Archive for: Hazard Communication

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.

New IAHSS guideline aims to help healthcare facilities respond to workplace violence

By: March 20th, 2018 Email This Post Print This Post

Looking to reduce the likelihood of workplace violence in healthcare, the International Association for Healthcare Security & Safety Foundation (IAHSS) released a new Threat Management guideline earlier this month stating that “healthcare facilities should establish a process and multidisciplinary team to identify, assess, validate, mitigate, and respond to threats of violence or other behaviors of concern.”

The multidisciplinary threat management team should, says IAHSS, identify threats and determine their seriousness and severity. Additionally, IAHSS recommends the team develop intervention plans that protect potential victims and address problems that precipitate threats, document the threat assessment process with privacy and confidentiality in mind, and conduct a review after addressing each threat.

The IAHSS guideline suggests the development of a threat management program “that is informed by data and research in this area.” To do so, IAHSS says that healthcare facilities should designate individuals who are responsible for, amongst other things, educating staff and promoting the reporting of threats; assessing all reports of concerning behavior; implementing timely response plans; and advocating for victims and offering support and counseling if needed.

IAHSS says all healthcare staff should get education —  based on their job function and potential risk — about identifying concerning behavior, reporting protocols, activating an emergency response, and documenting threats and incidents.

The new Threat Management guideline was initially developed by the IAHSS Council on Guidelines and incorporated feedback from IAHSS membership, the Emergency Nurses Association, and the American Hospital Association, according to a press release announcing the guideline.

“Implementing the intent of this guideline will be one of the least expensive and effective steps an organization can take to reduce the likelihood of violence,” Tom Smith, chair of the IAHSS Council on Guidelines, said in a statement. “The Threat Management Guideline establishes a framework for healthcare organizations to proactively identify and manage threats of violence. Input from our colleagues at the AHA and ENA helped us enhance the quality and value of the final product.”

The issuing of the guideline comes several months after a report by IAHSS, entitled “Mitigating the Risk of Workplace Violence in Health Care Settings,” encouraged healthcare facilities to take immediate steps to mitigate violent incidents.

New HHS fact sheet gives guidance for handling long-term patient surge

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

One of the deadliest flu seasons in recent memory has prompted the Department of Health & Human Services (HHS) to release a fact sheet that gives guidance on handling an influx of patients flocking to healthcare facilities for treatment of the flu and other seasonal illnesses.

While the latest briefing from the CDC suggests that this flu season has peaked, the fact sheet provides useful information healthcare facility emergency planners should consider when developing plans to deal with a similar surge of sick patients in the future. Note that this fact sheet states “these considerations are different than those of planning to handle surge from a no-notice, short duration event” like the recent mass shootings in Orlando, Las Vegas, and Parkland, Florida.

The HHS fact sheet states that “all hospitals must have an emergency operations plan” to deal with a long-term surge. Among the strategies it recommends are expanding normal clinic hours to limit the number of clinic patients coming to the ED, rescheduling elective procedures to free up beds, and setting up “surge sites” such as tents or mobile units located next to the ED.

It also recommends preventive steps that could minimize the surge during a severe flu season, including the use of telehealth, telephone prescribing, virtual information, community paramedicine programs, and risk communications and creating media campaigns encouraging vaccinations, handwashing, and other infection control practices.

The HHS fact sheet states that “there is little an individual hospital or health system can do to prevent patient surge from seasonal illness, but a region or healthcare coalition, in partnership with public health, can use coordinated strategies to help provide situational awareness to support patient surge management throughout the community.”

To download the fact sheet from the HHS website, click right here.

High-reliability healthcare, ‘preoccupation with failure’ and a valuable workshop

By: February 1st, 2018 Email This Post Print This Post

Gary L. Sculli, MSN, ATP, brings a unique perspective to safety in healthcare. In addition to being a registered nurse for more than three decades, he has served as an officer in the United States Air Force Nurse Corps and for many years worked as a pilot for a major U.S. airline.

Three years ago, Sculli shared some of his experiences and many of the insights gained during a diverse career in an HCPro book, “Building a High-Reliability Organization: A Toolkit for Success,” which was coauthored by Douglas E. Paull, MD, MS, FACS, FCCP, CHSE. Below is a book excerpt from a chapter on failure, in which the authors urged healthcare leaders, in the pursuit of high reliability, to embrace the concept of “preoccupation with failure.”

At the core, much of patient safety is dealing with uncertainties and unexpected events, the cardiac arrest being a prime example. In moments like these, not only do organizations rely on the technical expertise of staff and best practice guidelines, but also benefit from teams that are flexible, can adapt, and in essence, are resilient. Organizations themselves must be resilient to deal effectively with the changing face of healthcare.

Let’s examine a disaster from forest firefighting history—the Mann Gulch Fire in 1949. Young firefighters parachuted into Mann Gulch, near Helena, Montana, to combat what they believed was a rather routine forest fire. They were led by foreman Wag Dodge. But when the fire jumped from the south to the north side of the gulch, the firefighters were trapped and isolated from their escape route to the Missouri River. There were two possible routes for survival; either join Wag Dodge in his newly devised “circle of fire” or run to the top of the north ridge. This was the first time the circle of fire had been utilized during forest firefighting. Essentially, Dodge lit the grasslands on fire depriving the oncoming fire of any fuel to spread, thus protecting anyone within the circle. Whether due to a lack of trust, leadership, or communication, none of the other firefighters joined Dodge within the circle, despite his efforts to encourage them to do so. In addition, the young firefighters would not drop their heavy backpacks, slowing their ascent to the top of the north ridge. Thirteen firefighters died with their backpacks on and within sight of safety in the circle of fire or beyond the ridge. Dodge survived because he was able to pivot and adjust to rapidly changing and unexpected conditions.   

Several authors have discussed resilience, flexibility, innovation, and adaptability as attributes of successful organizations, including those in healthcare. Healthcare organizations must be able to learn from their mistakes. They must be able to face reality, “drop their old tools,” and accept the fact that the landscape can and will change suddenly and that unexpected events will occur. They must also accept that the best solutions to navigate the unexpected may be found in high-reliability industries. When viewed in this manner, leaders are not afraid to actively demand, even when faced with obstacles, such things as perpetual team training, mass standardization, briefings and handoffs, situational awareness support, just culture, staffing increases, and other patient safety initiatives. Leaders model open-mindedness and embrace innovation when unforeseen or novel situations arise. They talk with and listen to staff at the frontline when it comes to identifying and solving systemic challenges and failures. In many ways, current healthcare leaders are in a position similar to Wag Dodge. They must be resilient, prepared to build a circle of fire, and change course in order to solve unexpected and complex problems.

This spring, Sculli is again partnering with HCPro to give healthcare leaders the needed tools and guidance to create a culture of high reliability and safety within their organizations.

On April 16, Sculli will lead an intensive one-day workshop at Renaissance Orlando at SeaWorld® in Orlando, Florida. For more information on this upcoming HCPro workshop — which targets healthcare safety professionals, CEOs, COOs, VPMAs, risk managers, and quality/performance improvement professionals — please check out the event page at hcmarketplace.com.

Feds delay mandatory use of electronic injury reporting system again

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

Employers under federal OSHA jurisdiction have until Dec. 15, or an extra two weeks, to learn how to use the agency’s new electronic injury reporting system.

The day before Thanksgiving, OSHA officials announced the agency was extending the compliance deadline for filing the already-required workplace injury and illness reports in the agency’s new online system, officially known as the Injury Tracking Application (ITA). The ITA was designed to allow officials to track injuries electronically.

This is the same system that was suspended for a few days in mid-August after it went live because of a warning from the Department of Homeland Security that information from at least one company that had already submitted through the portal might have been compromised.

Public access to the portal was restored a few days later. An OSHA spokesperson told HCPro’s OSHA Healthcare Advisor in an email in late August that the National Information Technology Center conducted a scan and confirmed that none of the ITA data had been compromised. (HCPro is a partner publisher to DecisionHealth under H3.Group.)

“As part of this review, the entire OSHA website was scanned and improvements implemented,” the spokesperson said.
Concerns about the ITA and the security of information have been among controversies that have dogged the program since it was first approved in a final rule in May 2016. The ITA was originally supposed to go into use in July, but was delayed because of related legal challenges.

In announcing this most recent delay, the federal agency noted that certain states with their own OSHA programs that have not yet adopted the requirement to submit injury and illness reports electronically were not under the Dec. 15 deadline.

“Unless an employer is under federal jurisdiction, the following OSHA-approved State Plans have not yet adopted the requirement to submit injury and illness reports electronically: California, Maryland, Minnesota, South Carolina, Utah, Washington, and Wyoming,” according to the OSHA announcement. “Establishments in these states are not currently required to submit their summary data through the ITA. Similarly, state and local government establishments in Illinois, Maine, New Jersey, and New York are not currently required to submit their data through the ITA.”

And other changes may be ahead. In addition to announcing the delay, OSHA said it is “currently reviewing the other provisions of its final rule to Improve Tracking of Workplace Injuries and Illnesses, and intends to publish a notice of proposed rulemaking to reconsider, revise, or remove portions of that rule in 2018.”

— A.J. Plunkett (aplunkett@h3.group) and Steven Porter (sporter@blr.com)
Resources
• OSHA announcement of December 2017 delay: https://content.govdelivery.com/accounts/USDOL/bulletins/1c6be1d
• OSHA Healthcare Advisor blog on potential security breach: http://blogs.hcpro.com/osha/2017/08/potential-security-breach-prompts-suspension-of-oshas-new-injury-tracking-portal/
• OSHA webpage on new electronic recordkeeping rule: https://www.osha.gov/recordkeeping/finalrule/ 

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

This week: OSHA emphasizes fall prevention

By: May 8th, 2017 Email This Post Print This Post

A failure to provide workers with adequate fall protection is the violation cited most frequently by OSHA inspectors. Each year, hundreds of construction workers are killed in falls, which is why OSHA and its partners set aside this week, May 8-12, as a “National Fall Prevention Safety Stand-Down” to encourage employers to pause during the workday and revisit safety topics.

Given the high number of fall-related fatalities among construction workers, that industry serves as the natural focus of this week’s events, but the stand-down carries worthwhile reminders for those overseeing safety in healthcare settings as well.

Late last year, OSHA cited Jersey City Medical Center RWJ Barnabas Health with one willful and four serious safety violations, proposing a penalty of nearly $175,000 after a maintenance worker was electrocuted while working on a 6-foot A-frame ladder. The worker, who fractured multiple bones and sustained a subdural hematoma, died from the injuries more than two weeks after the fall. Kris Hoffman, director of OSHA’s Parsippany Area Office, called the death “tragic” and “preventable.”

Employers who hope to prevent fall-related injuries and deaths are encouraged this week to have conversations with their workers about hazards and protection. To that end, OSHA assembled a website, www.osha.gov/StopFallsStandDown/. The free resources available on the site include fall-prevention training guides in English and Spanish and a downloadable version of Falling Off Ladders Can Kill: Use Them Safely, a document that details proper ladder usage.

Will you pause this week for a fall prevention stand-down? If not, you should consider working these resources into your future training sessions. The emphasis may be only a week long, but the hazards exist year-round.

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Take a lesson about chemicals from janitor’s death

By: July 9th, 2014 Email This Post Print This Post

We hear it every day like a broken record – wear your PPE and know what you are doing when you are working with hazardous chemicals in the workplace. Unfortunately, too many people don’t listen and they end up paying the ultimate price.

I’m reminded of this today as I read more about the janitor in an elementary school in Plymouth, Massachusetts who was apparently overcome and died from exposure from an as-yet unknown chemical on Monday morning.

If you’re just learning about this, 53-year-old Chester Flattery, the head custodian at Manomet Elementary School, was found dead by the school secretary at about 8 a.m.  That employee and 12 other people – many of them police officers, firefighters and other first responders who were exposed – had to also be taken to the hospital for treatment.

The investigation is still ongoing, but reports say Flattery had been at work for an hour before anyone else and that he may have been applying a floor sealant at the time of his death. School is not in session and there is a lot of maintenance work that goes into getting the building ready for next year.

Now, we all in workplace safety world know he was supposed to be wearing a respirator, eye protection, and other protective equipment. I have been a teacher in an elementary school, and I have seen these guys hard at work getting the school ready, even as I was getting my own classroom ready for students.

Most of the time, they are in regular street clothes as they go about their duties and I am willing to bet Flattery was no exception. As someone who had been working there since 2007, he was probably just doing what he always did – this time the fumes were too much for him and no one was there to help him until it was too late.

It almost happened to me. Back in college, I worked as a pool director at a country club in Connecticut, responsible for maintaining the proper chemical levels. One morning, I went into the supply closet looking for chlorine pellets, not knowing that one of my lifeguards hadn’t tightened the cover of the bucket properly the night before, allowing rain water to seep in. When I took the cover off, I got hit with a cloud of chlorine gas that knocked me off my feet and burned my throat. Happily, I was able to get to fresh air quickly and was fine. But no one was around and I was not wearing any kind of protection. I was lucky, and I never made the same mistake twice.

In the healthcare field, you can take a lesson from this tragedy. Don’t assume that just because you have done a job for a long time, you can ignore the rules. OSHA has bloodborne pathogens and hazardous chemical standards for a reason. If you are working with patients, wear your gloves, use your safety sharps, and lift safely.

If you are in a lab and work with chemicals, make sure you know the hazards of what you are working with and how to handle it properly, as well as any first aid information – it’s why OSHA says you must have SDS safety sheets on site. And always be sure someone is around, because it may save your life.

How do you store, manage, and access your MSDS?

By: November 14th, 2012 Email This Post Print This Post

Many workplaces are going paperless with their MSDS, storing them as PDFs or relying on fax-on-demand services. Others are sticking with paper, or are using a combination of electronic and paper files. How does your facility acquire, store, and manage access to your MSDS?

Create your free online surveys with SurveyMonkey, the world’s leading questionnaire tool.

NIOSH reports chemotherapy drug exposures to oncology clinic staff

By: July 13th, 2012 Email This Post Print This Post

Concerns voiced by staff at an oncology clinic can help protect your workers, who may also handle hazardous drugs.

NIOSH posted a new Health Hazard Report prompted by a request from a Florida oncology clinic where staff members complained about upper respiratory irritation, headache, fainting, diarrhea, and loss of appetite.

Read the rest of this entry »

NIOSH updates healthcare hazardous drug list

By: July 2nd, 2012 Email This Post Print This Post

NIOSH has updated for 2012 the list of drugs commonly found in healthcare considered hazardous and requiring special handling.

List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings was last updated in 2010 and identifies drugs that could pose an occupational threat through various routes of exposure to workers, including doctors, nurses, pharmacists, and housekeeping staff.

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