OSHA’s focus on workplace violence in healthcare continues
On May 10, 2023, OSHA issued a citation to a Texas-based children’s hospital due to workplace violence by an aggressive patient against an employee. As the citation and OSHA press release state, “On Nov. 10, 2022, an aggressive patient pulled a security officer to the ground by the hair and kicked them repeatedly in the chest and abdomen.” The officer “lost consciousness, was taken to the emergency room and hospitalized.” The citation states that there were 15 incidents with injuries involving aggressive patients at the hospital in 2022 alone. Some of the measures suggested by OSHA include the following:
- Conduct a worksite hazard assessment to identify employees and departments at risk of patient-on-staff workplace violence. Analyze the OSHA 300 log data and de-escalation calls for trends.
- Update, implement, and communicate worksite-specific workplace violence policies and procedures that include:
- A workplace violence coordinator who is known to employees and managers.
- Clear and consistent procedures for requesting assistance. Ensure employees are informed of and trained on the correct procedures.
- Employee participation in meetings and identifying controls to address workplace violence incidents.
- A system for tracking and investigating all workplace violence incidents, regardless of recordability. Conduct thorough incident investigations, including communicating with affected employees following an incident.
- Ensure all staff have a reliable means to immediately communicate when they need assistance and all staff are trained on proper procedures to call for assistance.
- Train all employees (including sitters) at risk of patient-on-staff workplace violence on methods, such as de-escalation techniques, and ways to protect themselves in situations where patients may become violent.
- Ensure that patients are assessed for aggression during admittance to the hospital in order to identify patients who may become aggressive.
- Ensure that PPE such as hair nets, face shields, arm guards, and impact vests are freely and readily available for use.
The press release further quotes OSHA Area Director as stating: “Healthcare employers must protect their employees, particularly those in contact with aggressive or potentially aggressive patients, from the danger of being attacked by a patient. Employers must have certain effective policies and procedures in place so employees don’t have to work in fear of their safety.” The hospital was cited $15,625 and is now at risk of “repeat” violations of much higher amounts.
This case highlights OSHA’s ongoing enforcement efforts in the healthcare industry, even without a specific workplace violence standard. A specific standard, however, is coming. OSHA is in the rulemaking process and is expected to issue a workplace violence regulation in the coming year, which will make it even easier for OSHA to issue citations like this one.
Based on our experience, many healthcare facilities have certain violence-related policies, but they are piecemeal and may conflict at times. Now may be a good time to consider combining these individual policies to create a comprehensive policy that meets both CMS and OSHA requirements by addressing patient safety, employee safety, and emergency preparedness.
Written By: Weathers Bolt
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