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

OSH ACT of 1970 Section (5)(a)(1): 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 physical threats and assaults by patients: a) On or about November 18, 2019, and at times prior, the employer, Cedar Springs Hospital, Inc./UHS of Delaware, Inc., dba Cedar Springs Hospital, failed to keep the workplace free of hazards. Employees in direct contact with patients (including but not limited to crisis evaluators, mental health specialists (MHSs), registered nurses (RNs), licensed practical nurses (LPNs), therapists, and teachers) have suffered serious workplace violence (WPV) related injuries such as concussions, broken skin, bruising, scratches, sprains and strains, and injuries to the head and torso during routine interactions, including breaking up fights, providing shots, conducting assessments during intake and restraining patients. The majority of affected employees are MHSs who are responsible for direct patient care. Employees also reported that they experienced higher incidents of WPV during times of reduced staffing such as overnight and weekend shifts. The employer has not developed and implemented adequate measures to protect employees from this recurring serious hazard. Among other methods, feasible and acceptable means to abate the workplace violence hazards at Cedar Springs Hospital include implementation of a comprehensive and effective workplace violence prevention program (WVPP) which includes engineering and administrative controls, as well as training to materially reduce workplace violence hazards. These controls include: Engineering Controls 1. Re-configure the nurses? stations in the units, to include design features that prevent patients from jumping over, reaching into, over, or otherwise entering into the workstations. Ensure items in the workstations, such as but not limited to hole punchers, staplers, telephones, cords, pens, computers, computer peripherals, and other items are not accessible by the patients, so they cannot be used as weapons. 2. Provide all staff members who work in close proximity with patients with reliable communication devices to rapidly communicate need for assistance, including but not limited to, times when staff members leave the unit to escort patients. Provide a means to silently communicate need for assistance without alerting the patient population. Install thealert signal in a way that it is not visible to patients. In addition, provide training and procedures on use and limitations of equipment. Administrative Controls 3. Implement the Workplace Violence Prevention Program and include elements such as: a. Conduct a building-specific hazard analysis that analyzes the building as a whole and each unit, job tasks, and occupations for risks, including but not limited to, potential weapons, potential for victims to be cut off from communication, delays in activating emergency alert systems, and potential for physical entrapment of victim. The assessment should also include a records review and employee surveys to further assess potential risks; b. Follow procedures as described in the company WPV Prevention policy to provide opportunities for direct care staff such as: MHSs and nursing staff to participate in the program; providing access to committees that discuss workplace violence incidents; or dedicated means which allow employees to state concerns or ideas for improvement to the workplace violence program (one example may include periodic surveys); c. Conduct post-incident debriefings with all staff involved as stated in the Workplace Violence Prevention policy. Allow employees directly involved in workplace violence events to participate in reviews of the incidents, including but not limited to, reviews of camera footage. Conduct a root-cause analysis of events to determine potential contributing factors beyond patient behaviors (example: physical keys aiding in patient elopement attempts, or lack of engineering devices leading to needlesticks during administration of medication). Identify and develop solutions for systemic causes of events which frequently occur but may not be associated with a single patient, such as employees being pinned to walls or the floor; d. Provide copies of the WVPP and make it readily available to all staff; e. Review the WVPP for effectiveness of current policies and to ensure all stated policy elements are being implemented. Update WVPP as necessary to address any noted areas for improvement. Solicit employee feedback during the review process; f. Implement an effective reporting process for workplace violence events. 4. Maintain staffing that is adequate to safely address changes in patient acuity and patient census. Staffing levels must allow for safety of staff during admission of new patients, behavioral health emergencies, one-on-one patient assignments, staff breaks, and the accompaniment of patients off-unit. Staffing levels must also allow for and ensure safety during educational instruction on and off the unit, therapeutic activity groups, and recreational periods. 5. Develop and implement a policy in the Admissions and Referrals (A&R) unit to secure potential patient belongings upon arrival for assessment, such as providing patients with a locker where they can secure personal belongings. Minimize the length of time patients spend in common areas with potential contraband, including weapons. Inspect patient belongings in a secure area prior to escorting patient to the unit. Develop and implement procedures for confiscating items in a manner which reduces or eliminates risk to A&R employees. Consider implementing a policy where local law enforcement is contacted to secure contraband such as illegal substances or weapons. Develop a means for A&R employees to keep their hands free and unobstructed while escorting patients to the unit. 6. Designate specific staff with specialized training in security and/or hire trained security specialists to monitor patients for potential aggression on all shifts and to assist in preventing and responding to Code Green events occurring in the units. Staff must have the skill necessary to re-frame issues, seeking how to keep the patient and persons in the surrounding area safe, while responding to aggressive behaviors. The staff designated to monitor and respond to patient aggression should not be given other assignments, such as patient rounds, which would prevent the designated person from immediately responding to an alarm or other notification of a Code Green. Conduct ?Code Green? training sessions to allow all designated staff to practice and evaluate their skills in a variety of environments and scenarios. Post Incident: 7. Conduct an investigation and debriefing after each act of workplace violence, including near misses, with the attacked and/or injured employee and other involved employees, including root cause or similar analysis, lessons learned, and corrective actions to prevent reoccurrence. Maintain accurate records of patient assault on staff. Provide the attacked and/or injured employee and other involved employees with an opportunity to provide feedback about specific measures that could prevent such future incidents. Review and evaluate each workplace violence related incident, both on a case-by-case basis and to monitor for trends in areas with high rates of incidents such as the acute units. Thoughtfully review and evaluate any formal or informal requests for increased staffing based on unit acuity. Ensure that formal and informal requests are valued, acknowledged, reviewed and evaluated, and the resultant outcome and actions are communicated in the most effectual forum.