OSHA Inspection: ARMSTRONG CENTER FOR MEDICINE AND HEALTH, INC.

Issued

Jul 5, 2013

Abate by

Aug 9, 2013

Penalty

Initial $7,000 · Current $3,000 Reduced

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.  Employees in the behavioral health unit are exposed to the recognized hazard of assault by violent patients due to the personal interaction they have with such patients when they render care and treatment to them:    a)      Location- Armstrong County Memorial Hospital, One Nolte Drive, Kittanning, PA 16201:             Since at least  January 8, 2013 and continuing thereafter, staff within the Behavioral Health Unit have been exposed to patient-initiated physical assaults such as stabbing, kicking, and punching while providing medical mental health services to residents within the unit.      Among other methods, feasible and acceptable means to abate the hazard of workplace violence at Armstrong Center for Medicine and Health, Inc. include:          ENGINEERING CONTROLS    Provide staff with improved methods for surveying the facility.  Such surveillance devices should be properly maintained and when applicable, appropriately staffed.  Such devices include:  1.       Security cameras that comprehensively cover common areas in both the Adult and Adolescent areas;  2.       Curved mirrors in corners,  and secluded areas;  3.       Replace wood doors between adult and adolescent area that allow for a better way to see and hear employees in the adolescent section in an event of an emergency.      Reduce the likelihood that items be used as weapons:  4.       Remove moveable furniture that could be used as a weapon and/or mount down fixtures;  5.       Replace metal utensils with plastic utensils;  6.       Locate fire extinguisher so that they are not accessible to patients.        Create a safe room for employees to use during emergencies.        Replace key entries with swipe card entries.      Provide staff members with means to communicate in the event of a violent incident.  Ensure all communications/emergency systems implemented have full coverage of the areas, are maintained and staff members are trained in the uses of any devices.  Such systems/devices include:  8.       Personal wireless emergency assistance alarms;  9.       Private channel walkie talkies;    10.   Intercom call buttons placed on the wall near the door of the room, so employees can use when exiting the room.         ADMINISTRATIVE CONTROLS    Develop and annually review ACMH policies on workplace violence prevention, physical intervention, and safety to ensure that the following elements are integrated into a comprehensive workplace violence prevention program:   1.       Develop a Workplace Violence Policy Statement that includes responsibilities of all staff for workplace violence addressing accountability elements of management performance, hazard assessment, prevention, data review of incidents and injuries which is shared with staff and clients;   2.       Create a clear policy that is disseminated to clients, clients relatives and employees explaining that violence or threats of violence are not permitted and will be investigated;  3.       Implement incident reporting and investigation into root cause for each assault incident;  4.       Implement a system for reporting safety concerns internally, and provide employees with assurances that concerns can be reported without fear of retaliation;  5.       Review incidents and ensure that staff are trained on the personal safety skills to break out of holds applied by patients or to prevent biting injuries, as currently occur;  6.       Develop a Hazard/Threat/Security assessment including records review of incidents, inspection of the worksite, and employee survey;  7.       Establish liaison with law enforcement and others who can help identify ways to prevent and mitigate workplace violence;  8.       Assign responsibility and authority for the program to individuals or teams with appropriate training and skills;  9.       Affirm management commitment to worker-supportive environment that places as much importance on employee safety and health as on serving patient.  Management commitment, including the endorsement and visible involvement of top management provides the motivation and resources to deal effectively with workplace violence;  10.   Review the Workplace Violence Prevention policies at least annually and include solicitation of employee input in this review.       Implement a system for alerting employees to a client?s history of violent behavior:  11.   Determine an accurate behavioral history of new/transferred clients;  12.   Ensure client information is exchanged during shift changes; establish a procedure such as chart tags, log book, or color wrist bands, in addition to verbal census reports for identifying clients with a history of violent behavior;   13.   Implement procedures to ensure communication of any incident of workplace violence to any staff that might come in contact with the client, so that staff who may not have access to the client?s daily chart would be aware of previous acts of aggression or violence;  14.   Train all staff to understand this system of communication.      Provide Training to Staff  15.   Conduct new hire and refresher training to ensure affected employees are aware of what the company?s workplace violence policy is, and where it can be found, and what the expectations are of the company for dealing with workplace violence hazards.  Training should be conducted in a manner in which employees can easily understand the terminology and should incorporate hands-on exercises and practice drills to improve staff skill and confidence levels;  16.   Train employees on ACMH?s policies and requirements for recording and documenting on the daily chart when a client is exhibiting aggressive or violent behaviors;  17.   Train employees on assault prevention/control measures for direct care workers to employ when de-escalation techniques are inadequate.    Implement Procedures for comprehensive property check of patients/clients entering hospital.  18.   Ensure staff assigned to this task is appropriately trained.        Ensure adequate numbers of properly trained designated responders are available for each shift and are readily and immediately available to render assistance in the event of an incident of aggressive and violent behavior.  19.   The designated responders for any given shift should be personnel who have specialized training to deal with aggressive and violent behaviors;  20.   Develop policy and training to address the gaps in the current client containment strategy, particularly those gaps associated with staff and client injury.      Ensure incident reporting is complete.  21.   Update facility Incident Reports to include documented supervisor input and follow-up with the affected employee;  22.   Perform root cause analysis for each reported incident of assaultive behaviors, such as but not limited to, shoves, bites, scratches, punches, kicks, ect.      Ensure staff understands the purpose of post-incident debriefing with employee, e.g., to determine lessons learned vs. reprimanding.      Ensure that employees who are victims of violence are provided with medical and emotional treatment.      Create a centralized location for the distribution of medicines and stop using medicine carts-since these carts are large and obstruct doorways.  Ensure the room for distributing medicines is secured and procedures developed for the safe distribution of medicines.