OSHA: Take steps to reduce work violence

In its compliance directive on workplace violence, the U.S. Occupational Safety and Health Administration advises employers to conduct a hazard analysis, assess needs for physical changes to reduce risk, provide employee training, and implement a variety of controls, such as bright lighting and security cameras. The agency also advises employers to keep an incident log and develop a workplace violence prevention program.

Some of the key recommendations for health care administrative and work practice controls are summarized below. (More information is available at the new OSHA website on workplace violence: http://1.usa.gov/6zEZBp)

• State clearly to patients, clients and employees that violence is not permitted or tolerated.

• Ensure that adequate and properly trained staff is available to restrain patients or clients, if necessary.

• Provide sensitive and timely information to people waiting in line or in waiting rooms. Adopt measures to decrease waiting time.

• Ensure that adequate and qualified staff is available at all times. The times of greatest risk occur during patient transfers, emergency responses, mealtimes and at night. Areas with the greatest risk include admission units and crisis or acute care units.

• Institute a sign-in procedure with passes for visitors, especially in a newborn nursery or pediatric department. Enforce visitor hours and procedures.

• Establish a list of "restricted visitors" for patients with a history of violence or gang activity. Make copies available at security checkpoints, nurses' stations and visitor sign-in areas.

• Review and revise visitor check systems, when necessary. Limit information given to outsiders about hospitalized victims of violence.

• Supervise the movement of psychiatric clients and patients throughout the facility.

• Control access to facilities other than waiting rooms, particularly drug storage or pharmacy areas.

• Determine the behavioral history of new and transferred patients to learn about any past violent or assaultive behaviors.

• Establish a system — such as chart tags, log books or verbal census reports — to identify patients and clients with assaultive behavior problems. Keep in mind patient confidentiality and worker safety issues. Update as needed. Review any workplace violence incidents from the previous shift during change-in-shift meetings.

• Treat and interview aggressive or agitated clients in relatively open areas that still maintain privacy and confidentiality (such as rooms with removable partitions).

• Use case management conferences with coworkers and supervisors to discuss ways to effectively treat potentially violent patients.

• Prepare contingency plans to treat clients who are "acting out" or making verbal or physical attacks or threats. Consider using certified employee assistance professionals or in-house social service or occupational health service staff to help diffuse patient or client anger.

• Transfer assaultive clients to acute care units, criminal units or other more restrictive settings.

• Ensure that nurses, physicians and other clinicians are not alone when performing intimate physical examinations of patients.

• Discourage employees from wearing necklaces or chains to help prevent possible strangulation in confrontational situations. Urge community workers to carry only required identification and money.

• Survey the facility periodically to remove tools or possessions left by visitors or maintenance staff that could be used inappropriately by patients.

• Provide staff with identification badges, preferably without last names, to readily verify employment.

• Discourage employees from carrying keys, pens or other items that could be used as weapons.

• Provide staff members with security escorts to parking areas in evening or late hours. Ensure that parking areas are highly visible, well lit and safely accessible to the building.

• Use the "buddy system," especially when personal safety may be threatened. Encourage home healthcare providers, social service workers and others to avoid threatening situations.

• Advise staff to exercise extra care in elevators, stairwells and unfamiliar residences; leave the premises immediately if there is a hazardous situation; or request police escort, if needed.