance and/or filing charges.
10)  Create a stand alone written Workplace Violence Prevention Program
for the hospital
which includes the following elements:
-A policy statement regarding violence in the workplace including a
zero-tolerance
policy for workplace violence and assignment of oversight and prevention
responsibilities.
-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.  A step by step of records, monitoring of trends,
analysis of incidents,
conducting employees screening surveys, and an analysis of security.
-Development of workplace violence controls including, administrative and
engineering
controls and methods used to prevent potential workplace violence
incidents. Engineering
controls may include 1)  alarm complete assessment includes analysis and
tracking 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 to patients and
visitors that violence is not permitted or tolerated; 2)  Adequate
staffing 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,
mealtimes, 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 to effectively treat potential violence patients; 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.