Archive for: General Safety and Health

Safety Month Showcase: Prevent workplace violence by recognizing threatening acts

By: June 25th, 2018 Email This Post Print This Post

The National Safety Council has designated June as its annual National Safety Month as a way to focus on “reducing leading causes of injury and death at work, on the road, and in our homes and communities.” In accordance with that, HCPro’s safety team will highlight a different healthcare-oriented safety topic each week in the month of June by sharing an excerpt from one of our many books, all available on HCMarketplace.com.

The focus this fourth and final week of June is workplace violence. The excerpt is from “Preventing Emergency Department Violence: Tips, Tools, and Advice to Keep Your Facility Safe,” authored by Lisa Pryse Terry, CHPA, CPP.

In her book, Terry provides healthcare personnel and security professionals with guidance for how to deal with violent patients and visitors, active shooters, uncooperative behavioral health patients, and disruptive prisoners. Terry also helps healthcare professionals recognize signs of violence, take steps to defuse tension, and respond appropriately. Plus, she offers real-life examples and training tools and provides sample response protocols and emergency department design ideas to help readers develop plans and make improvements in their facilities.

In this excerpt, Terry writes about recognizing threatening behavior in the ED.

The clock is ticking. The risk of a loved one not being treated quickly enough before her condition worsens causes great anxiety for a family member who begins pacing and becomes increasingly angry (potential risk). Seeing the crowded ED and assuming the staff are too busy to provide immediate attention for his family member triggers the perpetrator to seek immediate medical attention by commandeering staff to assist him (stimulus). An unattended door with a restricted access sign for employees only provides an opportunity for the perpetrator to grab and force a clinician to help now (opportunity to act). Violent behavior erupts, nurses are terrified, and chaos ensues.

The theoretical situation above could have been avoided with proper training and ability to recognize threats early. Understanding how perpetrators behave is key to managing threats. There are some commonalities among individuals who pose a threat. Recognizing threatening behaviors allows resources to intervene at the earliest possible stage.

Most all perpetrators consider, plan, prepare, and then act. This allows intervention at multiple points along the violence spectrum. But effective intervention to decrease threats is dependent on training and experience that enable security officers, public safety, and police officers to fully recognize and identify the early signals. Intervention also relies on nurses and healthcare staff understanding the signs of pending violence.

Nursing by nature requires staff to be physically close to patients who can quickly become agitated or violent. Close contact increases the likelihood that a nurse or other clinician will become the victim of physical violence, especially if the signs of violence are not recognized early. This increases the need for clinical staff training on the violence spectrum as well as related security training, de-escalation techniques, and personal safety training.

A collaborative effort and integrated training for healthcare security staff and clinicians increases safety for everyone. It also helps define roles and responsibilities if an event occurs. Collaboration reinforces what to expect if an event occurs and how resources can be quickly assimilated.

Security and healthcare staff who are able to proactively deal with threats and/or threatening behavior early—detecting threats early, evaluating them, and knowing how to address them—may be the single most important key to preventing and managing violence.

So how do security and healthcare professionals identify the signs to decrease threats?

In Chapter 3, we discussed the impact of the violence spectrum and the importance of managing threats of violence. All staff should be trained on the components of anger and impending violence, which present in three primary ways:

  • Physical reactions—These reactions include an individual’s response to anger, frustration, and potential violence such as an adrenaline rush, increased heart rate and blood pressure, and tightening of muscles for the “fight or flight”
  • Cognitive Experience—This involves how an individual perceives he or she is being treated. If he believes he is being treated unfairly, prejudicially, or in any negative way, the risk of becoming angry and violent escalates.
  • Behavior Changes—Individuals considering a violent action or response will display behavioral changes such as change in demeanor, verbal or voice changes, and nonverbal cues of agitation and frustration such as tapping fingers, rapid eye movement, or pacing.

Security and healthcare staff must understand the significance of verbal and nonverbal cues. Key threat management strategies focus as much on nonverbal communication as they do on verbal communication. According to various researchers, body language is thought to account for between 50 to 70% of all communication.

  • In a crowded waiting area, a family member feels claustrophobic and becomes agitated
  • A worried parent continually reaches out for the nurse’s arm in hopes of getting more attention
  • An agitated spouse paces back and forth in front of the doors leading to restricted treatment areas
  • The eyes of a frustrated patient dart back and forth continually.
  • An anxious spouse believes it is taking way too long to get an updated report on his wife, and begins clenching his jaw
  • A forensic patient visually scours the treatment room for a weapon of opportunity

These are all signs of potential violence. Space, touch, body movement, and perception of time are all ways people express their frustration and anxiety. Proactively identifying these particular behaviors of concern can help reduce the risk of violence in the ED and contribute to a better patient experience.

Responding to nonverbal cues may be as simple as providing a brief update on the status of a loved one; giving a person a reassuring smile and greeting; explaining that it’s important to conduct thorough testing to provide the best treatment possible; acknowledging a person’s feelings; or offering to get an anxious parent a cup of water while she waits. Eye contact can also indicate genuine interest and concern for a person and alleviate anxiety. In an overcrowded ED, speaking to the agitated person and offering to help him find a more comfortable place to wait can defuse anger.

Verbal communication is also an important indicator of agitation, frustration, and pending violent actions. Tone of voice, loudness, inflection, intonation, and rapid speech are red flags. Once verbal communication escalates to cursing, threats, and disrespectful language, rapid de-escalation is critical to lessen risks.

Working together, security and healthcare professionals can decrease or minimize threats to safety and block opportunities to act. They can integrate case management into the security management strategy to lessen the threats. Effective threat management strategies incorporate the STEP process.

  • S: De-escalate, contain, or control the subject who may take violent action
  • T: Decrease vulnerabilities of the target
  • E: Modify physical and cultural environment to discourage escalation
  • P: Prepare for precipitating events that trigger adverse reactions

 Utilizing the STEP Process is an effective means of managing threats. Some questions to ask in the process include:

  • What is motivating the individual to become a threat?
  • Has the individual communicated his/her intentions as a threat?
  • Is the individual demonstrating physical actions of threat?
  • Does the individual have access to weapons?
  • Are there unusual objects that could be used as weapons?
  • Are there bystanders to consider and remove from harm’s way?
  • Has the person taken aggressive action (pushing, striking)?
  • Is the person argumentative?
  • Is he/she displaying unwarranted anger?
  • What is the stimulus for action and how can it be removed?

Responding positively to verbal signs of anxiety is extremely important in the ED environment.  Keep your voice calm, repeat what you hear to reassure the person you understand, look the person in the eye when she is speaking, and seek to understand the underlying cause of agitation. People who visit the ED are usually nervous and fearful of a diagnosis or treatment process. Many things in the ED environment can put that fear into overdrive and then violence occurs. Watching for the earliest signs of violence and utilizing strategies to overcome fear and anxiety are an essential part of the healthcare security team’s job.

To purchase “Preventing Emergency Department Violence: Tips, Tools, and Advice to Keep Your Facility Safe,” please click here.

NELP report shows that OSHA enforcement has steadily declined under Trump

By: June 21st, 2018 Email This Post Print This Post

A few months ago, we wrote in our Medical Environment Update newsletter about how the Trump administration’s oft-stated desire to trim the federal workforce would likely lead to fewer OSHA inspections, and how that would be big problem for the safety folks who are tasked with keeping healthcare workers out of harm’s way.

Well, we have an update on that from our colleagues over at EHS Daily Advisor. This morning, they wrote about a new National Employment Law Project (NELP) report that showed that the number of OSHA inspectors continues to steadily fall under the Trump Administration, thus leading to a decline in OSHA enforcement overall.

Under the revised measurement system, OSHA reported that total enforcement activity reached 42,900 enforcement units (EUs) for 2016. For 2017, the number reported by the agency dropped by 1,071 EUs to 41,829. Also, reports NELP, OSHA’s data for the first five months of 2018 show that EUs are already down by 1,163 from 2017.

According to the NELP brief, the drop in enforcement activity can be tracked to the drop in inspectors. As of January 2018, OSHA had 764 inspectors, down from 814 in January 2017. “This has clearly led to serious cutbacks in enforcement activity that raises vital questions about OSHA’s ability to protect workers,” says NELP.

The brief does not address enforcement of OSHA or state standards by state agencies.

You can read the three-page NELP brief in .pdf form by clicking this link.

Safety Month Showcase: Tips for assessing behavioral health units for ligature risks

By: June 18th, 2018 Email This Post Print This Post

The National Safety Council has designated June as its annual National Safety Month as a way to focus on “reducing leading causes of injury and death at work, on the road, and in our homes and communities.” In accordance with that, HCPro’s safety team will highlight a different healthcare-oriented safety topic each week in the month of June by sharing an excerpt from one of our many books, all available on HCMarketplace.com.

The focus this week is on life safety. The excerpt is from Analyzing the Hospital Life Safety Survey, Third Edition, authored by Brad Keyes, CSHP.

In that book, Keyes, formerly of The Joint Commission and currently an HFAP life safety surveyor and independent consultant, provides a practical, strategic approach to the life safety survey process. He walks you through a room-by-room, floor-by-floor analysis of the life safety measures you must have in place to avoid costly citations. The book simplifies Joint Commission standards and CMS requirements and focuses on ways to pass your next life safety survey.

One issue being scrutinized by TJC, CMS, and others right now is ligature risks for suicide, something Keyes tackled in the book excerpt we are sharing this week.

Every behavioral health unit needs to be assessed for potential suicide hanging points. I am an advocate for a process that has a continuous risk assessment, conducted routinely (such as once a quarter), to make sure nothing has been overlooked—every assessment has a chance to uncover something new. The assessment itself simply evaluates any point on the unit where patients could potentially hang or harm themselves without the staff observing it. This primarily concerns the patient’s room and shower area, but could include any other room where patients are not continuously monitored.

Some items that a surveyor may inspect for possible hanging points are:

  • Shower curtains
  • Sink and toilet plumbing pipes
  • Open handrails and grab bars
  • Shower faucets and spray heads
  • Bed rails and grab bars
  • Patient clothes closet doors
  • Doorknobs and hinges
  • Tops of doors
  • Acoustical tile and grid suspended ceilings in areas that are not supervised by staff

If any of these items can support the weight of an individual, then they present a safety risk. A typical risk assessment should be conducted by various stakeholders from the organization, such as the behavioral health unit manager, the risk management manager, the safety officer, the facilities manager, the environmental services manager, the chief nurse, the security manager, and anyone else the organization believes should be included.

The basic assessment should: 1. Identify safety risks, 2. Assess the potential for patient harm, 3. List actions that could eliminate or reduce the risks, and 4. Identify what actions, if any, are to be taken and by whom.

After the risk assessment is completed, everything discussed should be documented and taken to the safety (environment of care) committee for its review and approval. I consider it best practice for the safety committee to vote for approval of the risk assessments since the assessments will then be entered into the committee minutes for everyone to see. This can be very helpful when demonstrating to a surveyor that the assessment was actually conducted. A sample risk assessment template is included in the appendix.

You cannot operate a behavioral health unit without provisions to keep patients from walking off the unit. Therefore, in a hospital environment, you are permitted to lock the exit doors. The LSC refers to locks in this situation as “clinical need” locks. Clinical need locks are permitted in healthcare occupancies where patients require special security measures for the safety of themselves or others.

There must be an adequate provision made for rapid removal of all patients; this could entail a remote control that unlocks the doors or a key carried by staff that can open all locks on the unit. If you choose the latter, then all staff who perform their job responsibilities on the behavioral health unit must carry the appropriate key with them at all times. This includes the clinical staff, obviously, but it also includes support staff such as environmental services, maintenance, food service, etc.

(Editor’s note: Specifics on locking patients rooms, included in the book, were cut from this free digital excerpt for space reasons.)

Some behavioral health units have craft or activity rooms that can be used for patient therapy. These rooms can contain sharp or hot instruments, presenting an obvious potential for patients to injure themselves or others. A thorough risk assessment must be conducted with the same or similar group of people who assessed the unit’s potential suicide hanging points. All utensils and equipment in craft or activity rooms should be accounted for and stored behind locked doors and drawers. Patients should be screened to ensure only suitable individuals enter the room, and patients in the room must be continuously monitored.

If your behavioral health unit has corners or dead-end corridors that are hidden from view of security cameras or nurse stations, these blind spots present possible areas for an attack by an agitated, frustrated, or aggressive patient. Again, an assessment must be made to determine if these risks to staff safety exist, and if they do, then suitable action needs to be taken. AO surveyors are looking for blind spots and are asking what the hospitals are doing about them.

Possible solutions to these problems include:

  • Closed circuit television cameras that are monitored at the nurse station
  • Removing or modifying walls to increase line of sight
  • Eliminating dead-end corridors by installing a wall and a door to keep patients away
  • Personal radio transmitters worn by staff so they can signal for assistance when needed

Surveyors have cited hospitals when they believe the staff is at risk of attack in areas that are not monitored. It is the responsibility of the hospital to ensure the working environment for staff is as safe as possible.

Here are some additional things to consider that could pop up during a survey:

  • Furniture must be assessed to determine if it can be used as a weapon or as a means of breaking a window. Heavy-duty screens or nonbreakable plastic should be considered over the windows to prevent individuals from breaking the window with a chair and jumping out.
  • Remember that electrical cords on patient beds and televisions in common areas can be used as weapons by patients.
  • Many behavioral health units choose to have platform beds rather than standard hospital beds, even if they are manual crank beds instead of electric. This is because platform beds cannot be easily used as a hanging point, unlike standard hospital beds.
  • Be careful where you place the public telephone. The handset of a typical pay phone is rather heavy and can be used as a weapon. Therefore, the telephone should be in a place where it is continuously monitored by staff.

To purchase Analyzing the Hospital Life Safety Survey, Third Edition, please click here. And check back next Monday for a free HCPro book excerpt focusing on a different healthcare safety topic.

Safety Month showcase: Steps for when a worker is exposed to bloodborne pathogens

By: June 11th, 2018 Email This Post Print This Post

The National Safety Council has designated June as its annual National Safety Month as a way to focus on “reducing leading causes of injury and death at work, on the road, and in our homes and communities.” In accordance with that, HCPro’s safety team will highlight a different healthcare-oriented safety topic each week in the month of June by sharing an excerpt from one of our many books, all available on HCMarketplace.com.

The focus this week is on infection control. The excerpt is from The Infection Control Manual for Outpatient Settings, authored by Gwen M. Rogers, DBA, RN, CIC.

Her book explains the steps that physicians and staff at outpatient facilities should take to protect patients, employees, and the environment and to prevent the spread of infectious diseases, though safety pros who work at hospitals may also find this excerpt useful. It looks at the OSHA Bloodborne Pathogen Standard and what should be done when one of your employees is exposed to blood or other potentially infectious material (OPIM).

Are your employees familiar with the Bloodborne Pathogen Standard from OSHA? They should be; it is one of the key documents for healthcare best practices in preventing the spread of and bloodborne pathogens (BBP). It is important for you to maintain a safe work environment for yourself and your employees, and to provide documentation that you have done so, especially because agencies such as OSHA and The Joint Commission are narrowing their scrutiny of the physician’s office environment. Representatives from these and other groups want to see whether physician practices have a plan in place to educate and train employees in enacting an infection control plan.

The goal of OSHA’s Bloodborne Pathogens Standard, published in 1991 in the Federal Register, is to guide you in minimizing exposure. A good way to introduce employees to the concept of the standard is simply to tell them that they must assume that any needle and any specimen (i.e., anything relating to blood or bodily fluids) should be considered infectious. The standard applies to all employees who have occupational exposure to blood or other potentially infectious material. Occupational exposure is defined as “reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or OPIM that may result from the performance of the employee’s duties.”

As employers, physician practices are required by OSHA to take precautions to protect staff members likely to be exposed to blood or OPIM while on the job. Separate but dependent sets of rights and responsibilities were established for both employees and employers within the OSHA standards. Employees are obligated to follow office rules, wear personal protective equipment (PPE), and report hazardous conditions. Meanwhile, employers are required to become familiar with all OSHA standards, communicate them to employees, and enforce them in the workplace.

So, what steps must be taken when an employee is exposed to BBP?

Employees should follow a certain protocol after bona fide BBP exposure has occurred. Protocols for evaluation and management of an employee or patient exposure to the blood (or other potentially infectious material) of a patient need to be outlined in the exposure control plan. Any response should begin with providing immediate first aid.

What information must the employer provide to the healthcare professional following an exposure incident? The healthcare professional must be provided with a copy of the standard, as well as the following information:

  • A description of the employee’s duties as they relate to the exposure incident
  • Documentation of the route(s) and circumstances of the exposure
  • The results of the source individual’s blood testing, if available
  • All medical records relevant to the appropriate treatment of the employee, including vaccination status (which are the employer’s responsibility to maintain)

What serological testing must be done on the source individual?

The employer must identify and document the source individual if known, unless the employer can establish that identification is not feasible or is prohibited by state or local law. The source individual’s blood must be tested as soon as is feasible, after consent is obtained, to determine HIV and HBV infectivity. The information on the source individual’s HIV, HBV, and Hepatitis C testing must be provided to the evaluating healthcare professional. Also, the results of the testing must be provided to the exposed employee. The exposed employee must be informed of applicable laws and regulations concerning disclosure of the identity and infectious status of the source individual.

What if consent cannot be obtained from the source individual?

If consent cannot be obtained and is required by state law, the employer must document in writing that consent cannot be obtained. When law does not require the source individual’s consent, the source individual’s blood, if available, shall be tested and the results documented.

When is the exposed employee’s blood tested?

After consent is obtained, the exposed employee’s blood is collected and tested as soon as is feasible for HIV and HBV serological status. If the employee consents to the follow-up evaluation after an exposure incident but does not give consent for HIV serological testing, the blood sample must be preserved for 90 days. If, within 90 days of the exposure incident, the employee elects to have the baseline sample tested for HIV, testing must be done as soon as is feasible.

What information does the healthcare professional provide to the employer following an exposure incident?

The employer must obtain and provide to the employee a copy of the evaluating healthcare professional’s written opinion within 15 days of completion of the evaluation. The healthcare professional’s written opinion for hepatitis B is limited to whether hepatitis B vaccination is indicated and whether the employee received the vaccination. The written opinion for post-exposure evaluation must include information that the employee has been informed of the evaluation results and has been told of any medical conditions resulting from exposure that may require further evaluation and treatment. All other findings or diagnoses must be kept confidential and must not be included in the written report.

What type of counseling is required following an exposure incident?

The standard requires that post-exposure counseling be given to employees following an exposure incident. Counseling should include U.S. Public Health Service recommendations for transmission and prevention of HIV. These recommendations include refraining from blood, semen, or organ donation; abstaining from sexual intercourse or using measures to prevent HIV transmission during sexual intercourse; and refraining from breastfeeding infants during the follow-up period. In addition, counseling must be made available regardless of the employee’s decision to accept serological testing.

What should be done with an employee’s confidential medical records?

Records of all employees with occupational exposure must be maintained for 30 years after the employee terminates employment. These records should be stored separately from patient records, and access to the records requires the employee’s written permission. The medical records include a copy of the employee’s vaccination status and copies of the results of all medical examinations and tests. Post-exposure records must include the employee’s name, Social Security number, hepatitis B vaccination status, results of follow-up procedures to exposure incidents, and a copy of the evaluator’s written opinion.

To purchase The Infection Control Manual for Outpatient Settings, please click here. And check back next Monday for a free HCPro book excerpt focusing on a different healthcare safety topic.

Safety Month showcase: Prep for emergencies by completing a hazard vulnerability analysis

By: June 4th, 2018 Email This Post Print This Post

The National Safety Council has designated June as its annual National Safety Month as a way to focus on “reducing leading causes of injury and death at work, on the road, and in our homes and communities.” In accordance with that, HCPro’s safety team will highlight a different healthcare-oriented safety topic each week in the month of June by sharing an excerpt from one of our many safety books, all available on HCMarketplace.com.

The focus this first week is on emergency preparedness.

The excerpt is from The Emergency Management Handbook, authored by Mary Russell, EdD, MSN, CEN, RN. Whether you need to launch a program or revamp your training, this resource provides the step-by-step road map for how to set up a program, obtain buy-in, and train staff. This excerpt focuses on completing a hazard vulnerability analysis.

One of the most valuable tools in your emergency planning repertoire is the risk assessment process. A hazard vulnerability analysis (HVA) is a tool designed to help you become familiar with hazards that your facility may face and to help you prioritize your planning, training, exercises, and corrective action improvements for your facility based on the likelihood of an event occurring.

Hospitals need to complete an HVA for their facility that identifies actual or potential events that can result in a demand for medical services or can affect the ability of the hospital to provide services. Your hospital’s HVA must consist of an assessment of each facility on its campus and any satellite outpatient centers it considers part of the hospital complex. The focus is to identify vulnerabilities that could affect the safety of patients, visitors, or employees during an emergency. It should also identify hazards within the larger community setting inclusive of the hospital’s campus. In this way, the HVA can uncover valuable opportunities for planning and mitigation to reduce vulnerabilities to specific threats. The HVA process will also identify scenarios that are a priority for your hospital to exercise.

Hospitals are part of a community’s critical infrastructure because of their role in providing medical care and services for the ill and injured. Because of this role, however, there are inherent vulnerabilities in terms of daily operations. These include the following:

  • Twenty-four-hour-a-day operational needs
  • Critical power dependence due to lifesaving equipment and procedures that hospitals offer
  • An essential need for effective communication both within the hospital and externally to physician providers, other hospitals, EMS, and other partners
  • Utilities support, including electric, water, waste disposal, IT, and communication support
  • A high density of persons on-site at any one time, including inpatients, outpatients, employees, the medical staff, volunteers, visitors, students, vendors, service personnel, and others
  • Inpatients with high acuity levels, including a high percentage that could be non-ambulatory (the vast majority will require some level of assistance if an evacuation is necessary, as most persons are tethered to some form of equipment)
  • Hazardous materials in the form of pharmaceuticals, antineoplastic drugs, anesthetic gases, lab specimen solvents, formaldehyde, radiological materials, xylene, compressed gases, bulk liquid oxygen, biohazardous waste, on-site fuel, cleaning materials, and others
  • Structural aspects of hospitals (e.g., many small rooms) that can make evacuation difficult, especially in older structures that include dead-end corridors and added-on wings

Hospitals that proactively take steps to reduce their vulnerabilities for one hazard will benefit from doing so by providing a level of reduced risk for other hazards. For example, hospitals that use shuttering and window protection systems to shield from hurricane winds know that such systems also offer security protection during any other hazard. The same concept goes for perimeter fencing around a facility as a mechanism to restrict access and manage crowd control, regardless of the scenario.

The hospital should review their HVA annually with key community partners as well as with the hospital’s emergency management team and Environment of Care Committee. The review should also assess the hospital’s capability to respond to various threats, advance mitigation strategies, inventory resources and assets to manage an incident, and plan exercises to trend progress in meeting objectives.

The HVA is a living document. Some things will not change, such as your hospital’s geographic location and its major transportation routes. Other things, such as local businesses and industries, can change from year to year. Agencies that can assist you with the development or annual review of your HVA include, but are not limited to, the following:

  • Local fire-rescue services can be a great resource to update you on any new environmental threats in your area as fire inspectors become aware of new hazards in the community during business inspections and as part of their ongoing risk surveillance
  • Police are aware of crime statistics, substance abuse issues, and potential terrorist threats, including persons of interest or groups such as gangs and activists
  • Local, county, or regional emergency managers can be consulted to ensure that your HVA encompasses proximity to area hazards in which your facility may not be in the immediate impact zone but could be a receiving facility for casualties who flee the scene
  • Local utility companies for electricity, water, and communications can detail risk and their mitigation strategies that are proposed or already in place for the grid location of your hospital complex
  • Local chamber of commerce, which maintains an updated listing of population demographics, businesses, seasonal events, and other resource information
  • Your local healthcare coalition includes additional key community partners beyond those listed above that can contribute both threat and hazard information and knowledge of existing resources to a local or regional HVA that is also applicable to an individual hospital HVA

The following are five steps you can take to complete your HVA.

Step 1: Complete your HVA community profile

Completing a community profile will help you understand the surrounding community and give you a context within which your hospital will consider its priorities (e.g., social, economic, political, and legal realities). A profile contains details related to your geographic location; demographics of the community; resident, seasonal, and tourist populations; top employers; weather and climate; economic status of residents; educational levels; multimodal transportation systems; and other considerations.

Step 2: Identify all hazards in your community risk profile

Insert all known community and area hazards into a hazard vulnerability matrix to create a community risk profile. Request the assistance of your community partners to ensure that your list is complete. These stakeholders can help you determine the probability that the hazards you identify will occur, and your facility’s vulnerability to them. Hospitals can also identify hazards in a visual way using community maps or a summary PowerPoint slide. Provide clear detail on top-ranked hazards so that your hospital’s emergency management team, Environment of Care team, and HICS team can all clearly articulate each risk and what they are doing to prepare for such potential occurrences to the organization.

Step 3: Assess the hazard’s risk

The risk of a hazard is a product of its likelihood, and the impact or consequences of the hazard on the community, and how it would affect the hospital’s ability to manage such an event. Determine risk by estimating the potential number and types of casualties your facility could expect from a given hazard; in most cases, you should base your estimation on your community’s population.

The risk of a hazard occurring can be assigned a score based on expert judgment or actual intelligence, or it can be assigned to a category of risk—for example, low, medium, or high. Some hazards may not be applicable due to a hospital’s geographic location. Factors that influence ranking of hazards include history of prior occurrences, vulnerability of population and property, and probability for the hazard to occur, based on both short-term and long-term predictions.

Step 4: Analyze the vulnerability to each hazard

Analyze each hazard separately to determine the likelihood of it affecting your hospital in terms of susceptibility, impact, and consequences to the organization. Impact can be determined in terms of the human impact (patient or staff injury, workforce availability), property impact (damage to facility, flooding, equipment damage, debris), and operational impact (disruption of services, utility failure).

Step 5: Prioritize the vulnerabilities for hazards and identify risk interventions

It is not enough to fill out an HVA for your hospital simply to identify hazards and rank them. The next critical step is to look at the hazards you have identified to find common vulnerabilities across different scenarios and establish shared mitigation measures. A subsequent exercise can determine whether the mitigation was successful for a specific scenario; however, such interventions will reduce vulnerability for other threats too. The severity of a hazard can be identified by the magnitude of the incident as measured by potential human, property, or business impacts but mitigated by preparedness (preplanning, training, exercises), internal response (initiating an efficient and effective response and mobilizing resources), and an external (community or mutual aid) response.

The highest-priority vulnerability is for patient and staff safety concerns—that is, those hazards that can result in illness or death or other health risks. Another high-ranking concern is business continuity, which translates into minimizing service disruption or failure and maintaining the trust of the community.

Local residents expect that hospitals will do all they can to protect the facility from harm and to prepare both the facility and its staff for threats. Hazards that result in property damage are also important, as they can affect access to the facility and can cause disruption in services.

To purchase The Emergency Management Handbook, please click here. And, as we highlight Safety Month, check back next Monday for another free HCPro book excerpt that focuses on a different healthcare safety topic.

AOHP asks healthcare organizations to ‘consider’ mandatory flu shot policies

By: May 22nd, 2018 Email This Post Print This Post

The Association of Occupational Health Professionals in Healthcare (AOHP) has joined the growing ranks of industry groups that are calling for hospitals and other healthcare facilities to consider a vaccination policy that makes annual flu shots mandatory for healthcare workers, which AOHP defines as any paid or unpaid person working in any healthcare setting.

AOHP, which calls itself “the only national professional organization with the exclusive mission of addressing the needs and concerns of occupational health professionals in healthcare settings,” recently released a position statement that recommends annual flu shots along with other mandatory vaccinations, including hepatitis B and MMR, for healthcare workers.

AOHP also asks administrators “to consider a policy that makes annual influenza vaccination mandatory (with medical exemptions) or offer alternatives to vaccination such as requiring the use of surgical masks for patient care by healthcare workers who refuse the vaccine.” It says the vaccines should be offered for free and must comply with state and federal regulations.

Mandatory flu vaccination for healthcare personnel is already recommended by organizations such as the Society for Healthcare Epidemiology of America (SHEA), the Pediatric Infectious Diseases Society (PIDS), and the Infectious Diseases Society of America (IDSA).

Many healthcare workers know that getting a flu shot each fall helps protect not only themselves, but coworkers, friends, family, and, most notably, patients. Some have legitimate objections to being vaccinated, such as an allergy or a strong religious belief. However, there are still healthcare workers who simply oppose the mandatory nature of these policies.

Despite that, the Centers for Disease Control and Prevention, which recommends flu shots for all healthcare personnel, reported a vaccination rate of over 95% during the 2015-16 flu season for healthcare workers whose employers required them to get vaccinated for seasonal influenza, which compared to a 79% vaccination rate overall among healthcare workers.

“Over and over again, the research has shown that the mandatory vaccination policies are the strongest indicator of high vaccination rates among healthcare personnel,” says Terri Rebmann, PhD, RN, CIC, FAPIC, the director of the Institute for Biosecurity at Saint Louis University and a professor in epidemiology and biostatistics at the university.

She adds: “It’s really important for healthcare personnel to be vaccinated because they are in really close contact with the most vulnerable of our populations. If the healthcare personnel become infected, regardless of whether or not they have symptoms, when they shed the influenza virus during patient care activities, they can then expose those really high-risk patients.”

Editor’s note: With the next flu season right around the corner, Rebmann will host on July 31 an HCPro webinar entitled “Infection-Free Vaccination: Safely Storing, Handling, Injecting, and Infusing Medications.” During the 90-minute webinar, she will explain how improper administration of vaccines can result in injuries or prevent the vaccines from providing optimal protection. She will also discuss the components of safe storage, handling, injection, and infusion practices for vaccines and how to put them into action. Click here for more information.

OSHA cites another healthcare facility for not protecting staff from violence

By: May 16th, 2018 Email This Post Print This Post

Be aware that OSHA is continuing to cite healthcare organizations for not protecting their staff from workplace violence.

In the latest announced penalty, an acute care inpatient behavioral health facility in Bradenton, Florida is facing more than $71,000 in fines for “failing to institute controls to prevent patients from verbal and physical threats of assault, including punches, kicks, and bites; and from using objects as weapons,” according to information released by the U.S. Department of Labor.

OSHA cited Premier Behavioral Health Solutions of Florida Inc. and UHS of Delaware Inc., which operates Suncoast Behavioral Health Center in Bradenton, after investigating a complaint that employees were “not adequately protected from violent mental health patients.” The citation, announced May 2, follows the OSHA citation of another UHS subsidiary in 2016 “for a deficient workplace violence program.”

“This citation reflects a failure to effectively address numerous incidents over the past two years resulting in serious injuries to employees of the facility,” said Les Grove, OSHA Tampa Area Office Director, in a published news release.

OSHA, CMS, The Joint Commission (TJC), and other regulators are cracking down on failures to protect workers from violence. TJC issued a Sentinel Event Alert in April and OSHA is considering proposing a new standard to deal just with workplace violence, which currently is cited under the General Duty clause requiring employers to protect workers from hazards “that are causing or are likely to cause death or serious harm.”

The OSHA citation report offered up a list of problems and potential solutions for Premier Behavioral Health Solutions and UHS to consider. Those solutions included:

  • evaluating the configuration of the nurses’ workstations to keep patients from jumping over desks or otherwise gaining access to personnel as well as weapons such as staplers, phones, cords, pens, and computers
  • develop a “disruptive behavior response team” and provide that team with “clear written procedures for how employees should respond to clients making threats, showing aggression, and assaults
  • evaluate intake procedures to better identify incoming patients with potential for violence
  • ensure security cameras are continuously monitored
  • provide panic alarms
  • discourage employees from wearing necklaces or lanyards that can be used for strangulation, and encourage staffers to secure “loose hair so that it is not accessible to patients, to minimize the risk of neck strains and hair pull injuries”
  • to regularly train staff in methods to protect themselves when patients become violent
  • conduct effective investigations and root cause analyses into violent events
  • establish a comprehensive medical and psychological counseling and debriefing for employees experiencing or witnessing violent assaults or incidents

Premier Behavioral and UHS have 15 business days from when they were notified of the citations and penalties to pay the fines, request an informal conference with OSHA’s area director, or contest the findings before the independent Occupational Safety and Health Review Commission.

This OSHA citation follows a similar case last year in which a psychiatric treatment center in Massachusetts faced 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. That center said it was contesting OSHA’s allegations.

In another case, a hospital in New Jersey was able to successfully defend itself against allegations that it had failed to protect workers from workplace violence.

Editor’s note: This post is from AJ Plunkett, our colleague over at DecisionHealth.

New report on emergency preparedness says U.S. healthcare system is improving

By: April 18th, 2018 Email This Post Print This Post

We recently published online an article from the upcoming edition of our Healthcare Life Safety Compliance newsletter about a recent report by the Johns Hopkins Center for Health Security that examined how the U.S. healthcare system has fared while responding to emergencies both large and small.

Their conclusion? The bigger the emergency, the less prepared healthcare facilities are for handling the crush of patients that come through their doors.

“Although the healthcare system is undoubtedly better prepared for disasters than it was before the events of 9/11, it is not well prepared for a large-scale or catastrophic disaster,” the authors wrote in the report, which was released in late February. “Just as important, other segments of society that support or interact with the healthcare system and that are needed for creating disaster-resilient communities are not sufficiently prepared for disasters.”

Their research, however, spanned from 2010 to 2015, meaning that responses to recent emergencies such as Hurricane Harvey, the wildfires that torched California, the harrowing mass shootings at a country music concert in Las Vegas and at Stoneman Douglas High School in Florida were not examined.

Now a new report has come out, this one concluding that hospital readiness for managing health emergencies has improved over the last five years.

From our colleagues at Patient Safety & Quality Healthcare:

The Robert Wood Johnson Foundation (RWJF) this week released the 2018 National Health Security Preparedness Index, which found that the U.S. scored a 7.1 out of 10 for preparedness, up 3% over the last year and almost 11% since the Index was begun in 2013.

The assessment found improvements in most states, but also noted serious inequities in health security across the country, according to a RWJF release. Maryland was the highest scoring state, 25% higher than the lowest-ranked states, Alaska and Nevada. The report found that states in the Deep South and Mountain West scored poorly compared to those in the Northeast and Pacific Coast.

“Five years of continuous gains in health security nationally is remarkable progress,” said Glen Mays, PhD, MPH, who led the University of Kentucky research team that developed the index, in the release. “But achieving equal protection across the U.S. population remains a critical unmet priority.”

The index found that 18 states had preparedness levels exceeding the national average, while 21 states fell below the average. Thirty-eight states and the District of Columbia increased their overall health security last year, with eight remaining steady and four declining.

So, while this new RWJF report suggests that the response of the U.S. healthcare system to emergencies has generally improved in recent years, a lot of work still needs to be done, which aligns with what the authors of the report from the Johns Hopkins Center for Health Security wrote a couple of months ago.

TJC creates new Sentinel Event Alert for violence against healthcare workers

By: April 17th, 2018 Email This Post Print This Post

The Joint Commission (TJC) is the latest healthcare heavy-hitter to call for better protection of healthcare workers, announcing on Tuesday the creation of Sentinel Event Alert 59, which addresses violence — physical and verbal — against healthcare workers.

TJC writes in this latest Sentinel Event Alert publication that the purpose of the new alert is to help hospitals and other healthcare organizations better recognize workplace violence directed by patients and visitors toward healthcare workers and better prepare healthcare staff to address workplace violence, both in real time and afterward.

TJC notes that Sentinel Event Alert 59 has some overlap with Alerts 40 and 57 — which were released in 2008 and 2017, respectively, and focused on the development and maintenance of safety culture — and therefore were not addressed in this alert.

Per the Occupational Safety and Health Administration (OSHA), about 75% of workplace assaults annually occurred in the healthcare and social service sector. Violence-related injuries are four times more likely to cause healthcare workers to take time off from work than other kinds of injuries, according to the Bureau of Labor Statistics (BLS).

TJC cites both of those facts in this Sentinel Event Alert publication and adds that TJC data show 68 incidents of homicide, rape, or assault of hospital staff members over the past eight years – and that’s mostly only what hospitals voluntarily reported.

TJC is calling for each incident of violence or credible threat of violence to be reported to leadership, internal security, and — if necessary — law enforcement, and TJC also wants an incident report to be created. Under its Sentinel Event policy, TJC says that any rape, any assault that leads to death or harm, or any homicide of a patient, visitor, employee, licensed independent practitioner, or vendor on hospital property should be considered a sentinel event and requires a comprehensive systematic analysis.

Additionally, TJC says it’s up to the healthcare organization to specifically define unacceptable behavior and determine what is severe enough to warrant an investigation.

This Sentinel Event Alert, which you can download here along with other resources, comes on the heels of an emergency preparedness rule from CMS that recently went into effect and efforts from the National Fire Protection Association to fast-track its new standard for active shooter events and other violent incidents. OSHA is also considering a standard to help protect healthcare and social workers from violence.

Three proposed tweaks to ASHRAE’s ventilation standard open for comment

By: April 6th, 2018 Email This Post Print This Post

The American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) is now accepting public comment on a trio of proposed changes to ANSI/ASHRAE/ASHE Standard 170-2017, Ventilation of Health Care Facilities.

Addendum o to Standard 170-2017 is scheduled for public comment until May 7. This “voluntary risk-based approach” to establish “operational ventilation rates for spaces” calls for infection control and prevention professionals to segregate infected persons to both protect them and prevent them from putting others at risk.

Addendum p to Standard 170-2017, also scheduled for public comment until May 7, would update Table 7.1 by, amongst other things, moving requirements for Residential Health, Care, and Support spaces to a new table in a different addendum; relocating and updating filtration requirements; and also revising the “space name terminology, table organization, and subheadings to better correlate with” 2014 FGI Guidelines for Design and Construction of Hospitals and Outpatient Facilities.

Addendum q to Standard 170-2017, scheduled for comment until April 22, would change the scope of the standard by including “resident” to differentiate from “patient” in residential health applications and by clarifying that the standard addresses more than outside air quantities and that it does not establish “comprehensive thermal comfort design requirements,” which are addressed in Standard 55.

This is just a summary of the proposed changes. To access these public review drafts, see a full rundown, and comment, visit ASHRAE’s online database.

CDC study: Excessive noise can contribute to high blood pressure and cholesterol

By: April 3rd, 2018 Email This Post Print This Post

Door alarms, heart monitors, surgical equipment, and Ted Nugent? Yes, Ted Nugent.

As I wrote in this month’s Medical Environment Update newsletter, excessive noise is an issue in the OR, where the eardrums of surgical team members are often bombarded by a bunch of different sources. Believe it or not, that sometimes includes classic rockers like the aforementioned Mr. Nugent, a popular playlist pick among surgeons.

Excessive noise in the OR can affect auditory processing among surgical team members, leading to miscommunication in critical moments and, subsequently, medical mistakes that affect patients plus needlestick injuries and slip-ups with a surgical knife.

I also focused on how it can expose surgical team members to hearing damage, too.

“[The surgical team is] like a construction crew,” Matthew Bush, MD, of the University of Kentucky, told me in a phone conversation. “Perhaps there are some people who have to use jackhammers and there’s other people who are using paintbrushes.” But in any case, that noise can add up, and “we need to be very conscious of that.”

Another thing to be wary of, according to a recent CDC study published in the American Journal of Industrial Medicine, is high blood pressure and high cholesterol.

“A significant percentage of the workers we studied have hearing difficulty, high blood pressure, and high cholesterol that could be attributed to noise at work,” Liz Masterson, MD, one of the study’s authors, said in a CDC press release. “This study provides further evidence of an association of occupational noise exposure with high blood pressure and high cholesterol, and the potential to prevent these conditions if noise is reduced.”

While the healthcare was not mentioned in that press release as an industry “with the highest prevalence of occupational noise exposure,” OR staff members often must work through loud bursts of noise that occur throughout many surgeries.

This is a concern that Lisa Spruce of the Association of periOperative Registered Nurses brought up during our recent chat about excessive noise, saying it “has been linked to impaired sleep, increased stress, physical discomfort, increase in blood pressure, heart rate, and breathing. And that all just has an effect on a person’s well-being.”

Spruce says some healthcare facilities have noise-related policies. And if yours doesn’t, she recommends forming an interdisciplinary team to evaluate noise in facilities and by individual types of surgery, and then determining what actions you can take to decrease noise levels, including exploring quieter alternatives for surgical equipment.

“I think we’re bringing more attention to [noise] as a problem where we haven’t in the past,” she said. “So, I think we are going to see more and more hospitals having policies and looking at it from a patient safety, and also a staff safety standpoint.”

Joint Commission shares 2017 standards compliance data for healthcare facilities

By: March 27th, 2018 Email This Post Print This Post

The Joint Commission (TJC) has released its lists, each based on the type of facility surveyed, of the requirements most frequently scored as “not compliant” during accreditation surveys and certification reviews during the 2017 calendar year.

The list of requirements scored as “not compliant” during 1,443 hospital surveys:

  1. LS.02.01.35: Systems for extinguishing fires are provided and its systems/devices are appropriately installed and maintained. (86%)
  2. EC.02.05.01: Utility systems are well designed, inventoried, monitored, and managed according to written procedures when disruptions in the utility system occur. (73%)
  3. LS.02.01.30: Building features are maintained which prevent the spread and fueling of fire and smoke. (72%)
  4. IC.02.02.01: Infection prevention and control activities are performed relative to the cleaning, storing, and disposing of medical equipment/devices. (72%)
  5. EC.02.06.01: Physical environment (e.g., lighting, temperature, ventilation, equipment, furnishings, space, etc.) is safe and functional. (70%)
  6. LS.02.01.10: Effects of fire, smoke, and heat are mitigated through the design and maintenance of building and fire protection features. (66%)
  7. EC.02.02.01: Risks related to hazardous materials and hazardous waste are managed as described in written policy. (63%)
  8. LS.02.01.20: Means of egress are maintained. (62%)
  9. EC.02.05.05: Testing and regular inspections of utilities are done. (62%)
  10. EC.02.05.09: Medical gas and vacuum systems are labeled, tested, inspected, and maintained. (59%)

The list of requirements scored as “not compliant” during 104 surveys of office-based surgery practices:

  1. IC.02.02.01: Infection prevention and control activities are performed relative to the cleaning, storing, and disposing of medical equipment/devices. (63%)
  2. HR.02.01.03: Individuals permitted by law and the organization to practice independently are granted by the practice initial, renewed, or updated clinical privileges. (61%)
  3. EC.02.04.03: Testing and regular inspections of medical equipment are done. (37%)
  4. MM.03.01.01: The hospital’s medications are stored in a manner which maintains their integrity, minimizes their diversion, reduces dispensing error, and promotes availability while following manufacturer guidelines, laws, and regulations. (34%)
  5. IC.02.01.01: Implementation of the written infection surveillance, prevention, and control plan is implemented by the hospital. (27%)
  6. NPSG.03.04.01: Medications, medication containers, and other solutions removed from their original container and placed into a container, both on and off the sterile field, are labeled as consistent with safe medication practices. (24%)
  7. HR.01.06.01: The organization has a competency assessment process in place. (23%)
  8. EC.02.05.07: Emergency power systems are tested, inspected, and maintained as required by the Life Safety Code®. (22%)
  9. WT.04.01.01: Quality control checks are performed as defined in the quality control plan for waived testing. (20%)
  10. MM.01.01.03: High-alert and hazardous medications defined by the hospital are safely managed. (18%)

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