OSHA likes to tout itself as a governmental agency that looks out for workers in all industries. But they aren’t doing a very good job of announcing a huge change to guidelines that could help protect healthcare workers from the rising problem of workplace violence.
It took a couple of well-connected readers to let me know that OSHA earlier in April released an update to its Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers, known to many in the safety field as OSHA Rule 3148. Good luck finding any of this on the OSHA web site, by the way.
After an inquiry to OSHA public relations, I was sent the updated guidelines, which you should pay attention to if you are in charge of safety at your facility.
According to its own statistics, OSHA says in 2013 more than 23,000 significant injuries were caused due to assaults at work. More than 70 percent of these assaults were in healthcare and social service settings. Health care and social service workers are almost four times more likely to be injured as a result of violence than the average private sector worker, OSHA says. Further statistics show that about 27 out of the 100, or about 30% of the fatalities in healthcare and social service settings that occurred in 2013 were due to assaults and violent acts.
Under pressure to do something about this, the updated OSHA 3148 recommends that all healthcare facilities develop an effective workplace violence prevention program. Pay attention, because the word is that the Joint Commission is also following these changes closely.
The new OSHA guidelines are very specific in the types of workplace controls that employers should consider, especially when it comes to facility security and keeping track of employers. Examples include:
- The use of silent alarms and panic buttons in hospitals and medical clinics
- Providing safe rooms and arranging furniture to make sure there are clear exit routes for workers and patients
- Installing permanent or hand-held metal detectors to detect weapons, and providing staff training on the use of these devices
- Ensuring nurse stations have a clear view of all treatment areas, including the use of curved mirrors and installing glass panels in doors for better viewing, as well as closed circuit cameras to help monitor areas
- Using GPS, cell phones, and other location technology to help keep track of staff working with patients in off-site locations
- Protection front-end and triage staff using facility design elements such as deep counters, secure bathrooms for staff separate from patient treatment areas, and using bulletproof glass and lockable doors with keyless entry systems
In addition, the recommendations include employing administrative controls designed to track patients and visitors who have a history of violence, to better educate workers on the dangers and signs of impending violence, and to ensure better reporting procedures. Some of these recommendations include:
- Providing clear signage in the facility that violence will not be tolerated
- Instituting procedures that require off-site staff to log in and log out, as well as checking in with office managers periodically
- Keeping a behavioral history of patients, including identifying triggers and patterns
- If necessary, establish staggered work times and exit routes for workers who may be subjects of stalkers
- Keep a “restricted visitor” list for suspected violent people, such as gang members, and make sure all staff are made aware
Also, OSHA recommends that employers provide updated training for employees, including:
- Risk factors that cause or contribute to violent incidents
- Early recognition of escalating behavior or recognition of warning signs
- Ways to recognize, prevent or diffuse volatile situations or aggressive behavior, manage anger and appropriately use medications
- Proper use of safe rooms—areas where staff can find shelter from a violent incident;
- Self-defense procedures where appropriate
- How to apply restraints properly and safety when necessary
- Ways to protect oneself and coworkers, including use of the “buddy system”
For more information, the Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers can be found at https://www.osha.gov/Publications/osha3148.pdf
Hi folks –
As you know, from time to time, I will ask you for your feedback about various safety products and books that we are working on for you here at HCPro.
We are currently planning to publish a book about planning and conducting hospital emergency exercises and I could use your help with a little market research.
I would like to know what our customers would like to see in reading and utilizing such a book, and so I invite you to please take five minutes to complete this quick six question survey to let us know what you think.
As always, I appreciate your input, as we are constantly striving to create products that help you do your job better.
Have a great day!
Managing Editor, Safety
After watching the news reports of the devastation caused by the tornadoes out in the Midwest last week—and hearing the relief in the voice of my aunt who lives 20 miles away from an Illinois town that was completely wiped out by a monster twister—I have a newfound respect for the weather.
As the weather turns warm, I also have a bit of a soft spot for the healthcare safety folks who have to prepare for the onslaught of severe weather that inevitably marks the arrival of spring every year. We may have had our share of a tough winter here in the Boston area, but I sleep soundly at night knowing spring will arrive with showery weather at worst. A monster windstorm that can wipe out a facility in seconds with 300 mile-per-hour winds is just something folks here don’t worry about.
It’s a much different story in the Midwest, and that’s why I was so excited to hear (and to write) about the grand reopening of Mercy Joplin Hospital in Missouri late last month. It’s been about four years since the previous hospital, St. John’s Regional Medical Center, was completely destroyed after a direct hit from an EF-5 tornado in May 2011. It’s really pretty amazing that anyone survived; the roof of the building was blown off, cars in the parking lot were tossed like toys into the hospital’s waiting room, almost every exterior window shattered, communication was completely shut down, and an electrical generator and HVAC system on top of the hospital was tossed off the building and rendered useless.
Still, only six people in the hospital died, as the facility’s well-rehearsed emergency plan went into place and staff members evacuated 183 patients from the building.
The community pulled together and on March 7, Joplin opened its new $450-million hospital with features that make it as “tornado-proof” as it can be. Logistical things such as concrete bunkers that house backup utilities underground, as well as glass panels that can withstand a twister’s changes in atmospheric pressure will at least allow the hospital to stay operational and safer should the unthinkable ever happen again.
I’d like to personally congratulate Mercy Joplin on their new digs, and I think anyone interested in learning how to harden their own facility against the worst the weather has to throw at us should take a good, long look at Joplin.
As we approach the 50-degree mark here in Boston, I for one am doing the equivalent of a happy dance.
There’s no doubt—for most of us, it’s been a cold and snowy winter and with April 1 comes, at least psychologically, the fact that spring has sprung.
But unless you take a good look around, and inventory the safety issues around your facility, safety experts say the medical clinic or laboratory can actually be a pretty dangerous place when the weather warms up.
Here are the things safety expert say you should keep in mind to help keep your facility safe this spring.
Room temperature. As the temperature outside rises, it’s important to make sure the temperature inside stays constant, both for personal comfort and for safety.
“You need to make it comfortable for your staff so they will wear PPE,” says Dan Scungio, MT (ASCP), SLS, Laboratory Safety Officer for Sentara Healthcare, a multi-hospital system in the Tidewater region of Virginia, and otherwise known as “Dan, the Lab Safety Man.
If you don’t already have a stash in storage, now is the time to buy lightweight lab coats for your staff that are made with materials designed to be cooler, but with the same protective and spill-proof qualities.
Another thing to consider, especially in the lab environment, is that many reagents and chemicals need to be kept at a constant temperature and humidity level to maintain their stability and quality, Scungio says. By changing the temperature of the air inside you risk compromising the safety of those chemicals.
Slips and falls. The problem with transitional seasons like spring and fall is that it’s so difficult to count on any consistency. Temperatures might be warm and toasty during the day, melting any snow and ice that may have accumulated. At night, however, temperatures can dip back down into freezing territory, making your entrances and parking lots hazardous.
Remember also that Mother Nature often likes to tease. In many areas of the country, it’s not unheard of to get snowstorms into May. For that reason, you should always have a supply of sand and salt nearby, as well as snow shovels so you can keep common areas clear of snow and ice.
Propped doors. Sure, it’s a nice day and the sun is shining. The temptation to open the door and let a little of that goodness inside increases as soon as the temperature does. But don’t allow your employees to do it, experts say. In addition to making it difficult to keep inside air temperature and humidity at a consistent level, it’s a security issue.
An open door is a breach in your security wall, and invites intruders inside. At night, it becomes more of a safety concern because an intruder could use the darkness as a way to hide themselves from detection.
Shoes. Warmer weather brings with it the temptation to break out the flip flops, sandals, and open-toed shoes, which have no place in the healthcare workplace. In addition to opening up toes to hazards from falling equipment and spilled chemicals and body fluids, sandals and flip-flops can lead to tripping hazards, and exposed toes can be a sanitary issue.
A better choice is a shoe with better traction such as sneakers that offer comfort while protecting the feet. It’s also a good idea to remind your staff and visitors to watch their step outside when it’s slippery and on wet floors. Some experts suggest “walking like a penguin,” shifting body weight from side to side and taking small steps to help prevent falls.
Fans. If they can’t open the door to let some air in, some of your employees might be tempted to turn on a fan to cool things down. Bad move, experts say.
If you’re dealing with any kind of work that involves lab slides with cultures or samples on them, using a fan can blow dust and other matter on them and contaminate them, Scungio says. If you need a fan, it’s too hot. Lower the temperature with the HVAC system instead.
Most of you in the healthcare safety profession spend your career trying to keep your facility out of the way of mayhem and destruction.
Last week, I spent some time talking to Wayne Hellerstedt, the interim CEO of Curry General Hospital in Gold Beach, Oregon. If you’ve ever been to the beautiful beaches of Oregon you understand why the folks who live there along Route 101 wouldn’t want to be anywhere else.
But living there is a gamble: Only about 100 miles off the U.S. Pacific Coast lurks a seismically active fault that emergency management professionals have been saying for years will produce an earthquake of magnitude 8 or greater – as well as a monster Tsunami—within the next 50 years.
So why is it that the town of 22,000 just approved the construction of a brand-new, $28-million critical access hospital right in the path of such a potentially destructive wave?
Call it necessity. The town’s current 18-bed Curry General Hospital was built in 1949 when there were no seismic building codes, and the building was last renovated in 1969. A one-envelope building located four blocks from the beach, the facility has no smoke corridors or fire doors, leaving it woefully behind today’s accreditation standards and has left it in constant threat of being shut down by local fire marshals. So what needs to be considered?
Risk assessment. For one, tsunamis are mercifully rare. The new Curry General Hospital is being built based on the risk of the area being hit by a monster tsunami. While yes, recent events in Indonesia and Japan show that a monster tsunami is indeed possible, the odds of a 100-foot tsunami hitting any one place on the planet are really very small.
Height above sea level. In Gold Beach, the town proper is only about a half-mile wide before the mountains start rising behind it. While the new hospital may be located only four blocks from the water’s edge, it’s still located 50 feet up on the hillside, a bet the town’s planners were willing to take.
Location. Gold Beach, while a beautiful place, is quite isolated, with the closest hospital facility located about 60 miles away to the north and the south. For that reason, the facility had to be designed to operate independently and cost-effectively—and it had to be located in the part of town where the population was centered. While going uphill would place the building out of the way of a higher tsunami, it puts it in danger from landslides and unstable ground. The building footprint is designed so water from a tsunami would drain back to the ocean.
Contingency plans. In the event of a crippling earthquake or tsunami, there’s a good chance the town of Gold Beach would be isolated for weeks or months, and may not have access to outside government resources.
Emergency plans call for transportation arrangements with local ambulance services to help patients and staff get to and from the hospital, and if needed, air ambulance service would be coordinated with helicopters and fixed-wing aircraft. In Gold Beach, the municipal airport is located right on the beach, so the new hospital is being built with a helipad in case it was unusable after a tsunami.