Text For Citation: 01 Item/Group: 001 Hazard:

Section (5)(a)(1) of the Occupational Safety and Health Act of 1970: The employer did not furnish employment and a place of employment which were free from recognized hazards that were causing or likely to cause death or serious physical harm to employees in that employees were exposed to acts of workplace violence including, but not limited to: verbal threats of assault, physical assaults, choking, punches, kicks, human bites, scratches, and/or pulling of hair by patients. Location: 391 Varnum Ave. Lowell, MA On or about November 20, 2014, employees working at the UHS of Westwood dba Lowell Treatment Center were exposed to acts of workplace violence, including, but not limited to, verbal threats of assault, physical assaults, choking, punches, kicks, bites, scratches and/or pulling of hair. The employer's workplace violence prevention program, training, and other measures did not adequately address the hazards of verbal and physical assault that may be posed by patients. From January 1, 2011 through December 31, 2014 there have been at least 16 documented cases identified in the OSHA 300 log of employees assaulted on the job by patients resulting in approximately 255 restricted duty days and 730 days away from work. Additionally there has been at least 38 documented non-recordable cases resulting in a dislocated shoulder, concussion, sprains, strains, contusions, swollen body parts, headaches, human bites, punched in the face, kicked, hit, choked, hair pulled, scratched, bitten, grabbed and thrown by patients. During 2014 there were at least five instances of work place violence, including an incident on November 30, 2014, when a nurse was punched in the face and knocked out unconscious by a patient, resulting in soft tissue damage to the face and jaw, contusions, swelling, and headaches. Feasible means of abatement, among others include: 1. Create a stand-alone adequate, comprehensive, written workplace violence prevention program to include the following elements: a. Including a comprehensive workplace violence program that includes all potential sources of workplace violence or threatening acts by patients. b. Clear written description of how employees should respond to patients making threats, aggression and assault, including guidelines on when to call police; c. Clear written statement that employees will not experience retaliation for reporting incidents of threats or violence or for calling police; d. Clear written procedure of how the company communicates to patients the consequences of workplace violence. e. Revise the current existing workplace violence prevention program to include that the facility will investigate all workplace violence events and not on a case-by-case basis. f. Hazard/threat/security assessment including records review to assess potential threats posed by patients. Inspection of the worksite for risk assessment, e.g. potential weapons, potential for victim to cut off from communication, potential for physical entrapment of victim, and employee survey to further assess potential risks; g. Perform a workplace hazard assessment of the units to ensure that work areas have two exits and that furniture and doors are arranged to prevent entrapment. Ensure that articles in the patient areas or on open nursing stations that may be used as weapons are removed or properly secured. Ensure that doors are locked to prevent patient access. Evaluate Adult 1 (A1) nursing station configuration including, but not limited to, the unlockable half door to access the nursing station, the depth of the desk to ensure patients cannot reach over or jump over the desk and assault staff members, and ensure items on the nursing station?s desk are secured (i.e. 3 hole punch, stapler, phone, cords, DeWalt Stereo, umbrella, and other items) and cannot be used as weapons. Evaluate A1 back nursing station desk area and reconfigure the space so the staff members? backs are not to the unlocked door, to eliminate vulnerability of patients being able to come up behind staff members without warning. Evaluate the use of plastic lawn chairs on the unit as they are not secured and can be thrown and used as a weapon. Reassess and evaluate the current doors on patient rooms and other rooms on the units to a double hinge style door to prevent patients from barricading themselves and/or a staff member in a room. h. Training to staff pertaining to responsibilities of staff for responding and reporting incidents or threats and a system in place to ensure all acts of workplace violence are reported and recorded, including but not limited to verbal assaults, physical assaults, and near miss incidents. i. Incident/near miss incident reporting and investigation to include root cause analysis, lessons learned and prevention plans; j. Injury reporting and investigation to include root cause analysis, lessons learned, trend analysis of summary data and prevention plans; k. A system in place to ensure that debriefing meetings occur after each act of workplace violence and that follow-up including root cause analysis, lessons learned, and corrective actions to prevent reoccurrence; l. Re-training on how and where an employee should seek emotional support and mental health care, including after-hours care; m. Mechanism for employees and managers to elevate the reporting of workplace violence incidents above the level of an immediate supervisor, in the event that supervisor fails to act in a timely manner; n. At least annually, review and update the facility?s workplace violence policies to ensure that procedures are in place for managing worst-case scenarios in which staff are unable to control or contain an incident, and to ensure that these policies allow staff to impose physical control measures in accordance with treatment plans determined by mental health professionals, when necessary to ensure their own safety. Solicit and include employee input in this review. o. Periodic review of the program?s effectiveness, using objective measures and identifying interventions for improvement. 2. Provide employees with personal duress/panic buttons with no-response alarms connected to a continually monitored and automatic response system as described for example in the Lone Worker Safety Systems. 3. Provide all employees a communication device (i.e. walkie talkie radio or cell phone). 4. Assign the duties of the overall workplace violence prevention program to a specific position (individual person) as soon as possible. Ensure the position includes overall coordination of the facility?s Workplace Violence Prevention Program and the responsibility for conducting thorough incident investigations, with assistance from the facility?s safety committee. 5. Ensure that the coordinator and the safety committee have the requisite skills to identify the underlying causes of violence and develop effective intervention strategies. 6. Establish a system where the doctors at the Lowell Treatment Center have the ability to review the patient?s history of violence prior to admission and to approve or disapprove the patient prior to arrival, to ensure the safety for staff and for the patient. 7. Document and communicate all workplace violence incidents in a system that ensures management?s timely review and response. 8. Establish a stand-alone safety committee for the Lowell Treatment Center. Notify and involve staff members, including but not limited to doctors, nurses, and mental health technicians (MHTs) about the safety committee and encourage their participation in the meetings. Review workplace violence incidents in the safety committee meetings to ensure effective and timely follow-up mechanisms are in place to eliminate reoccurrence of violent acts. 9. Develop a system for employees to report safety concerns and suggestions anonymously. Develop a system to provide communication and feedback to staff members? safety concerns and suggestions to ensure timely follow-up with their concerns and/or suggestions. 10. Assess the facility for the need of protective devices (i.e. bite guards, protective gloves, etc.). 11. Provide security to all units on each shift to respond to aggressive behavior and/or to monitor surveillance cameras which are present. 12. Conduct more extensive training so that all employees clearly understand the company?s workplace violence prevention program. Train employees on behavioral limits in threatening and/or aggressive patients where appropriate and authorize employees to implement limits appropriately. In addition, train all employees to state clearly to patients and employees that violence is not permitted or tolerated. Train all employees that perform work on the units, how to respond during violent incidents at work. Further train employees on: recognizing when a patient is exhibiting aggressive behavior and techniques for timely de-escalating the behavior; risk factors that cause or contribute to assaults. 13. Conduct new hire and refresher training to ensure employees are aware of what the company?s workplace violence policy is, where it can be found, and what the company?s expectations are for dealing with workplace violence hazards. Training should be conducted in a manner in which employees can easily understand the terminology and should incorporate the company?s Handle with Care training and UHS verbal de-escalation training, hands-on exercises and practice drills to improve staff skills and confidence. Training should also include the company?s policies and requirements for recording and documenting patients? aggressive or assaultive behavior on the patients? communication whiteboard, in an Employee Accident Report (EAR) form, and in an assault consultation.