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Last month Hospital Home Health examined on-the-job safety for home health care employees, looking at ways in which employees can reduce their risk of danger at the workplace and steps home health care workers can take to avoid calling attention to themselves while working in dangerous neighborhoods. While every individual holds some personal responsibility when it comes to playing it safe, the home care agency shoulders a large part of the burden of keeping its employees out of harm’s way.
This month, Hospital Home Health looks at agencies’ responsibility and how to develop an effective safety plan.
"Given the potential for injury or damage to home care workers, we have been awfully lucky," says Elizabeth Hogue, Esq., a home care attorney from Burtonsville, MD.
That luck though is not the result of a widespread movement on the part of home careagencies to implement standardized workplace-violence prevention programs. Nor is it due to statewide regulation.
In fact, few states have regulations requiring a workplace-violence plan, although there are some that now have begun mandating them. Washington state is just one example. In 2000, the state passed legislation requiring that by July 1 of that year, all home health, home care, and hospices would have developed and implemented workplace- violence plans. As part of the plans, agencies are now required to keep records of any acts of violence done against employees or clients and must include such detailed information as:
Washington’s legislation goes a step farther, requiring agencies to have developed violence prevention training plans, whereby, with the exception of temporary employees, all staff must receive training within 90 days of employment. The programs may employ a variety of teaching tools including but not limited to videotapes, brochures, verbal training, and class time. Topics to be covered include:
While Washington agencies have been busy developing violence prevention plans, most other agencies across the country rely on inservices to address the issue. If your agency is lacking a formal safety program, it’s not alone. Progressive Home Care in Cleveland doesn’t have one either, says Barb Johnson, administrator. But her agency does "have security available if it is a seriously unsafe situation" and has its compliance officer, who is trained in security matters, working on developing a program, she explains.
Although most agencies are lacking a formal plan, many do address the subject, either during employee orientation or inservices. Henry Ford Home Health Care in Detroit is one such example, explains Greg Solecki, vice president.
"We have a personal safety policy, and we also have personal safety guidelines that we give to staff. Personal safety is stressed throughout new-employee orientation and is bolstered by a mandatory, annual safety inservice, which covers patient safety, in-the-office safety, and personal safety in the field," he says. "In the past, we had our hospital’s security department inservice our staff, but that proved to be less helpful than we hoped. In addition to being light on safety precautions for employees not working in a facility, we encountered some judgmental speakers who . . . offered comments like, You go where?!’"
Alice Fritz-Warren, RN, BSN, MSN, regional performance director for Sun Plus Home Health in San Leandro, CA, says her agency also relies on inservices to spread the safety message. "We provide safety education on an annual basis both to our office and field staff. Our local police and fire departments come and do inservices, and we use the Street Smarts video for all new hires," she explains.
Like Sun Plus, Cuidado Casero Home Health in Dallas addresses workplace safety issues in inservice meetings "maybe once a year or so when we sometimes have a speaker from the police department," says home care nurse Paul Dewhitt, RN.
Utilizing off-duty law enforcement is a great asset, says Hogue, who emphasizes the importance and value of using police officers as part of an agency’s overall safety program. Their presence, she says, lends credibility to a program and also allows law enforcement people to become familiar with home care and your personnel. "That way if you ever need help, there’s already a tie that’s been created there." Whenever possible, agencies should provide staff with escorts, Hogue adds. "They have been very effective," Hogue notes, adding that they are most effective when "they meet the nurse outside the area and travel with [that person] to the home and go in and remain in the home until the nurse is finished."
When it comes to developing a program, agencies can take several measures toward ensuring that their employees are as safe as possible while on the job. (See "General Rules for Developing a Workplace Safety Program," in this issue..) First and foremost, the agency should practice what it preaches insofar as being supportive of its staff and their impressions of the level of safety in a given area or patient’s home. Agencies should also act as the go-between for the staff and patients or their family members who are issuing complaints, notes Hogue. When complaints turn to harassment, she encourages agencies to turn the calls over to their lawyers.
"Over the years, I’ve had clients that did that when staff were being harassed by former patients, and their strategy was that they relayed the message to me and I would answer. Putting someone in between the agency and the person seemed to really keep a lid on [the harassment], and these people eventually went away in short order when they realized the agency’s lawyer was calling."
Home care agencies also should maintain a working log of their staff’s locations and require staff to check in and out at every assignment. Another good idea is to develop scenarios about what home care nurses might encounter and how they should handle it. This is an excellent example of how working closely with law-enforcement agencies in your area can be beneficial.
No matter how your agency chooses to deal with violence prevention, it’s important that it address the issue, says Hogue. "Violence in home care is nothing to kid around about."
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