OSHA Inspection: BERGEN REGIONAL MEDICAL CENTER, L.P.

Issued

Aug 18, 2015

Abate by

Sep 20, 2015

Penalty

Initial $7,000 · Current $0 Reduced

General-duty citation text

OSH ACT of 1970 Section (5)(a)(1): 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 was 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 workplace violence.   At Bergen Regional Medical Center, employees who provide medical and psychiatric care to patients in the hospital?s Long Term Care, Behavioral Health Care and Acute Care divisions were exposed to physical assaults and threats. During routine interactions with patients and others, employees including but not limited to Mental Health Assistants, Certified Nurse Assistants, Registered Nurses, Licensed Practical Nurses, Social Workers, technicians, and security officers were exposed to numerous incidents of violent behavior and threats by patients, and visitors. These incidents resulted in injuries to the head, eyes, face, hands, legs, and body from hits, kicks, punches, as well as exposure to bloodborne pathogens from human bodily fluids. Specifically:    (a) On or about February 22, 2015, a patient in the Psychiatric Emergency Department violently attacked a Patient Care Provider and then punched, kicked and bit a Security Guard who intervened.    (b) On or about March 23, 2015, a Registered Nurse in Behavioral Health Services, unit C-1, was punched in the face while attempting to diffuse a verbal altercation between two patients.    (c) On or about April 9, 2015, a phlebotomist in the Emergency Department was punched in the eye while drawing blood from a patient who had consented for the blood draw.    (d) On or about May 12, 2015, while intervening when a patient attacked another patient in Behavioral Health Services, unit B-1, a Registered Nurse was pushed to the floor by the patient and sustained contusions and a laceration.    (e) On or about May 15, 2015, a Registered Nurse in Behavioral Health Services, unit B-1, was hit in the head by a telephone when a patient threw the Nursing station phone at the nurse.    (f) On or about May 28, 2015, in Behavioral Health Services, A-G department, a Mental Health Assistant was trapped in a room with a patient when the patient barricaded himself in his room using his mattress after he charged and threatened employees with a sharp pencil.    (g) On or about May 29, 2015, a Registered Nurse was shoved and punched in the arm and breast by a patient in Behavioral Health Services, B-G department, while she escorted the patient to the seclusion room.    (h) On or about June 12, 2015, a Security Guard responding to a ?Dr. Strong? incident in Behavioral Health Services, A-G department, was bitten by a patient and exposed to bloodborne pathogens.  Among other methods, feasible and acceptable means to abate the workplace violence hazards at Bergen Regional Medical Center include:   1) Engineering Controls: ? Install and regularly maintain alarm systems and other security devices, panic buttons, hand held alarms or noise devices at workstations or worn. ? Re-evaluate secure access controls in use at nurse?s stations, including but not limited to self-locking doors. ? Secure furniture, telephones and other items that could be used as weapons.  2) Administrative Controls: ? Develop and implement an effective and comprehensive Workplace Violence Prevention Program that includes management commitment, union and employee involvement, worksite analysis, hazard prevention and control, incident reporting and review, safety and health training, recordkeeping and program evaluation. ? Hire an outside consultant with expertise in assessing and addressing workplace violence in hospital and healthcare settings.   ? Conduct a thorough and unit-specific worksite hazard assessment regarding workplace violence, which includes the following:  Review reports and minutes from staff meetings on safety and security issues;   Analyze trends and rates in illnesses, injuries or fatalities caused by violence relative to initial or baseline rates;  Track changes in engineering, administrative and work practices to prevent workplace violence to evaluate effectiveness;   ? Establish a uniform violence incident reporting system across all hospital units and develop procedures for regular review of reports;  ? Implement, maintain or improve a system and procedures to perform a root cause or similar type of analysis for every incident of work place violence. The hospital should also review and evaluate the data collected to identify patterns and trends and to identify appropriate steps to minimize workplace violence hazards. Ensure that the post-incident review of workplace violence includes discussion with the affected employee(s). ? Establish and use system such as chart tags, log books or verbal census reports to identify patients and visitors with a history of violence. ? Ensure that all new and transferred patients are promptly screened for potential violence and past violent or assaultive behavior, and that such screening is considered when assigning patients to particular areas of the hospital. ? Evaluate workplace controls and implement new policies and procedures when appropriate to reduce violence in the workplace. ? Use the "buddy system" especially when personal safety may be threatened. ? Establish procedures to ensure communication of any incident of workplace violence to the staff that might come in contact with that patient so the employees who might not have access to a patient?s chart would be aware of a previous act of aggression or violence. ? Ensure that security staff members, and/or a response team other than employees on the floor are readily and immediately available to render assistance in the event of an incident of workplace violence and that all are provided with specialized training to deal with aggressive behavior. ? Ensure that units with heightened risk of workplace violence, such as the psychiatric floors/areas, have sufficient security staffing.   ? Develop and implement explicit procedures for employees to follow in the case of psychiatric patient medication refusals. ? Ensure regular meetings and involvement of the safety committee in the development, implementation, monitoring, and evaluation of the Workplace Violence Prevention Program.  The committee should be made up of representatives from management, security, and labor, as well as representatives from all departments and shifts. The committee should be involved in all aspects of worksite analysis, hazard prevention and control, training, recordkeeping and program evaluation.