OSHA Inspection: HRI HOSPITAL INC

Issued

2017-01-19 00:00:00

Abate by

2017-04-21 00:00:00

Penalty

Initial $12675.00 · Current $0.00 Reduced

General-duty citation text

OSH ACT of 1970 Section (5)(a)(1): 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 in that employees were exposed to the hazard of being physically assaulted by patients who exhibited aggressive behavior, resulting in serious injuries to employees while working at HRI Hospital.    On or about August 3, 2016, Nurses and Mental Health Workers  (MHW) in the inpatient psychiatric units  and dual diagnosis units at HRI Hospital were exposed to acts of workplace violence while working with patients who presented aggressive behavior including but not limited to: direct attacks involving punches, kicks, scratches, being hit with objects such as a soda bottle that was bounced off a wall and injured an employee and an employee being hit with a  drawer that a patient pulled out of a dresser.  Employees were assaulted and injured during restraint holds where a patient was resisting, including biting hitting and kicking. Employees have suffered bodily injuries including concussions, hematomas, fractures, bruises, lacerations, and bites while providing care to aggressive and violent individuals. The employer has not developed and implemented adequate measures to protect employees from the hazard.  Among other methods, feasible and acceptable means to abate the hazard of workplace violence at HRI Hospital include:     1)      Development of workplace violence controls, including implementation of engineering and administrative controls and methods used to prevent potential workplace violence incidents.       a)      Ensure adequate staff coverage for ?Code Green? incidents to ensure these responses can be fully functional, and that the required patient acuity and staffing ratios can be maintained on each shift, including when there are multiple admissions during a shift, and to ensure continued adequate coverage for remaining patients such as those requiring one-to-one care.  Ensure that all staff know which staff members are designated to respond to Code Green incidents on each shift.    b)      Implement a buddy system when necessary to provide service to patients with a history of violence.    c)      Employ security staff when necessary to assist in responding to violent events. If such security staff is used, ensure they are provided appropriate training and staff understands their duties, and the specific needs of a psychiatric hospital and patients.    d)     Provide silent emergency alerting buttons that are carried by workers throughout their shift to call for help in any location in the event of an escalating situation with a patient. In the event that these alarms are not functional in all locations throughout the facility due to poor signals, ensure that staff  know the areas where panic buttons are functional and where they are not, and provide an alternative alerting system for those areas that do not have signal coverage. Dedicate security personnel or other trained staff to monitor the alerting system and location indicators to allow for quick response time.      e)     Train and assign staff to monitor the camera surveillance system in the inpatient psychiatric units to allow for quick response time.  Ensure staff and patients are informed of the camera surveillance in terms of coverage and use.     f)       Where feasible, replace or redesign furniture with drawers that can be pulled out and used to hit people. Utilize open shelving units to replace dressers and desk drawers.      g)      Evaluate the open design nurses stations and ensure that patients cannot reach into the work area and assault or injure employees. One option is to install unbreakable clear barrier to raise the height of the station. Secure items that can be accessed and used as to hit people such as phones, computers and other equipment at the nursing stations.     h)      Evaluate the med rooms with ?split doors? to minimize the upper opening to prevent patients from reaching in and assaulting employees.       2)      Ensure that the Restraint Reduction Committee or another safety committee or subcommittee addresses the safety of staff; conduct regular meetings and ensure the committee involves frontline employees including social workers, nurses and mental health workers.  The committee?s function and goals should include the review of any workplace violence incidents and near misses, trend analysis and follow up on any/all items noted within Loss Prevention Control Site Report(s).   Ensure that the workplace violence prevention team members have the requisite skills to identify the underlying causes of violence and develop effective intervention strategies. This team should have an equal number of management and non-management members, specifically frontline workers who are experiencing the violence.    3)       Implement incident reporting and prompt investigations to ensure all reports resulting in injury are promptly investigated with written findings, recommendations, and plan for corrective actions.    4)      Clearly post protocols for reporting safety concerns internally, and provide employees with assurance that concerns can be reported without fear of retaliation. Develop a system to provide communication and feedback to employees about their safety concerns and suggestions.       5)      Implement additional training components for supervisory, nursing, on-site mental health workers, and other employees providing direct care to patients with a history of violent behavior, including but not limited to:       Appropriate use of de-escalation, self-care and protection, utilization of Code Green systems including appropriate documentation of this training.      Train personnel in how to conduct effective investigations of workplace violence incidents.      Implement site drills targeting In Patient and Dual Diagnosis Units for staff utilizing emergency response systems; care, use and maintenance of alarm tools and other PPE and devices.      Implement additional live training components (Handle with Care, Safety Care and/or Crisis Care) focusing solely on the  appropriate use of physical and holding restraints as per policy to Mental Health Workers, supervisory staff, nursing staff, and others working directly with patients with a history of violent behavior.      Conduct regular meetings with State and Local law enforcement personnel to facilitate appropriate responses to incidents.      Assess the need and schedule refresher training on de-escalation (such as the Handle with Care system currently in use) for new hires, and other staff, and include real world scenarios during training events.      6)      Evaluate and update the present written violence prevention policy. A written program shall include site specific details on the implementation of the program. Ensure workers are all in informed of contents of the program and how to access a copy of the comprehensive document. A written program for preventing workplace violence for health care workers should include sections with specific details in the following areas: i) Management commitment and employee involvement;  ii) Implementation of the written program; iii) Worksite analysis;  iv) Hazard prevention and control;  v) Training and education; and vi) Record Keeping.      a)      Assign the duties of an overall workplace violence prevention program to a specific position (individual); ensure the position includes overall coordination of the hospital?s Workplace Violence Prevention program and the responsibility for conducting thorough incident investigations with assistance from the workplace violence prevention team.      b)      Clearly verbally explain to all admitted patients, as well as family members and visitors, that physical violence against staff and destruction of hospital property is not tolerated. Provide this message in writing as well.    c)      Ensure the violence prevention policy includes specific protocols for contacting law enforcement in the event of an actual or threatened violent attack.  Communicate this policy to employees.    d)     Ensure the written workplace violence policy statement includes specific sections relating to patient violence/aggression on staff and co-worker violence.  The policy also needs to include protocols and management responsibilities in responding to incidents.  Ensure policy includes language prohibiting retaliation for staff reporting patient violent acts and aggression perpetrated by patients.    7)      In keeping with accepted clinical guidelines and training criteria, develop and communicate clear written protocols regarding the utilization of holding and physical restraints in response to patient aggression and violence.    8)      At least annually review and update the facility's Workplace Violence Policies and workplace violence awareness training including, ?Handle with Care, Behavioral Management System,? and emergency codes including ?Code Green? to ensure that procedures are in place for managing worst-case scenarios in which staff are unable to control or contain an incident.    9)      Update facility Incident Reports to include documented supervisor input and follow up with the affected employee.  Perform root cause analysis for each reported incident of assaultive behaviors, such as but not limited to, bites, scratches, punches, kicking, etc.