OSHA Inspection: U.S. DEPARTMENT OF VETERANS AFFAIRS

Issued

Jul 31, 2015

Abate by

Oct 3, 2016

Penalty

Initial $0 · Current $0

General-duty citation text

29 CFR 1960.8(a):  The Agency head 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 the hazard of being physically assaulted by patients causing serious physical injuries and possibly death.  During routine interactions with patients with known histories and/or potential of violence, employees were exposed to numerous incidents of violent behavior by patients which have resulted in rotator cuff injuries, dislocated rib, injury to the head, scratches and bites, contusions, and sprains and strains.     a)  Mental Health Unit - On or about February 3, 2015, a doctor was providing mental health services when a patient, who was known to be violent, assaulted the employee by pounding the head and neck of the employee.    b)  Mental Health Unit - On or about February 3, 2015, a nurse sustained knee and ankle injuries while trying to deescalate a patient, who was known to be violent.  c)  Emergency Room - On or about May 22, 2015, a VA police officer was bitten by an aggressive patient while trying to deescalate the patient.  Management failed to ensure a site specific workplace violence program was developed and implemented to address incidents involving assaults on workers.  Among other methods, feasible means to abate this hazard include:   1)  Develop and implement a stand-alone Workplace Violence Prevention Program that would materially reduce the hazard by addressing patient to staff workplace violence and disruptive behavior.  Conduct annual reviews to evaluate the effectiveness and implementation of the program.    2)  Provide employees with an easily accessible, reliable and consistent way to rapidly summon emergency assistance from not only VA police but also other staff.  Ensure all staff members are trained on the use of these systems, when and how to use them, and that their effectiveness is evaluated and documented.      3)  Ensure that training is sufficient to make all employees aware of the company workplace violence policy, and how that written policy can be accessed.  Training shall also include, but not be limited to:        -Instructing all employees to state clearly to patients and employees that violence is not permitted or tolerated;     -Training all employees on effective methods for responding during a workplace violence incident;     -Training all employees on recognizing aggressive behavior exhibited by patients or others, and on techniques for timely de-      escalating the behavior;     -Instructing all employees about risk factors that cause or contribute to assaultive behaviors (including threats of violence);     -Training all employees to report all incidents of workplace violence, including assaults and threats of assaults, and            instructed that such reporting is mandatory; and     -Training shall be conducted at orientation before employees are exposed to patients, and annually as refresher training.     -Training on effective self-defense and control techniques.    4)  Ensure all incident reporting is done in a uniform and timely manner with all staff and management being trained on the time requirements, required documentation, and each person's responsibilities in incident reporting to ensure the reporting is accurate and effective.  In addition to that, ensure there is a system for reporting safety concerns internally.  Encourage open incident reporting by employees of all levels and work areas.  5)  Fully investigate and document all Workplace Violence incidents involving disruptive, threatening, and violent behavior.  Develop and implement uniform procedures to ensure that providers, security personnel, and medical support staff with the potential to provide services to the patient or who are expected to protect employees, visitors, and other patients from assaults.  6)  Establish a comprehensive program of medical and psychological counseling and debriefing for employees experiencing or witnessing assaults and other violent incidents.  7)  Ensure disruptive behavior response teams specific to high risk areas are formed and trained to respond to incidents of assault, threatening behavior, or disruptive behavior.  Provide training and equipment to response team members to ensure they are prepared to quickly and successfully respond to incidents of assaultive behavior.  In addition to response team training, ensure other affected staff members are trained to ensure they are aware of the role of the response team, the identity of the team members, and their own role in assisting with efforts to deescalate a person causing a disturbance.     8)  Visitors and patients should be screened for weapons prior to entry.  Visitors and patients previously identified as disruptive should be identified as such prior to entry.  Staff should be appropriately assigned, and trained to use the equipment and remove weapons.  Screening for weapons can be completed by a metal detector, hand wands or by hand.    9)  Install cameras in high risk areas; repair and maintain all other cameras in operating condition.  Cameras should be regularly tested and monitored to ensure they remain in working condition.    10) Provide easily accessible panic alarms in all high risk areas, repair and maintain panic alarms in operating condition.  Security or silent alarm systems should be regularly maintained and tested.  Managers and staff should fully understand the range and limitations of the system.    11) Follow the recommendations in Department of Veterans Affairs Office of Inspector General Report No. 11-00215-194 ?Management of Workplace Violence in Veterans Health Administrations Facilities? dated June 14, 2012, including:  require the DBC to convene regularly and review disruptive behavior incidents, refer disruptive patients to the DBC, and engage VA police in the DBC.

Issued

Jul 31, 2015

Abate by

Feb 3, 2016

Penalty

Initial $0 · Current $0

General-duty citation text

29 CFR 1904.4(a): The employer did not record each work-related fatality, injury or illness case that resulted in the general recording criteria on the OSHA Form 300 or equivalent.   Mental Health Unit - On or about February 3, 2015, a doctor sustained injuries from a patient assault that caused three days away from work.  The employer failed to record the incident on the 2015 OSHA 300 log.