WORKPLACE VIOLENCE AND THE NEW REQUIREMENTS

New Requirements

California Code of Regulations Title 8 - Section 3342

Violence Protection in Health Care

New Regulations a) Determine if this applies to your organization b) Understand the definitions c) Create Workplace Violence Plan d) Create Workplace Violence Log-4/1/2017 e) Create System to Review Plan f) Provide Training g) Reporting Requirements for Hospitals h) Create Recordkeeping Log-4/1/2017 Deadlines: 4/1/2017 or 4/1/2018

Who Must Comply

• Health facilities • Home health care and hospice • EMS and medical transport, including services

provided by firefighters and other emergency responders

• Drug treatment programs • Outpatient services in correctional and detention

Note: Hospitals have additional requirements

What is Workplace Violence?

Any act of violence or threat of violence that occurs at work. Does not include self-defense or defense of others. Workplace violence includes: (A) The threat or use of physical force against an employee resulting in, or high likelihood of, injury, psychological trauma or stress. (B) An incident involving the threat or use of a firearm or other weapon regardless of an injury

Four Types of Workplace Violence • “Type 1 Violence” - Person with no legitimate business at work.

Includes violent acts by anyone who enters the workplace with the intent to commit a crime.

• “Type 2 Violence” - Directed at employees by customers, clients, patients, students, inmates, visitors or individuals with a patient.

• “Type 3 Violence” - Against an employee by a present/former employee.

• “Type 4 Violence” - Committed by someone who does not work there, but has/had a personal relationship with an employee.

Workplace Violence Prevention Plan

• Establish, implement and maintain an effective workplace violence prevention plan that is in effect at all times in every unit, service, and operation.

• The Plan shall be: 1. in writing. 2. specific to the hazards and corrective measures for

operation. 3. available to employees at all times. 4. Incorporated in the IIPP or maintained as a separate

document.

Plan Requirements The Plan shall include the following elements: (1) Who is responsible for the Plan. (2) Employee involvement in creating the Plan. (3) Methods to implement the Plan (4) How to get Law Enforcement assistance. (5) How Company responds to workplace violence

Plan Requirements (Cont.) (6) How to ensure employees comply with the Plan (7) How to communicate with employees RE workplace violence including:

(A) How employees communicate to other employees RE workplace violence (B) How to report a violent incident, threat or other concern (C) How to communicate concerns without fear of reprisal (D) How concerns will be investigated and how employees receive the investigation outcome

(8) How will employees participate in developing of training.

Plan Requirements (Cont.) (9) (A) How to identify and evaluate risk factors and review all incidents in the previous year. Risk factors include:

1. Employees in isolated locations 2. Poor visibility where assailants may be present 3. Lack of physical barriers protecting employees 4. Lack of effective escape routes 5. Obstacles to access alarm systems 6. Locations where alarm systems are not operational 7. Entryways where unauthorized entrance may occur 8. Any objects that can be used as weapons 9. Storage of high-value items, currency or drugs

Plan Requirements (Cont.) (9) (B) Special considerations for home health care/hospice

(C) For EMS and medical transport • Dispatch Procedures to identify risk factors at the

scene (10) Identify non-employee risk factors including Patient-specific factors:

(A) A patient's conditions (B) A patient's treatment and medication status (C) A patient's history of violence (D) Any threatening behavior displayed by a patient.

Plan Requirements (Cont.) (11) Procedures to correct workplace violence hazards, including:

(A) Staff are trained and available to prevent and respond to incidents. (B) Communication where patients or the public may be present. (C) Configure facilities so access to doors and alarms cannot be impeded. (D) Remove or fasten objects that may be used as improvised weapons. (E) Prevent the transport of unauthorized weapons into visitor/patient areas. (F) Staff to maintain order and respond to incidents. (G) How employees can summon security and other aid. (H) How employees can be alerted to security threats. (I) Establish a response plan for emergencies including help from Security/Law Enforcement. (J) Assign staff to reduce patient-specific Type 2 (Customers/family) hazards.

Plan Requirements (Cont.) (12) Post-incident response and investigation procedures:

(A) Provide immediate medical care to injured employees. (B) Identify all employees involved in the incident. (C) Trauma counseling to affected employees. (D) Post-incident debriefings. (E) Review patient-specific risk factors and risk reduction measures. (F) Were corrective measures in the Plan implemented. (G) Get personnel’s opinions of the cause and if measures would prevent injury.

Violent Incident Log Effective April 1, 2017

• Create a Violent Incident Log • Document every incident, response and

investigation. • Based Log on information from affected

employees. • Omit personal identifying information. • Review the Log during annual Plan review.

Log Fields 1) Incident date, time, location, and department 2) Incident description 3) Who committed the violence 4) Circumstances at the time of the incident. 5) Where the incident occurred. 6) Incident type

1) Physical attack (biting, choking, grabbing, hair pulling, kicking, punching, slapping, pushing, pulling, scratching, or spitting)

2) Attack with a weapon 3) Threat of physical force or use of a weapon 4) Sexual assault or threat

7) Consequences of the incident: 1) Did employee receive medical treatment 2) Who provided assistance 3) Was security or law enforcement contacted 4) Amount of lost time 5) Actions taken to protect employees from a continuing threat

8) Who completed the Log

Our Log

Log Information Sources 1) Crew Emergency Response Report Created by dispatch 2) Worker’s Comp Injury Reports

Review of the Workplace Violence Prevention Plan

• At least annually • With employees/representatives regarding the

employees' respective work areas, services, and operations.

• Problems found during the review shall be corrected.

Review Requirements (1) Staffing levels that contribute to the risk of violence (2) Sufficiency of security systems (3) Job design, equipment and facilities (4) Facility Security risks (5) The Plan as it applies to units, the entire facility, or the particular operation,

(A) To reflect new procedures which may affect the Plan (B) New workplace violence hazards (C) Incidents which result in a serious injury or fatality (D) Information indicating the Plan is deficient in any area. (E) If a Plan revision is needed for part of the operation,

the review process may be limited to that area.

Training

• Provide training for the workplace violence risks employees are reasonably anticipated to encounter

• Obtain employees involvement in developing, participating, reviewing, and revising the training program.

Initial Training (1) Provide initial training when the Plan is established and for all new employees. (A) Address identified workplace violence hazards and corrective measures: 1. An explanation of Plan. 2. How to recognize the potential and escalation of violence and how to counteract them, and when and how to seek assistance. 3. Strategies to avoid physical harm. 4. How to recognize alarms about emergency conditions such as mass casualty threats and how to use escape routes or sheltering. 5. The role of private security. 6. How to report violent incidents to law enforcement. 7. Employees resources for coping with incidents. 8. Questions about the Plan.

New Equipment and Refresher Training

Training for new Equipment and Practices • Provide training when new equipment or work practices are introduced or

when a workplace violence hazard has been identified. • Training not given in person shall fulfill all requirements and shall provide

for interactive questions to be answered within one business day by a person knowledgeable about the Plan.

Refresher Training – Requirements • Employees having patient contact and their supervisors shall have

refresher training at least annually. • Review the initial training topics and the results of the Plan Review. • An opportunity for interactive questions and answers with a person

knowledgeable about the Plan. • Training not in person shall fulfill all the subject requirements and

interactive questioning which must be answered within one business day.

Specialty Responder Training Employees assigned to respond to notifications of violent incidents or who confront or control persons exhibiting aggressive or violent behavior shall be trained prior to initial assignment and at least annually. This is in addition to the initial training. This additional training shall include: • General and personal safety measures • Aggression and violence predicting factors • The assault cycle • Characteristics of aggressive and violent patients and victims • Verbal intervention and de-escalation techniques and physical maneuvers to defuse and prevent

violent behavior • Strategies to prevent physical harm • Appropriate and inappropriate use of restraining techniques in accordance with Title 22 • Appropriate and inappropriate use of medications as chemical restraints in accordance with Title 22 • An opportunity to practice maneuvers and techniques with other employees, including a meeting

to debrief the practice session. Problems found shall be corrected.

Recordkeeping Effective April 1, 2017

• Records of workplace violence hazard identification, evaluation and correction shall be created and maintained.

• Training records shall be created and maintained for a minimum of one year. – Includes dates, training summary, names and qualifications of

instructors, and names and job titles of attendees. • Records of violent incidents shall be maintained for a minimum of

five years. – Includes violent incident logs, reports and investigations. These

records shall not contain medical information. – All records shall be made available to the Cal/OSHA Chief for

examination and copying. • All records shall be available to employees and their representatives

for examination and copying.

Need Help

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California Tactical Casualty Care Training Guidelines

Require basic and ongoing training for law enforcement, fire, EMS, and other first

responders including training and education on active shooter incidents and tactical casualty

care.

TEMS FRO Training Overview

• An overview of the California tactical casualty care initiative and EMS/Fire response to active law enforcement incidents.

• Tactical and rescue terminology and operations. • Demonstrate basic tactical casualty care techniques. • Casualty movement and evacuation techniques. • Medical planning and threat assessment

considerations. • Competency-based student demonstration and student

skills testing.

Workplace Violence Components

• TEMS FRO geared for responses to Active Shooter Incidents

• Workplace Violence Plan needs to include procedures for the following: – Crew Emergencies while on a call

• On scene and while transporting patient

– Emergencies while not on a call – all departments • Active shooter – Run, Hide, Fight • Other employee emergencies