Hospital slapped for with workplace violence citation

By: July 19th, 2010 Email This Post Print This Post

An inspection prompted by an employee complaint led to OSHA citing the Danbury (CT) Hospital “for failing to provide its employees with adequate safeguards against workplace violence,” according to an agency news release, July 16.

The investigation found several instances where workers were injured by act of violence from patients in the psychiatric, emergency, and general medical floors, reports OSHA.

Additionally, inspectors identified 25 instances during the past five years of employees losing work days or assigned to restricted duty due to attacks by patients.

Under the general duty clause, the agency fined the hospital $6,300. Danbury Hospital has 15 business days to respond to the citation.

“This citation points to the need for the hospital to develop a comprehensive, continuous and effective program that will proactively evaluate, identify, prevent and minimize situations and conditions that place workers in harm’s way,” said Marthe Kent, OSHA’s New England regional administrator.

According to the news release, the OSHA citation suggested that the hospital take the following measures:

  • Create a stand alone written violence prevention program for the entire hospital that includes a hazard/threat assessment, controls and prevention strategies, staff training and education, incident reporting and investigation, and periodic review of the program
  • Ensure that the program addresses specific actions employees should take in the event of an incident and proper reporting procedures
  • Ensure that security staff members trained to deal with aggressive behavior are readily and immediately available to render assistance
  • Ensure that all patients receiving a psychiatric consultation are screened for a potential history of violence
  • Use a system that flags a patient’s chart any time there is a history or act of violence and training staff to understand the system
  • Put in place administrative controls so that employees are not alone with potentially violent patients in the psychiatric ward

For resources on preventing workplace violence in healthcare settings, see the June issue of Medical Environment Update and related reports and checklists under the workplace violence heading on the Tools page.


This is particularly difficult to address in a rural hospital setting, where violent situations rarely occur. When you cannot afford to hire security staff 24/7, nurses end up in the most dangerous situations. Facilitating a conflict de-escalation course has helped, along with summoning help from other staff in the building. Usually all it takes is the response of others for the perpetrator to realize they cannot continue their behavior…

Bonnie you bring up very valid points. In addition to those concerns we also have similar issues within the home health care environment. For all the patients hospital and treatment centers admit, they are discharged to home where our home health care workers are often going into the homes alone for the provision of home care as ordered by the physician. Many of the practices in place by facilities with respect to work place violence are not compatible in the home care world which brings staff into the homes where potential violence lives.

By David LaHoda on July 20th, 2010 at 11:46 am

Paula, be sure to see “Not so home-sweet-home healthcare.” It contains a link to a NIOSH alert specifically on violence in home healthcare.

It would be nice to really have a better picture on what these incidents were. I used to be on the board of directors for a nursing home and know that the incidents of “violence” increased significantly once the staff were no longer able to put a patient in restraints.

Others may say that there are other alternatives, but as stated above. Tough to implement alternatives when you are the only staff for x amount of patients.

By Steve Wilder on July 22nd, 2010 at 12:14 pm

I will respectfully disagree with some of the above comments, in that, while healthcare is a dangerous environment often laden with aggression and violence, it can be managed and prevented. I believe I can speak as qualified, as I am the co-author of the book “The Essentials of Aggression Management in Healthcare” published by Brady Publishing.

Key elements to a successful program includes a well written program, REALISTIC training, and ongoing evaluations. I have trained thousands of healthcare professionals across the nation, and you would be amazed how often I hear of hospitals and nursing homes having their staff watch a video, and considering that adequate training. No hands on…no training in verbal deescalation of escalating behaviors, no training in proper selection and use of restraints…no role playing or drilling…trying to use of soft restraints for behavioral control purposes…I could go on and on!

The same applies for the home care and long term care environments. There are good programs available for both, but either they don’t get the attention they deserve from administration, or the need isn’t taken seriously. I am excited to be presenting a program on violence in long term care in Arizona next month…it will be the first time we have been asked to address the subject for the LTC industry.

Thanks for letting me share.

Steve Wilder
Sorensen, Wilder & Associates
Champaign, IL

The type of violent incidents in LTC will differ greatly than in an ED, esp when you consider the population cared for (elderly vs younger) and the reasons that behaviors occur. I have worked extensively in both settings.
Our main area of concern is the growing number of prescription medication abusers and the unpredictable (ever see someone on PCP? It happens here, and no amount of verbal de-escalation will help) behaviors that they exhibit, esp when we educate them on our policy of not more than 3 days supply of a prescription from the ED. Also,in our immediate gratification society, people don’t want to wait an hour to see a doctor, even in a non-emergent situation. We have conflict de-escalation courses every year (for Home Care as well), a personal alarm system in three high risk areas, five local police agencies that will respond when we call, policies specific to security in the ED, prison population, etc, and in every exercise we incorporate security. The unfortunate reality is that these instances are probably going to increase.

I work in a small rural hospital. We have trained our staff on de-escalation & using Code White(Show of Force). We also have hired our local off duty police to do security at our hospital from 6pm to 6am seven days a week. This has worked very well for us and we have seen a reduction in the amount of issues. Staff love working with the officers and feel much more safe. The officers do building rounds (Internal/ External), escort visitors & just respond to any issues. Having the officers make themselves present has reduce the potential of any would-be problem makers.

Monica – I love the fact that you have taken proactive measures to ensure your staff safety. You are to be commended for protecting your staff and facility. We have been looking at hiring a contract company for security during the afternoon and evening hours when staff numbers are lower. I think the benefit would far outweigh the cost…

By Jennifer McDuffee on October 12th, 2010 at 12:17 pm

Here is a link for a podcast about workplace violence prevention in health care facilities, which addresses some of the issues in the comments above. The speaker is Eugene Rugala, a former profiler/supervisory special agent with the Federal Bureau of Investigation’s (FBI) Critical Incident Response Group (CIRG), and a national authority about workplace violence prevention.

Free posters to enhance Home Care and Hospice Safety are available at http://www.Best-Defense-USA.com_

Here is a link for free personal safety poster for home care and hospice

Here is a link to download free safety poster for home care and hospice.

By Matt Shafer on October 29th, 2010 at 10:46 am

I work in a metro atlanta trauma center. We encounter all types of people. After searching for the best class to help out associates with verbal control techniques and physical control techniques we found that was the best program for our staff. Not only do you get control of a situation, but you also make sure that the patient does not hurt your staff or them self. The course is a 16 hours course it goes over how to block a punch/kick. Also how to escape from someone chocking you and how to get someone off of you if you are on your back. Also the verbal techniques also stress the importance that you are here to help them and also to stop any threat toward you or any body else. There is also a woman DT class that is eight hours. Most nurses like this class. If you have any questions go to the website and find the contact information for Kip Teisort.


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