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Occupational Safety and Health Administration OSHA

Violation Detail

Standard Cited: 5A0001 OSH Act General Duty Paragraph

Violation Items

Nr: 314683558 Citation: 01001 Issuance: 01/25/2011 ReportingID: 0111100

Viol Type:Serious NrInstances:191 Contest Date:
Abatement Date:06/15/2011 X Nr Exposed:483 Final Order:
Initial Penalty: $6,300.00 REC:C Emphasis:
Current Penalty: $6,300.00 Gravity:10 Haz Category:FALLING

Penalty and Failure to Abate Event History
Type Event Date Penalty Abatement Type FTA Insp
Penalty Z: Issued 01/25/2011 $6,300.00 03/14/2011 Serious  
Penalty I: Informal Settlement 02/04/2011 $6,300.00 06/15/2011 Serious  

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

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 physical assaults by violent psychiatric patients: Facility-wideFrom January 1, 2008 through December 31, 2010 there have been at least 115 hospital employees identified in the OSHA 300 LOG that have been assaulted on the job by violent psychiatric patients resulting in approximately 1741 restricted duty days and around 570 days away from work as well as at least 76 non-recordable cases resulting in broken teeth, prescription glasses broken in physical assaults, contusions, human bites, being punched in the face,or being hit and kicked by violent psychiatric patients. During the current reporting year there were at least five instances of particular severity. On April 30, 2010 a psychiatrist in admissions was choked and beaten by a patient. The next day, May 1, 2010 the same violent patient choked, beat, pulled hair, and pounded a nurse's head into a wall. On July 8, and August 7, 2010 psychiatric technicians were aggressively assaulted by different violent patients resulting in a severe kick to the pubic area of one and a smashed face in the other technician. Some feasible and acceptable means to abate the hazard of workplace violence in the Acadia Hospital include but are not limited to: 1. Ensure that all patients are screened for potential violence before being admitted to the hospital. In addition, consider using hand-held metal detecting wands to discover concealed weapons and consider using closed circuit TV and other surveillance systems in order to discover workplace violence quickly. 2. Conduct extensive training so that all effected employees are aware of what the hospital's workplace violence plan is, and where the information can be found. In addition, train all employees to state clearly to patients, clients, and employees that violence is not permitted or tolerated. Further, train all employees on recognizing when a patient is exhibiting aggressive or violent behavior and techniques for timely deescalating that behavior. Workplace violence training includes 1) The Acadia Hospital Workplace Violence Program; 2) Risk Factors that cause or contribute to assaults; 3) Early recognition of escalating behavior or recognition of warning signs or situations that may lead to assaults; 4) Ways to prevent or diffuse volatile situations or aggressive behavior; 5) The standard response plan for violent situations including the availablity of assistance, response to alarm systems and communication procedures; 6) Ways to deal with hostile people other than patients and clients, such as relatives and visitors; 7) Progressive behavior control methods and safe methods to apply restraints; 8) Ways to protect oneself and coworkers including use of the"buddy system"; 9) Policies and procedures for reporting and record keeping; 10) Information on multicultural diversity to increase staff sensitivity to racial and ethnic issues and differences; and 11) Policies and procedures for obtaining medical care, counseling, worker compensation, and legal assistance after a violent episode or injury. Training on escalating behavior includes, but not limited to : 1) Recognize warning signs sucha s confusion, frustration, blame, anger, and hostility; 2) Use methods to de-escalate violent and excalating behavior such as listening to concerns, using clarifying questions, giving factual information, relocating to a quiet setting, reassuring, making a sincere effort to clarify concerns, disingaging, and bringing to help; 3) Respond to violence and potential violence by using venting techniques, preparing to evaluate, and contacting supervisors and security; 4) Use personal conduct to minimize violence such as projecting calmness, moving slowly, speaking slowly, listening empathetically, having relaxed but attentive posture, establishing ground rules with consequences, and using delaying tactics to allow the person to calm down. 3) Use a system such as flagging a patient's chart anytime there is a history or act of violence and train staff to understand the flagging system. Put procedures in place that would allow communication of any incident of workplace violence to the staff that might come in contact with a patient, so that emloyees who might not have access to the patient's chart would be aware of a previous act of aggression or violence. 4) Ensure that adequate numbers of properly trained security people (such as "Response Teams" or Security Department) are readily and immediately available to render assistance in the event of an incident of workplace violence and ensure that security has the specialized training to deal with aggressive and violent behavior. In addition, develop a good working relationship with the local police department in order to keep abreast of the rise and fall of criminal activity in the community. 5) Configure the workplace in such a way to maximize the ability of an employee to escape in the event of workplace violence. Ensure that work areas have two exits and that furniture is arranged to prevent entrapment. Ensure that articles in the patient areas that may be used as weapons are removed or properly secured. 6) Limit employees from working alone or in secluded places with patients, including stairways and elevators. Use a buddy system where appropriate. 7) Develop and implement the specific actions employees are to take for an incident of workplace violence in the hospital. For example, specify a specific workplace violence alarm system and a specific, reliable response to that system. Be very clear regarding the specific actions that the employees are to take for a workplace violence situation such as a "Green Code" or a "Silver Code" as described in the Acadia Hospital Interdepartmental Directive titled: "Overhead Paging System" dated October 16, 2008 and revised on August 31, 2010. Alarm systems may include use of panic buttons, beepers, cellular phones, surveillance cameras, and publc address alarms. The response to the system must be reliable and may include response teams, security teams, security guards, or local law enforcement. The response system must also include medical assistance for injured employees or other injured persons. Finally, develop and implement the specific reporting requirements for an incident of workplace violence. 8) Develop and implement specific procudures for reporting incidents of workplace violence including both reporting to hospital management as well as reporting to law enforcement for assistance and/or filing charges. 9) Create a stand alone written Workplace Violence Prevention Program for the hospital which includes the following elements: i) A policy statement regarding violence in the workplace including a Zero-tolerance policy for workplace violence and assignment of oversight and prevention responsibilities. ii) A workplace violence hazard assessment and security analysis, including a list of the risk factors identified in the assessment and how the employer will address the specific hazards identified in the assessment and how employer will address the specific hazards identified. A step by step complete assessment includes analysis and tracking of records, monitoring of trends, analysis of incidents, conducting employee screeing surveys, and analysis of security. iii) Development of workplace violence controls including, administrative and engineering controls and methods used to prevent potential workplace incidents. Engineering controls may include 1) alarm systems, panic buttons, hand-held alarms, noise devices, cellular phones, radios, and reliable response to those alarms; 2) Installed and hand-held metal detectors; 3) Closed circuit video; 4) Curved mirrors at hallway intersections; 5) Employee "Safe Rooms" for use during emergencies; 6) "Time Out" or seclusion areas for patients who "act out" and separate rooms for criminal patients; 7) Arrangement of furniture and rooms to prevent entrapment; 8) Minimal furniture and objects in rooms that may be used as weapons; and 9) Bright effective lighting. Administrative controls may include: 1) Clear statement ot patients and visitors that violence is not permitted or tolerated; 2) Adequate staffing including response teams, security, adequate and appropriately trained staff to restrain patients; 3) Adequate staffing during times of greatest risk including during patient transfers, emergency responses, meal times, and at night; 4) Establishment of policies for when employees are not allowed to work alone; 5) Use of case management conferences with employees and management to discuss ways to treat potential violence patients effectively; and 6) Use of security escorts or the buddy system in circumstances considered to be high risk such as during transport in elevators or stairways. iv) Institution of a recordkeeping system designed to report any violent incidents. The reports must be in writing and maintained for program review. Records must include medical records, safety meetings, OSHA 300 Logs, insurance records, police and law enforecement records, incidence reports, and records of near misses. v) Development of a workplace violence training program that includes a written outline or lesson plan. Workplace violence training includes: 1) The Acadia Hospital Workplace Violelnce Program; 2) Risk Factors that cause or contribute to assaults; 3) Early recognition of escalating behavior or recognition of warning signs or situations that may lead to assaults; 4) Ways to prevent or diffuse violent situations including the availability of assistance, response to alarm systems, and communication procedures; 6) Ways to deal with hostile people other than patients and clients, such as relatives and visitors; 7) Progressive behavior control methods and safe methods to apply restraints; 8) Ways to protect oneself and coworkers, including use of the"buddy system"; 9) Policies and procedures for reporting and recordkeeping; 10) Information on multicultural diversity to increase staff sensitivity to racial and ethnic issues and differences; and 11) Policies and procedures for obtaining medical care, counseling, worker compensation, and legal assistance after a violent episode or injury. vi) Annual review of the workplace violence prevention program, which should be updated as necessary. Such review and updates shall set forth any mitigating steps taken in response to any workplace violence incidents.

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