Although the media pays close attention to workplace homicides, many violent incidents in the workplace involve nonfatal but serious injuries. According to the most recent statistics available from The National Crime Victimization Survey (NCVS) and Bureau of Labor Statistics (BLS) between 2011 and 2013, most workplace assaults occurred in social service and health care settings.
Additionally, there were many more days away from work in 2013 for staff in healthcare and social assistance facilities due to their assault-related injuries compared to employees in the private sector, as shown below.
The assault risks that healthcare and social service workers face mainly stem from violent behavior demonstrated by their patients, clients or residents. Studies have shown that the following healthcare settings consistently present the most risk:
- Inpatient and acute psychiatric services
- Geriatric long term care settings
- High volume urban emergency departments
- Residential and day social services
As such, the Occupational Safety and Health Association (OSHA) created workplace violence prevention guidelines designed specifically for staff who work in these settings.
OSHA Guidelines for Healthcare and Social Service Settings
1. Track client behavior.
It may be difficult to gather information related to the behavioral history of new clients; however, any violent behaviors of current clients must be tracked and documented to reduce the likelihood of future events.
Establish a system.
A good system utilizes log books, census reports, and chart tags to recognize clients who have a history of violence. Logbook documentation should include potential triggers (e.g., dates, visitors or television programs, etc.), previous violent act information that includes the severity, type, pattern, and client’s intended purpose. A successful system requires ensuring that employees know the protocol for updating a client’s behavioral history.
Examine each client’s behavioral history.
By creating a system that identifies clients who have a history of violence and informing service providers of their triggers, the employee can be prepared to provide the best response to de-escalate the situation.
Design individualized plans.
The information collected can be used to create an individualized plan for each client to begin to identify and prevent any future acts of violence.
2. Create home visit contracts.
Construct a clear, easy to read contract that outlines which services will be provided during a home visit and what issues can lead to an employee’s refusal to provide services.
3. Incorporate engineering controls for social service and home health workers.
Every violent incident or threat must be reported to management. It is essential that employees know the procedures to follow in the event of a violent incident or threatening situation.
- Incorporate regular use of cell phones with GPS tracking capability. Most cell phones have a ‘help’ function that can easily be accessed in the event of an emergency.
- Service providers should take note of the exit routes within each home.
- A de-escalation area for the patient/client should be established somewhere within the home.
- All portable equipment must be locked when not in use.
- Medicine or any other valuables must be secured in a locked container.
- Ensuring reliable transportation requires following the vehicle manufacturer’s maintenance schedule.
- Develop and distribute emergency action plans so employees know what to do when they need assistance.
4. Incorporate administrative and work practice controls for home health and social service workers.
Every violent incident or threat must be reported to management.
Create an Acts of Violence response policy.
In the policy clearly state that acts of violence are not permitted and are considered intolerable. By establishing this up front with clients and staff members, all parties involved know that violent behavior will not go unnoticed.
Keep track of service providers.
Require employees to contact their manager following each home health service visit. Managers must establish a set of procedures to follow in case an employee fails to check in.
Allow employees to decide if they want to begin or continue working with a patient if they feel unsafe or threatened.
Technology has provided an array of valuable tools, including mobile apps with GPS tracking and employee login and logoff capabilities. This blog post offers information related to the best—and free—time-clock software systems.
5. Create and implement login and logoff procedures.
Detailed instruction on tracking client or patient visits is also critical to workplace violence prevention. Your procedure for this should include:
- The client’s name and address.
- A contact number.
- The scheduled time of the visit.
- Expected length of visit.
- A natural-sounding code word to use in the event of an incident or threat; for example, the worker may say, “I think I forgot to lock my desk, can you check it for me?” The code word could be ‘forgot.’
- Detailed information must be documented and given to the supervisor or manager if the employee will be traveling with a client, including the departure time, planned route, destination(s), expected arrival times, etc.
- Each service provider’s license plate number and vehicle description must be documented and then placed in his or her file.
- Employees should contact their supervisor if any changes to the planned appointment or journey arise.
6. Establish an employee dress code.
Dress code tips include:
- Staff members should have an identification badge with their first name on it: Avoid including the employee’s last name as this could be used to gather personal information.
- Encourage workers to keep items that could be used as weapons on his or her person (e.g., keys).
- In the event of a confrontation, a staff member’s hair may be pulled or grabbed; therefore, encourage those with long hair to wear it up, use head netting and/or wear a cap.
- Discourage employees from carrying money, wearing chains or necklaces, long earrings, or expensive jewelry while they are working. Chains and necklaces can be used to grab on to and choke an individual.
7. Always follow up after an incident.
Gaining support from management is essential to post-incident follow up.
- Provide employees with an outline of company procedures to follow and assist them when necessary (i.e., requesting assistance from the police, filing charges against the perpetrator, etc.).
- All complaints must be addressed promptly.
- Contingency plans should be in place for providing services to clients who tend to act out with verbal threats or physical attacks.
8. Investigate every incident.
To have an effective prevention program, responding to and evaluating each incident is mandatory. The goal of each investigation is to identify the root cause of the violent act. If the root cause of an incident is not discovered and addressed, the chance of another violent act occurring for the same reason increases. By investigating these incidents, a roadmap designed to assist in the prevention of injuries and/or fatalities related to future incidents is created.
Make a report.
Notify the appropriate individuals within the organization that an incident occurred. When necessary, notify outside sources (e.g., the police).
Speak with other employees.
Speaking with the victim is one of the first steps in starting an investigation. However, other employees working in home health services may have useful insight to share.
Review information related to the employee involved in the incident.
Take the time to review records related to past incidents and training that the employee received.
9. Investigate near misses: situations that could have led to an illness, injury, or fatality.
A violent outburst or situation ending with no one being physically harmed still needs to be investigated. A one-time near miss can turn into a violent act at some point in the future. Consider a near miss a sign that some of the potential hazards are not being controlled adequately or that there are still some unidentified hazards that need to be addressed.
10. Provide ongoing workplace violence awareness and prevention training to protect employees.
Once staff members are aware of the potential hazards they face and learn how to protect themselves using established policies and procedures, violent acts and threats may be reduced or avoided altogether.
Leaders and managers at healthcare and social service facilities are responsible for enforcing a culture of safety, not only for staff but also to protect clients and patients.
Do your employees have clear guidance on how to respond to and prevent workplace violence? Take a look at one of our course demonstrations below to experience firsthand how interactive training can better prepare your staff to respond to a high-stakes situation by helping them remember what they learn through active participation.