Archive for: General Safety and Health

Report: OSHA losing inspectors under Trump

By: January 8th, 2018 Email This Post Print This Post

Before taking office, President Donald Trump expressed a desire to trim the federal workforce, something he has taken action on since getting sworn in last year.

OSHA is reportedly one of the federal agencies that have been impacted.

According to data obtained by NBC News through a Freedom of Information Act request, OSHA has lost 40 inspectors through attrition since Trump took office last January, and as of October 2, the federal agency had made no new hires to replace them. The 40 vacant positions represent 4% of the OSHA’s total federal inspection force, which fell below 1,000 in early October, according to the NBC News report.

A Labor Department spokesman told NBC News that OSHA has hired “several additional inspectors” since early October and is currently recruiting at least two dozen more. Still, even if OSHA is allowed to fill some of those open positions in the coming months, last year’s hiring lull could affect the agency’s future performance, argued Jordan Barab, an OSHA official under former President Barack Obama.

“Even after OSHA hires someone, they can’t just send them out to do an inspection by themselves,” Barab told NBC News. “This will have an impact for years.”

Meanwhile, due to limited resources and manpower, OSHA is prioritizing high-risk workplaces — such as construction sites and manufacturing plants — with increased rates of fatal accidents, serious injuries, and illnesses, the report said. It is not yet clear how much impact the loss of inspectors has had on the healthcare industry.

Back in May 2017, when the White House released its budget request for 2018 that sought to slash, among other things, the Labor Department’s budget, a cut of about 2% of OSHA’s budget was proposed. We noted at the time that even a modest cut could significantly impair OSHA’s ability to enforce workplace safety regulations.

According to the Labor Department, OSHA from October 2016 to September 2017 actually increased its number of inspections for the first time in five years, NBC News reported. But some activists, politicians, and former OHSA officials argue the loss of on-the-ground inspectors in specific regions expose workers to greater risk.

“OSHA is far too understaffed to fulfill its mandate of reducing workplace injuries,” U.S. Representative Rosa DeLauro, a Democrat from Connecticut, told NBC News. “Under the Trump administration, OSHA has suffered a troubling decline in both staff and work-place inspections in key areas of the country.”

A noisy OR puts more than patients at risk

By: January 8th, 2018 Email This Post Print This Post

Excessive noise can be distracting in any work environment. You might expect that to be an issue on a construction site or at an airport, but not in the OR.

A recent story published online by OR Today serves as a reminder that it can get loud in the OR, too, adding another degree of difficult to already-challenging tasks.

“Noise is a distraction that interrupts patient care and potentially increases the risk for error,” Mary J. Ogg, MSN, RN, CNOR, senior perioperative practice specialist with the Association of periOperative Registered Nurses (AORN), told OR Today. “It may minimize the ability of OR team members to communicate effectively, making it difficult to understand content and contributing to miscommunication.”

And that not only puts patients in peril, but potentially your employees, too.

A lack of focus in the OR could result in accidental injuries to surgeons or one of their assistants via needlestick injuries or knife cuts, for example.

Plus, as Ogg told OR Today, excess noise in the OR can negatively impact employees because it “is associated with job dissatisfaction, irritability, tachycardia, anxiety, fatigue, illnesses, stress, emotional exhaustion, burnout and injury.”

The article cited one study that found that the average noise level during OR trauma procedures was 85 decibels, nearly double the EPA-recommended limit of 45.

In addition to medical equipment such as powered surgical instruments and clinical and alert alarms, Ogg said common sources of noise in the OR include HVAC systems, phones and audio players, and non-case-relevant chitchat.

OR Today offered suggestions for reducing noise and distractions in the OR. The list included turning off cell phones and personal music devices (or leaving them outside the OR), limiting the amount of foot traffic in and out of the OR, and evaluating the noise level of medical equipment while deciding which devices to purchase.

Study: OR docs suffer high rates of ergonomic-related injuries

By: January 5th, 2018 Email This Post Print This Post

Is scrubbing into the operating room akin to walking onto a busy construction site?

A study published online last week in the Journal of the American Medical Association (JAMA) found that the prevalence of work-related musculoskeletal disorders (MSDs) among at-risk physicians, defined as surgeons and interventionalists, is comparable to what is reported among industrial workers and other high-risk laborers.

Citing “long work hours involving repetitive movements, static and awkward postures, and challenges with instrument design” endured by procedural physicians in operating rooms, researchers said they appear to face a high risk of developing MSDs.

Researchers examined 21 articles in their meta-analysis. Of the 5,828 physicians that made up the data pool, 19% had degenerative lumbar spine disease, 18% had rotator cuff pathology, 17% had degenerative cervical spine disease, and 9% had carpal tunnel syndrome. Researchers also noted that from 1997 to 2015, the prevalence of degenerative lumbar spine disease and degenerative cervical spine disease increased by 27% and 18.3%, respectively.

In addition to the pain an estimated 35% to 60% of physicians with a work-related MSD experienced, the study found that 12% of those physicians required a leave of absence, had to make changes or restrictions to their practice, or were pushed into early retirement — concerns that the researchers say continue to be overlooked.

They concluded that “given the impending physician shortage, this problem warrants prompt attention and action” and “further research is needed to develop and validate an evidence-based applied ergonomics program aimed at preventing these disorders.”

Until the healthcare industry does that, work-related MSDs are likely to continue to take a physical toll on procedural physicians while also costing hospitals and clinics financially via workers compensation payouts and decreased productivity.

Second ‘immediate jeopardy’ status lifted, still falling short

By: October 4th, 2017 Email This Post Print This Post

After a follow-up visit by state surveyors late last month, a Missouri hospital has had its second “immediate jeopardy” finding this year lifted. But the facility remains out of compliance.

Mercy Hospital Springfield retains its CMS certification despite continuing to fall short of the Conditions of Participation (CoP) pertaining to nursing services and patient rights, a spokesperson for the CMS regional office in Kansas City said this week. Surveyors will return to the facility once again this month to determine whether the hospital has brought its operation into compliance with the CoPs, the spokesperson said.

In January, surveyors faulted the hospital’s Behavioral Health Unit (BHU) for failing to properly handle certain tense situations, including one incident that involved a scuffle between a nurse and a patient diagnosed with schizoaffective disorder. That survey resulted in an immediate jeopardy finding, but the status was removed when the hospital provided an immediate action plan to remedy the situation. The BHU worker involved in the scuffle was placed on administrative leave in January, then his employment was terminated in February.

In April, a follow-up visit determined that the hospital’s condition-level deficiencies had been corrected, though there were still standard-level citations pertaining to patient rights, according to records obtained via state and federal public records requests.

In August, the hospital was found in immediate jeopardy once again and given less than a month to address its problems or lose Medicare funding. The facility fired 12 workers, implemented new and additional training modules, and brought in an interim leadership team before surveyors returned for their follow-up visit.

One former nurse in Mercy’s Emergency Department (ED) wrote an opinion piece for the Springfield News-Leader defending the fired workers. David Schneider, a traveling nurse, argued that ED staff are subjected to verbal and physical threats and abuse on a daily basis, adding to the difficulty of their jobs.

“Health care staff in Springfield are being abused by members of the community on a daily basis and as the result of the employee terminations at Mercy … many of those health care members now feel more unsafe,” Schneider wrote.

Additional detail on the Statement of Deficiencies and Plan of Correction stemming from the August inspection are not yet publicly releasable but should be available soon, the CMS spokesperson said.

A hospital spokesperson didn’t respond to my request for comment this week, but the News-Leader reported that the hospital released a statement Friday announcing that the immediate jeopardy had been lifted. Jon Swope, interim president of Mercy Springfield Communities, thanked the hospital’s stakeholders for their input and hard work in implementing a variety of changes.

“I’m certain Mercy Hospital Springfield will be even better because of these efforts,” Swope said in the statement, as the News-Leader reported. “We are empowering our co-workers with additional skills and resources so they may fully cherish the dignity of every individual we serve.”

List of OSHA standards cited most frequently in 2017 released

By: September 28th, 2017 Email This Post Print This Post

Fall protection training requirement makes debut on annual top 10 list

The annual list of most-frequently cited OSHA standards was released this week at the National Safety Center (NSC) Congress & Expo in Indianapolis. Although the list looks pretty similar to years past, there has been some movement.

The general requirements of fall protection (1926.501) ranked first on the list again this year, as it did last year and the year before that. The top five categories, in fact, have held their positions for the past three years.

The hazard communication requirements (1910.1200)—which are especially pertinent to healthcare employers and other industries where workers handle hazardous substances—have held steady as the second-most-frequently cited set of OSHA standards.

Citations related to electrical wiring (1910.305) have continued their downward trend relative to the other top standards, moving from eighth place to 10th in two years. This year’s ninth-place finisher, fall protection training requirements (1926.503), jumped onto the list for the first time in recent memory.

For more detail on the OSHA standards for the past three years, review the chart below. (Or click here for the PDF version.) The numbers associated with each category indicate the number of violations cited under each set of standards. These numbers are based on each fiscal year, and they are considered preliminary. A final report will be published in the December edition of NSC’s Safety+Health magazine.

NSC President and CEO Deborah A.P. Hersman said in a statement that the list of top OSHA violations is “a blueprint for keeping workers safe.”

OSHA-Top10-citations-three-years

Deadline suspended for Missouri hospital facing second ‘immediate jeopardy’ finding this year

By: September 27th, 2017 Email This Post Print This Post

A hospital in Missouri had been given until September 22 to bring its operation into compliance with the CMS Conditions of Participation (CoP) after surveyors last month found significant problems pertaining to nursing services and patient rights. That deadline has been suspended, however, as federal regulators review the findings of a follow-up visit.

State surveyors returned last week to Mercy Hospital Springfield to determine whether the facility has fixed the problems that led to the “immediate jeopardy” findings in August, a spokesperson for the CMS regional office in Kansas City said this week. Suspending the deadline gives CMS time to review what the follow-up surveyors found, the spokesperson said.

In early September, the hospital announced that it had recently fired 12 employees after determining that their behavior in “highly tense situations” had been inadequate. Remaining staff members would receive additional training on de-escalation techniques and preventing patient abuse and neglect, the hospital said. The following week, an interim leadership team stepped in.

“Everything we’re doing is to ensure the well-being and safety of everyone, including our co-workers,” hospital spokesperson Sonya Kullmann said.

Details from the August inspection are not yet publicly available, but records obtained via the Missouri Sunshine Law and the federal Freedom of Information Act indicate that Mercy Hospital Springfield has struggled recently to recognize incidents of possible abuse and neglect. The Missouri Department of Health and Senior Services and CMS each released the findings of a complaint investigation conducted in early January and the hospital’s subsequent plan of correction. (To review the 219 pages of records released by the state, download the PDF.)

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Missouri hospital in ‘immediate jeopardy’ fires 12 workers, installs interim leadership team

By: September 13th, 2017 Email This Post Print This Post

Corrective steps being taken to protect patients and workers alike, hospital says

A hospital in Missouri at risk of losing its Medicare funding within the month installed an interim leadership team this week as it seeks to appease federal inspectors.

Mercy Hospital Springfield was placed in “immediate jeopardy” by CMS after an inspection last month found significant violations of the regulations pertaining to nursing services and patient rights. The hospital announced last week that it had fired 12 employees whose behavior in “highly tense situations” was deemed inadequate. That news was followed Tuesday by an announcement that the interim leaders would step in to right the ship.

“They bring a fresh perspective and will help bolster local resources,” said Jon Swope, interim president of Mercy Springfield Communities, in a statement announcing six temporary leaders.

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Treatment center slapped with $207k proposed fine as OSHA announcements grow rarer

By: August 16th, 2017 Email This Post Print This Post

Facility accused of failing to address workplace violence risks it had promised to remedy

A psychiatric treatment center in Massachusetts faces more than $207,000 in proposed penalties after OSHA accused the facility of failing to adequately protect employees from workplace violence, despite having promised specifically to do so.

Notice of the proposed action against Lowell Treatment Center, which is operated by UHS of Westwood Pembroke Inc., comes as OSHA has grown significantly quieter about its enforcement activity under President Donald Trump’s administration than it had been under former President Barack Obama. There have been fewer enforcement-related OSHA press releases issued in the seven months since Trump took office than there were in just the final month of 2016.

It remains unclear how OSHA decides which enforcement actions warrant a press release. An agency spokesperson was not immediately able Wednesday to answer questions about this threshold. But we know that this case entails allegations that the facility failed to keep specific promises it made last year in a formal settlement agreement stemming from an unfavorable 2015 evaluation by federal inspectors.

“Our inspectors found that employees throughout the Lowell Treatment Center continued to be exposed to incidents of workplace violence that could have been greatly reduced had the employer fully implemented the settlement agreement,” OSHA’s Boston-based regional administrator Galen Blanton said last week in a written statement.

The management company, which operates 350 facilities throughout the United States and United Kingdom, notified OSHA that it intends to contest the findings, according to the press release.

Micah Smith, an OSHA attorney with Conn Maciel Carey in Washington, D.C., said during a webinar Tuesday that the Obama administration had engaged in “regulation by shaming.” And any Republican in the White House would be expected to back off of Obama-era levels of enforcement, he said.

“We’re expecting to see this change, and that press-heavy enforcement model to be rolled back,” Smith said. “We haven’t seen any official actions, but in the early days of the administration, most agencies across the government have been encouraged or required to reduce their press activity.”

Smith said there were two or three OSHA enforcement press releases in June and July this year, compared to 25-40 for each of the same months last year. Even so, it’s important to note that OSHA’s priorities are just as unsettled as its staffing.

“As with all things, without the permanent OSHA team in place, we’re still reading the tea leaves a little bit,” Smith said.

The press release in this case comes two months after OSHA endured criticism for backing off an allegation that Bergen Regional Medical Center (BRMC) in Paramus, New Jersey, had an inadequate workplace violence prevention plan. Jordan Barab, a former OSHA official under Obama, drafted a lengthy blog post critical of the move, and he clashed on Twitter with Eric Conn, another attorney with Conn Maciel Carey, who was hired to represent BRMC’s defense against the citation.

Barab, who has also been critical of the marked decrease in the issuance of OSHA enforcement press releases, hasn’t blogged since OSHA issued its press release last week.

Update (8/23/17): Barab blogged yesterday about this case. “Although I am frequently critical of OSHA under the Trump administration,” he wrote, “never let it be said that I have failed to praise the agency when they do something good.”

Bizarre circumstances led to hospital’s hazmat response, ER lockdown

By: August 2nd, 2017 Email This Post Print This Post

Report: Suspicious package that prompted mini-emergency was letter from government agency

If you subscribe to HCPro’s monthly Briefings on Hospital Safety newsletter, you will recall the story of a hazardous material scare and emergency lockdown at Frederick Memorial Hospital in Maryland. Two men opened a piece of mail at home in May, discovered a suspicious substance inside, and began experiencing skin and respiratory irritation, so they went to the local ED—and brought the unknown substance with them. That, of course, sent hospital staff scurrying to contain the threat.

Because the men live across the street from the U.S. Army’s Fort Detrick, a hub for biodefense research, there was added concern that the substance might be a biological agent. That turned out not to be the case. Investigators quickly identified the substance as a relatively common household chemical. But the circumstances leading up to that hazmat scare and lockdown, as reported in the local newspaper, are still baffling.

The substance that caused the hubbub was ultimately determined to be an ingredient found in rat poisoning, The Frederick News-Post’s Jeremy Arias reported last week. That substance was delivered in an envelope from the National Institute of Standards and Technology (NIST) in Gaithersburg, Maryland, to the home address of Jay Zimmerman, who said he had held a position with NIST for 33 years. The envelope also reportedly contained a letter from NIST informing Zimmerman that he would be removed from his position.

Zimmerman, who retired from NIST in June, told the News-Post that he believes his former employer used the substance to target him as an act of retaliation because Zimmerman had filed a complaint against NIST earlier this year alleging discrimination and harassment on account of his sexual orientation and disability. A spokesperson for NIST declined to comment on the allegations, citing the Privacy Act.

Investigators reviewed surveillance footage at NIST that shows the suspicious package being sealed, Frederick police Sgt. Andrew Alcorn told the News-Post.

“There is nothing on the video that appears to be suspicious or that indicates any of that substance was put into the package at that point,” Alcorn said.

Although the case was officially suspended without any charges being filed, the resulting response gave Frederick Memorial an opportunity to test its own emergency preparedness.

“When events like this take place,” said Phil Giuliano, the hospital’s director of public safety and security, “I think it’s a reminder for hospital staff, hospital leaders, and community members as a whole how important it is to have strong relationships, to maintain strong relationships with those other partners you have in your county, in your jurisdiction, in your area of operations.”

For more on this story and how Frederick Memorial kept its workers and patients safe, be sure to read the News-Post’s full report and the August edition of Briefings on Hospital Safety.

Spruced-up online OSHA form aims to help whistleblowers

By: July 28th, 2017 Email This Post Print This Post

A revised online form backed by OSHA aims to make it easier for whistleblowers to complain about their employers, the U.S. Department of Labor (DOL) announced Friday.

Workers still have a right to lodge formal complaints in a number of other ways: snail mail, fax, hand-delivery, verbally on the phone or in person. But the updated web-based filing option offers an interactive option available all day every day, designed help workers navigate the potentially daunting seascape of laws and regulations that keep worker rights afloat.

The whistleblower provisions of some 22 statutes are enforced by OSHA, affecting everything from workplace health and safety to consumer protection and nuclear power. (Details on that are available at www.whistleblowers.gov.)

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Jobs report: American healthcare sector keeps growing amid uncertainty

By: July 7th, 2017 Email This Post Print This Post

While the number of people working in construction, manufacturing, and several other major industries held steady last month, the American healthcare sector continued to grow, adding 37,000 jobs in June, the U.S. Bureau of Labor Statistics (BLS) announced today.

That figure outperformed the average number of healthcare jobs gained monthly all of last year and so far this year, the BLS announcement noted. (The economy added 32,000 healthcare jobs per month, on average, in 2016 and 24,000 jobs per month in the first half of 2017.)

The number of people working in hospitals grew by 12,000 in June, but employment in ambulatory healthcare services grew even faster, with 26,000 jobs added. This reflects a decades-long shift in how and where physicians and their staffs care for patients. More services are being offered in outpatient settings, and some community hospitals, especially in rural areas, have fallen on hard times.

The shifting landscape impacts everything from the way clinics ensure basic environmental cleaning to how health systems strategize with regard to employment and market share. And, of course, it impacts the way OSHA and other regulatory bodies go about protecting workers and the public.

Across all industries, the U.S. economy added 222,000 jobs in June, beating both expectations and recent monthly averages. This bird’s-eye view of the economy, however, misses much of the nuance on the ground level, where many hiring managers are on unsure footing. Healthcare employers, especially, are watching Washington, where the Republican-controlled Congress and White House are struggling to finalize a budget and healthcare plan, as The New York Times reported.

“This is an unprecedented level of political uncertainty,” William E. Spriggs, chief economist for the AFL-CIO union, told the Times. “That is creating a drag on the economy.”

Hiring at medical labs and nursing homes, for instance, has been on the decline, Spriggs said, attributing the slowdown to the number of unknowns in the future of the U.S. healthcare system.

For the latest news and advice in healthcare safety and compliance, be sure to follow HCPro’s line of products to keep you informed and thriving.

‘Don’t Hold The Door’: Boston hospital uses multimedia approach to reinforce safety training

By: June 23rd, 2017 Email This Post Print This Post

Brigham and Women’s Hospital (BWH) in Boston is well-acquainted with the dangers an unauthorized person can pose when granted access to restricted areas. The facility suffered unflattering headlines earlier this year when the public learned that 42-year-old Cheryl Wang had bluffed her way into five ORs and other patient care areas late last year by posing as a doctor-in-training, despite having been dismissed from her surgical residency program.

Wang’s case—which brought an unsettling reminder of the 2015 security lapse that enabled a disgruntled man to corner and kill a BWH doctor in an exam room—drew attention to an extremely common security vulnerability known as “tailgating” or “piggybacking.” When walking through a doorway, it’s common courtesy to hold the door for whoever is behind you. That’s a problem, however, if the person behind you doesn’t have permission to go where you’re going.

To reinforce the lesson that every hospital employee has a responsibility to help keep unauthorized people out of restricted areas, BWH produced instructional videos that depict disturbingly mundane security lapses. The two dramatizations, titled “Be Aware” and “Don’t Hold The Door,” will be shown to all 18,000 of BWH’s employees.

“We intended for the videos to be provocative, to invoke a strong reaction, so that they would be memorable,” said Erin McDonough, BWH’s chief communication officer, in a statement.

One video depicts two workers chatting as they return to their stations from a coffee break, unaware that an unknown woman has followed them onto a restricted elevator. From there, the woman gains access to a maternity ward to abduct a newborn. The other shows a worker in scrubs politely holding the door for an unknown man.

Be Aware from BWH Public Affairs on Vimeo.

“Closing a door to someone feels uncomfortable and impolite, and it contradicts what many of us have been taught from a young age,” McDonough said. “We need our staff to know the potentially dangerous consequences of enabling people who do not have permission to access restricted areas—whether consciously or unconsciously—and give them tools that empower them to take action.”

The two videos are the centerpiece of BWH’s safety campaign, but they are buttressed by a multi-pronged approach that includes the following:

  • Signage. The points where unauthorized access is most likely to occur, including some 1,200 card scanners throughout BWH’s facilities, will be labeled with signs to remind workers to be aware of who’s coming with them.
  • Reminder cards. Workers will be issued additional cards that bear the slogan “Stop, Challenge, Assist,” with a phone number for hospital security, as a reminder to use their privileged access with caution and care.
  • Policies. Employees who are followed by an unauthorized person are now required to abide by two updated policies: Either question the person directly, or contact security to do so. There’s no option to merely dismiss the unauthorized access as nonthreatening.
  • Training. After hospital employees screen the two videos, they will role-play related scenarios with a security team, then follow-up to session with a Q-and-A to discuss what they learned.

In addition to training its own staff, BWH has opted to share the components of this campaign far and wide—a helpful gesture, considering that tailgating and piggybacking are a safety consideration in every healthcare facility.

“People who work in the healthcare setting have a natural inclination to help others,” said Dave Corbin, BWH’s director of security and parking, in the statement. “Our campaign emphasizes that being aware is one of the best ways for them to ensure the wellbeing of patients, their families and each other.”

Don't Hold the Door from BWH Public Affairs on Vimeo.

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