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

29 CFR 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 are exposed to violence, including physical threats and assaults, while working with behavioral health patients. During routine interactions with patients, employees such as but not limited to, Registered Nurses, Behavioral Health ("BH") Technicians, Program Aides, and Personal Care Aides were physically assaulted by behavioral health patients. Employees performing job duties such as one-to-one observations of patients, transferring patients from the psychiatric ED to behavioral health units, conducting patient rounds, providing assistance at the nurse's station, intervention in halting patient escape, intervention in halting assaults, and/or performing holds/restraints, experienced serious injuries due to workplace violence (WPV) in areas of the hospital including, but not limited to, BH Units and Psychiatric Emergency Department. This violence has resulted in employee injuries such as scratches, broken bones, fractured nose, detached retina, loss of consciousness due to strangulation, throat injuries, concussions, and a torn rotator cuff. The employer did not develop and implement adequate measures to protect employees from this recurring serious hazard, such as: a) Niagara Falls Memorial Medical Center, 621 Tenth Street, Niagara Falls, NY, 14302 - Psychiatric Emergency Department: On February 3, 2023, a Program Aide and Registered Nurse were escorting a patient, in a wheelchair, from the psychiatric emergency room to the behavioral health unit. As they approached an exit door which led to the outside the patient got up from the wheelchair and attempted to elope. When the nurse attempted to stop the patient, the patient lunged at the nurse. When the Program Aide attempted to restrain the patient, the patient head butted the Program Aide. The Program Aide suffered a broken nose and lost 3 days away from work because of the incident. b) Niagara Falls Memorial Medical Center, 621 Tenth Street, Niagara Falls, NY, 14302 - Behavioral Department Unit A3: On March 3, 2023, a BH Technician was assaulted by a patient while she was walking down the hallway while making patient rounds. The patient pulled the Technician's hair and punched her in the face. The employee suffered a detached retina and lost approximately 25 days away from work because of the incident. c) Niagara Falls Memorial Medical Center, 621 Tenth Street, Niagara Falls, NY, 14302 - Behavioral Department Unit A2: On March 24, 2023, a Registered Nurse was assaulted by a patient who was in an agitated state and shouting at a Behavioral Health Technician. When the nurse intervened and attempted to calm the patient, the patient grabbed the nurse and placed her in a choke hold. The employee lost consciousness, suffered a concussion, several herniated disks, neck injury, bruised nose, and a torn rotator cuff. This employee has lost more than 100 days away from work and has been unable to return because of the incident. d) Niagara Falls Memorial Medical Center, 621 Tenth Street, Niagara Falls, NY, 14302 - Behavioral Department Unit A3: On May 18, 2023, a patient was arguing with two other nurses at the desk of the nurses' station about his paperwork. A Registered Nurse intervened and attempted to help the patient. The patient opened the half-door of the nurse's station and punched the nurse who was attempting to help him in the face. The nurse who was assaulted suffered facial pain as a result of the incident. e) Niagara Falls Memorial Medical Center, 621 Tenth Street, Niagara Falls, NY, 14302 - Behavioral Department Unit A3: On May 20, 2023, a Personal Care Aide was bitten on the finger by a patient while attempting to restrain a patient who was in an agitated state. The employee lost 2 days away from work because of the incident. NOTE: IN ADDITION TO ABATEMENT CERTIFICATION, THE EMPLOYER IS REQUIRED TO SUBMIT ABATEMENT DOCUMENTATION FOR THIS ITEM, FAILURE TO COMPLY WILL RESULT IN AN ADDITIONAL PENALTY OF $ 1,000.00 AS PER 29 CFR 1903.19 Among other methods, feasible and acceptable methods of abatement to eliminate or materially reduce this hazard includes, but is not limited to: 1. Ensure Niagara Falls Memorial Medical Center (NFMMC) reviews its WPV policies to ensure that the following elements are integrated into a comprehensive workplace violence prevention program that addresses: a. Update the NFMMC Workplace Violence Policy, incorporating findings from the hazard assessment, incident investigations and employee input. Ensure the NFMMC Workplace Violence Policy is site specific. b. Review the Workplace Violence Policy annually, or sooner if workplace conditions or procedural changes occur, and update as needed. c. Assign responsibility and authority for all aspects of the workplace violence policy to ensure that all managers and supervisors understand their obligations. d. Review NFMMC's Patient Elopement Policy and update as needed. Procedures and protocols to prevent and address instances of elopement should include, but are not limited to, the following: - Elopement Risk Assessment - Notification to employees - Identification of patients with known elopement behaviors - Protocols to follow during and after patient elopement - Staff training on awareness and response - Supervisory notification and 911 calls - Communication protocols with local police 2. Engineering Controls: a. Provide employees with a reliable way to summon assistance when needed, such as a personal alarm device. Implement procedures for testing and maintenance of alarm devices to ensure operability. Ensure equipment coverage is available for each employee on each shift. - Employees must be trained on the use of the device prior to being assigned a device for use. - Arrange for a reliable response when an alarm is triggered or when a call for help is received from employees. Provide management support during emergencies. - Alarms must be maintained in operable condition. - Audible alarm devices must be distinctive and capable of being perceived above ambient noise when triggered to indicate that help is needed. b. Ensure adequate and qualified security staff and counselors can respond without delay to the immediate area when staff is providing one-to-one observation of psychiatric patients known to be physically violent (e.g., security watch patients). c. Use a monitored closed-circuit video or virtual patient observation technology on a 24-hour basis in high-risk areas. d. Install physical barriers between patients, visitors, and workers, such as enclosures with pass-through windows. e. Install deep counters at nurses' stations. 3. Administrative Controls: a. Management Commitment and Worker Participation - Assign responsibility and authority for all aspects of the workplace violence prevention program to ensure that all managers and supervisors understand their obligations. - Assign responsibility and authority for the workplace violence program to individuals or teams with appropriate training and skills. Ensure that adequate resources are available and that those responsible for the program develop expertise on workplace violence prevention. - Ensure Worker Participation - Through involvement and feedback, workers can provide useful information to employers to design, implement and evaluate the program. This involvement should include participation in Workplace Violence committee or safety and health meetings that receive reports of violent incidents or security problems, making facility inspections and responding to recommendations for corrective strategies. - Survey workers periodically to learn if they experience hostile situations in performing their jobs. 4. Worksite Analysis and Hazard Identification a. Conduct a workplace violence hazard assessment, and security analysis that includes a list of risk factors identified in the assessment and how each specific hazard will be addressed. A team that includes senior management, supervisors, and non-managerial employees should perform this assessment. b. Hazard identification - Once the worksite analysis is completed, it should be used to identify the types of hazard prevention and control measures that are needed to reduce or eliminate the possibility of workplace violence incidents occurring at your facility. Corrective actions should be identified and tracked through to completion. c. Ensure the outcome of the assessment, as well as any policies and procedures developed as a result of assessments, are effectively communicated to staff. d. Review annually or more often if workplace conditions or procedures are changed, and update as needed. 5. Hazard Prevention and Control a. Require employees to report all assaults or threats to a supervisor or manager (for example, through a confidential interview). Each reported incident should be recorded and maintained for review after each incident; all incidents should be analyzed at least annually to identify trends. b. Investigation of Incidents - Promptly investigate all incidents involving WPV, including threats and near-misses, to determine potential gaps in NFMMC's Workplace Violence Policy. Identify and adopt appropriate controls to address the hazard. c. Investigate Near Misses. In addition to investigating all incidents resulting in a fatality, injury or illness, any near miss (a situation that could potentially have resulted in death, injury, or illness) should be promptly investigated as well. Near misses are caused by the same conditions that produce more serious outcomes, and signal that some hazards are not being adequately controlled, or that previously unidentified hazards exist. d. Identify Root Causes: Identify the root causes of the incident. Do not stop an investigation at "worker error" or "unpredictable event." Ask "why" the individual acted, "why" the worker responded in a certain way, etc. Ensure that personnel performing incident investigations are suitably trained in how to perform root cause analyses. e. Involve workers in the incident investigation, especially those who work most closely in the area where the events occurred. f. Survey employees periodically to learn if they experience hostile situations in performing their jobs. g. Incident reports must be in writing and maintained for review after each incident and at least annually to analyze incident trends. Train employees on how to enter NFMMC "Violent Behavior Report Form" to include when a report must be completed and submitted. h. Information on patients with a history of past violence: Determine the behavioral history of new and transferred patients and clients to learn about any past violent or assaultive behaviors and establish a system to share the information with staff interacting with these patient - Identify any event triggers for clients, such as certain dates or visitors. - Identify the type of violence including severity, pattern and intended purpose. - Use information gained to formulate individualized plans for early identification and prevention of future violence. - Establish a system to track these patients and clients, such as chart tags, logbooks, or verbal census reports. - Ensure workers know and follow procedures for updates to patients and client's behavior. - Update staff during shift changes about violent history or new incidents of violence. - Ensure the outcome of the investigation, as well as any policies and procedures developed as a result of investigations are effectively communicated to staff. 6. Safety and Health Training a. Provide all employees with training on workplace violence. b. New and reassigned employees must receive training before being given their work assignment. c. Provide supplemental or refresher training if inadequacies in an employee's knowledge or work practices indicate that such additional training is needed. d. In high-risk settings such as working with residents with a history of violence refresher training may be needed more frequently, perhaps monthly, or quarterly, to effectively reach and inform all employees. 7. Recordkeeping and Program Evaluation a. Evaluate the effectiveness of controls at least annually, and improve, expand, or update them as needed. Such review and updates shall set forth any mitigating steps taken in response to any workplace violence incidents. b. Follow up to confirm the controls developed are being used and maintained properly and accurately. b. Maintain accurate records of injuries, illnesses, incidents, assaults, hazards, corrective actions, patient histories, and training. These records help to determine the severity of the problem; identify trends or patterns in particular locations, jobs, or departments; evaluate methods of hazard control; identify training needs and develop solutions for an effective program. c. Ensure that employees who report or experience workplace violence do not face retaliation. d. Ensure Post-Incident Procedures and Services are provided following any employee involvement in workplace violence. These procedures and services shall provide specific guidance such as, but not limited to, what number to call or where to go to obtain comprehensive treatment and/or counseling for employees who may be traumatized by witnessing or being involved in a workplace violence incident, regardless of severity.