Awareness boosts prevention of assaults

Oregon law requires training, reporting

At every quarterly safety meeting at Providence Health and Services facilities in Portland, OR, employee health and safety professionals pay careful attention to reports of violent incidents. What they learn may help them prevent future assaults.

"It's important for us to make sure we provide an environment in which our employees feel safe to report and that they see the results of the reporting," explains Rebbecca Maese, RN, BSN, MA, director of the Oregon region employee health services/ergonomics for Providence Health and Services, a system that includes seven hospitals.

Violent events in health care often go unreported. But with a recent state law, all of Oregon's hospitals are now implementing tracking programs, as Providence has had for several years.

The Workplace Violence Prevention Law for Healthcare went into effect last year, requiring periodic security and safety assessments, regular training, and an assault prevention program.

By January 2009, hospitals must report their workplace violence data on all assaults, as defined by the law, for 2008.

"We want people to be very aware of safety issues in their facility," says Yutonah Bowes, MA, ergonomics outreach coordinator for Oregon OSHA in Salem. The Healthcare Workplace Violence Assault Log will enable hospitals "to really study where the incidents are happening and what types of assaults are happening," she says.

The Oregon legislature also will review the data to determine whether other measures need to be taken to address workplace violence in health care, she says.

Ultimately, hospitals will be able to identify best practices and share successful approaches, says Lynda Enos, RN, MS, COHN-S, CPE, ergonomist and nurse practice consultant for the Oregon Nurses Association in Tualatin.

"[Workplace violence] is an increasing problem in health care nationally," says Enos, noting that as behavioral health units close, those patients are more frequently seen in acute care settings. "You have to identify where your high-risk areas are. You have to anticipate where your problems may be and put a program in place to address them."

Log illustrates trends

Good reporting is a vital tool in the effort to reduce workplace assaults. At Providence, the reports doubled in the year that the health system began using a new tool to log events. They range from the patient coming out of anesthesia who strikes a health care worker to a combative patient in the emergency department.

"As an organization, we begin to see where our challenging areas are, and we can focus what types of education we do to keep our employees and patients safe," says Maese. "We begin to understand more about what's going on."

Encouraging reporting also builds a "culture of safety," says Maese — a commitment to creating a safe environment for both patients and employees.

At Providence, every employee completes an annual module on workplace violence with their environment of care training. Employees who are in high-risk areas — behavioral health, security, the emergency department, and certain medical units — receive training on the escalation model and hands-on interventions in the prevention and management of violent behavior. The initial course lasts eight hours, and the annual refresher is a four-hour course.

Employees learn how to recognize warning signs and to calm agitated patients and de-escalate potentially violent behavior. If they are unable to diffuse the situation, employees learn how to protect themselves and the patient with physical intervention. They then work with the patient to respectfully diffuse the event, says Maese.

The Oregon law requires assault prevention and protection training "on a regular and ongoing basis," but doesn't specify that it must be annual. Safety assessment also must occur periodically.

The law allows employees to take actions to protect themselves from assault. They may refuse to treat a patient who has previously assaulted them. A home health worker also may refuse to treat a patient they believe to be potentially violent — based on past behavior or their physical or mental condition — unless they are accompanied by another employee. They also must be provided with a "communication device" that enables them to call for help. Employees also may use physical force in self-defense or to protect a third person, provided they used only the level of force that was necessary under the circumstances, the law states.

The law only covers home health workers who are employed by a hospital, not independent home health agencies.

(Editor's note: A sample workplace violence prevention plan is available from Oregon OSHA at