OSHA Inspection: NC DHHS CHERRY HOSPITAL

Issued

Aug 7, 2012

Abate by

Aug 10, 2012

Penalty

Initial $6,300

General-duty citation text

Service Workers, March 10, 1998;
www.dir.ca.gov/dosh/dosh_publications/hcworker.html
2) OSHA Guidelines for Preventing Workplace Violence for Health Care
& Social Service Workers, 3148-01R 2004
3) Michael R. Privitera, MD, MS, Workplace Violence in Mental and
General Healthcare Settings, 2011, ISBN 978-0-7637-7934-4
4) American Psychiatric Nursing Association (APNA) 2008 Position
Statement
5) Joint Commission Sentinel Event Alert, Issue 45, June 3, 2010
North Carolina General Statute 95-129(1) of the Occupational Safety and
7) To ensure that all staff members who may interact with potentially
aggressive patients
know that these patients have been designated as such, in addition to
coding a patientschart as  B-alert at the nurses station, include the
"B-Alert" code on the paperwork that
staff members use when they conduct checks to observe patients every15
minutes. The 15
minute check  paperwork should also include picture identification of the
patients so that
staff who have been pulled from other wards/sources and are not familiar
Health Act of North Carolina:
with patients on
the ward will know who the patients are before interacting with them.
Ensure that an
The employer did not furnish each of his employees conditions of
employment and a place of
employment free from recognized hazards that were causing or likely to
cause death or serious physical
harm to employees in that employees were exposed to: potential fatal or
serious physical injuries as a
result of being assaulted by psychiatric patients and as a result of
physically intervening with violent
employee safety and health component is added to the evaluation of all
patients when
screened and evaluated for potential violence before being admitted to the
hospital.
Extend  B-Alert status to patients with a history of aggression outside
the confines of
Cherry Hospital.
Reference(s):
1) Joint Commission Sentinel Event Alert, Issue 43, August 27, 2009
psychiatric patients while working in psychiatric wards of the hospital.
2) Joint Commission Sentinel Event Alert, Issue 40, July 8, 2008
8)Initiate a program that gives patients and employees joint ownership of
violence related
solutions such as that suggested in the work of Dr Marilyn Lanza and used
with a reported
violence reduction rate of 85at VA Hospitals.
Reference(s):
Lanza, ML et al, Regular Meetings of Patients and Staff Reduce Violent
Episodes by 85 Percent on Inpatient Psychiatric Unit,
http://www.innovations.ahrq.gov/content.aspx?id=3016]
Instance A: Facility - On or about 04/10/12, at the North Carolina
Additional References:
Department of Health and
Human Services (NCDHHS) Cherry Hospital facility, 201 Stevens Mill Rd.,
Goldsboro, NC
27530, a health care technician was injured when a patient attacked a
doctor. The technician
intervened and strained his back. A second technician was injured while
placing the same patient
in a nonviolent crisis intervention (CPI) hold. That technician suffered
Thomas J. Rippon, (1999), Aggression and violence in health care
professions, Journal of
Advanced Nursing, 2000, 31(2), 452-460
Kathleen M McPhaul et al, Environmental Evaluation for Workplace Violence
in Healthcare
and Social Services, Journal of Safety Research, 39, (2008), 237-250
OSHA INSTRUCTION CPL 02-01-052, September 8, 2011, Enforcement Procedures
for
Investigating Workplace Violence Incidents
injury to her hand, knee
OSHA Publication 3148: Guidelines for Preventing Workplace Violence for
Health Care and
Social Service Workers, 2004
NIOSH, Current Intelligence Bulletin 57: Violence in the Workplace. Risk
Factors and
Prevention Strategies, July 1996
NIOSH Publication #2006-144, Workplace Violence Prevention Strategies and
Research
Needs, 2006
OPM, Dealing with Workplace Violence: A Guide for Agency Planners,
February 1998
APNA Position Statement: Staffing Inpatient Psychiatric Units, Journal of
the American
Psychiatric Nurses Association 2012 18 (1) 16-22
Lanza, Marilyn Lewis et al, Staffing of Inpatient Psychiatric Units and
Assault by Patients,
Journal of the American Psychiatric Nurses Association, Vol 3 (2): 42,
SAGE - Apr 1, 1997
Recommendations for Developing Safe Nurse Staffing Models on Inpatient
Psychiatric UnitsIssued by American Psychiatric Nurses Association,
Arlington, VA (PRWEB) September 15,
2011
Lanza, ML et al, Regular Meetings of Patients and Staff Reduce Violent
Episodes by 85
Percent on Inpatient Psychiatric Unit,
http://www.innovations.ahrq.gov/content.aspx?id=3016
Sample Workplace Violence Prevention Program,
http://www.osha.gov/workplace_violence/wrkplaceViolence.PartIII.html
NIOSH Publication #2002-101, Violence Occupational Hazards in Hospitals,
2002
McGovern, P., Institutional Violence: When Does Care Giving become
Submission to
Violence? Work-related Risks for Health Care Providers (A), Center on
Women and Public
Policy Case Study Program, Humphrey Institute of Public Affairs, Univ of
Minnesota, 2001
Beech, Bernard, Leather, Phil, Workplace Violence in the Health Care
Sector: A review of
Staff Training and Integration of Training Evaluation Models, Aggression
and Violent
Behavior 11 (2006) 27-43
Workplace Violence, APNA 2008 Position Statement, 1-69
A Handbook for Workplaces, Prevention and Management of Aggression in
Health Services,
Pschodynamic Group Psychotherapy Compared to Cognative Behavior Therapy,
Perspectives
in Psychiatric Care; Jul-Sep 2002, Vol 38 Issue 3, p89, 9p
Lanza, M.L., Witkower, A, Concentric Interactive Group Model: A Unique
Experience for
Patients and Staff, Perspectives in Psychiatric care; Oct 2010, Vol 46
Issue 4, p294-300, 7p
Lanza, M.L., Modeling Conflict Resolution in Group Psychotherapy, Journal
of Group
Psychotherapy, Pschodrama & Sociometry (15453855); Winter 2007, Vol 59
Issue 4, p147-158, 12p
Lanza, M.L., et al, Patient Assault Support Group: Achieving Educational
Objectives, Issues
in Mental Health Nursing; Jul 2005, Vol 26 Issue 6, p643-660, 18pWorkplace
Violence and prevention in New Jersey Hospital Emergency Departments, NJ
Dept
of Health and Senior Services
NIOSH, Occupational Violence, p1-9,
http://www.cdc.gov/niosh/topics/violence/
Guidelines for Security and Safety of Health Care and Community Service
Workers, 1998, p
1-29, http://www.dir.ca.gov/dosh/dosh_publications/hcworker.html
Workplace Violence, Issues in Response, p1-79, US Dept of Justice, FBI
Worden, R.E., McLean, S.J., Hospital-Based Violence Prevention programs: A
Synopsis, Oct
2008,  p 1-69, The John F Finn Institute for Public Safety Incety
and back.
Instance B: Facility - On or about 03/15/12, at the North Carolina
Department of Health and
Human Services (NCDHHS) Cherry Hospital facility, 201 Stevens Mill Rd.,
Goldsboro, NC
27530, a health care technician was injured as a result of a patient
attack. He suffered a sprained
right leg and Achilles injury.  A second technician was also injured
during the same incident. The
technician was punched in the jaw and fell. He injured his knee, arms,
neck and back as a result.
The patient was described as 6'7", 350 lbs.
Instance C: Facility - On or about 05/01/12, at the North Carolina
Department of Health and
Human Services (NCDHHS) Cherry Hospital facility, 201 Stevens Mill Rd.,
Goldsboro, NC
27530, a health care technician was injured as a result of a patient
attack. She intervened between
two fighting patients when one patient turned on her resulting in
scratches, head and shoulder
pain. A second technician was injured in the same incident with resulting
contusions
and a
strained finger.
Instance D: Facility - On or about 05/13/12, at the North Carolina
Department of Health and
Human Services (NCDHHS) Cherry Hospital facility, 201 Stevens Mill Rd.,
Goldsboro, NC
27530, a health care technician was injured as a result of a patient
attack. He was placing the
patient in a CPI hold when the patient punched him in the head, resulting
in contusions. A second
technician intervened and received scratches, a swollen hand, and injury
to her knees and back.
Feasible Methods of Abatement include (but are not limited to) :
Conduct a hazard assessment of patient on patient and patient on staff
violence to identify
risks and abatement strategies that include but are not limited to changes
to and/or
additions of personal protective equipment (PPE), equipment, facilities,
procedures,
policies, and staffing.
Reference (s):
1)  Kathleen M. McPhaul et.al., Environmental Evaluation for Workplace
Violence in Healthcare and Social Services, Journal of Safety Research 39
(2008) 237-250
2) OSHA Guidelines for Preventing Workplace Violence for Health Care
& Social Service Workers, 3148-01R 2004
3) Guidelines for Security and safety of Health Care and Community
Service Workers, March 10, 1998;
www.dir.ca.gov/dosh/dosh_publications/hcworker.html4) Michael R.
Privitera, MD, MS, Workplace Violence in Mental and
General Healthcare Settings, 2011, ISBN 978-0-7637-7934-4, Chap. 7
2) Maintain a system of record keeping and reporting that tracks all
violence related
episodes/events as well as circumstances surrounding those events that
would permit
statistical analysis to identify cause and effect relationships. Conduct
frequent statistical
analysis to assess how such incidents might be prevented or how employee
injuries might
be prevented when such incidents occur. Include employee safety and health
representatives on any investigation teams to identify factors, problems,
lessons learned
and solutions. Record and report results. Analysis should focus on both
violence
and
violence prevention.
Reference(s):
1) OSHA Guidelines for Preventing Workplace Violence for Health Care
& Social
Service Workers, 3148-01R 2004, Pg 15
2) Michael R. Privitera, MD, MS, Workplace Violence in Mental and
General Healthcare Settings, 2011, ISBN 978-0-7637-7934-4, Chap. 11
3) Joint Commission Sentinel Event Alert, Issue 45, June 3, 2010
4) Joint Commission Sentinel Event Alert, Issue 40, July 8, 2008
3) Increase frequency and quality of CPI training. Conduct CPI training as
often as needed to
make employees comfortable and proficient with the moves. Introduce
facility padding
and PPE to the training to permit more realistic training and help prevent
injury. Make
CPI training more realistic by including training in confined areas and
training in
interacting with patients in wheelchairs. Review videos of actual
incidents of patient
violence as learning tools. Require all employees who are present when a
patient
becomes
violent to provide aid when needed, and ensure that this requirement is
communicated to
and understood by all employees. Provide additional training in techniques
for timely de-escalation of inappropriate behavior.
Provide frequent feedback and studies of incidents involving client
control procedures
(CPI). Determine when CPI works well and those instances where it did not
work.
Provide a rapid feedback and communication system to allow employees to
know which
techniques for timely de-escalation of potential altercation worked.
Introduce and train
additional CPI holds if appropriate.
Always utilize a team approach (per CPI methods) for instances where
patients must be
physically separated due to fighting.
Reference(s):
1) CSHO observation
2) Employee interviews
3) CPI Workbook
4) OSHA Guidelines for Preventing Workplace Violence for Health Care
& Social
Service Workers, 3148-01R 2004
5) Michael R. Privitera, MD, MS, Workplace Violence in Mental and
General Healthcare Settings, 2011, ISBN 978-0-7637-7934-4, Chap. 11
4) Establish an overall hospital policy addressing employee safety with an
emphasis on
recognizing potential injuries from patient interactions as a hazard to
employees. The
policy should reflect that such injuries to employees are not necessarily
an inevitable partof the job, and the policy should have a focus on, and a
goal of, preventing and
eliminating injuries from patient workplace violence. In designing and
implementing such
policies, management and affected employees should be involved and should
work
together, and ideas from affected employees should be sought and
considered to ensure
that there is joint ownership of the problems assessment and solutions.
Management
should involve a  steering committee including employees and safety and
health personnel
with a focus on preventing patient workplace violence and employee
injuries from patient
workplace violence. There should be sufficient staffing to cover patient
duties and to
allow employees who participate on the committee to be away from their
regular duties to
attend meetings. The committee should use statistical analysis to target
problems and
form solutions.
Reference(s):
1) American Psychiatric Nursing Association (APNA) 2008 Position
Statement, Page 15
2) Joint Commission Sentinel Event Alert, Issue 43, August 27, 2009
5) Use case management meetings to address the social, medical, and
medication needs of
patients with a goal toward minimizing violence.
Reference(s):
1) Michael R. Privitera, MD, MS, Workplace Violence in Mental and
General Healthcare Settings, 2011, ISBN 978-0-7637-7934-4, Chap. 11
2) American Psychiatric Nursing Association (APNA) 2008 Position
Statement
6) Provide adequate resources, including staffing of sufficient numbers to
ensure employees
have the ability to protect themselves, to control patients, and restrain
patients as needed
to prevent patient attacks on employees or other patients. Staffing
decisions should be
directed toward minimizing exposures where unaccompanied employees must
deal with
patients alone or in secluded areas including stairs, elevators, bathrooms
and bedrooms.
An employee buddy system should be used where appropriate. Establish
policies and
guidance on the situations in which employees are not allowed to work
alone. Develop a
communication system that allows all levels of management to review shift
staffing and
changes to the staffing on a daily basis.  Study and improved the
scheduling of personnel
to minimize the need and use of double shifts and to minimize the
resulting fatigue
associated with 16 hour shifts. Ensure employees who are expected to use
CPI have the
physical abilities to do so.
Reference(s):
1) Guidelines for Security and safety of Health Care and Community

Issued

Aug 7, 2012

Abate by

Aug 10, 2012

Penalty

Initial $6,300

Issued

Aug 7, 2012

Abate by

Aug 10, 2012

Issued

Aug 7, 2012

Abate by

Aug 10, 2012

Penalty

Initial $900

Issued

Aug 7, 2012

Abate by

Aug 10, 2012

Penalty

Initial $900

Issued

Aug 7, 2012

Abate by

Aug 10, 2012

Penalty

Initial $900