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The U.S. Occupational Safety and Health Administration (OSHA) in Washington, DC, advises health care facilities to maintain a violence prevention program with the following elements:
Management commitment and employee involvement
This includes the visible involvement of top management, appropriate allocation of resources, and medical and psychological counseling and debriefing of employees witnessing or experiencing violent events. Employee involvement includes participation in committees or teams, prompt reporting, and education.
Work site analysis
A "Threat Assessment Team" or similar task force should assess the potential for workplace violence and identify preventive actions. The team should include representatives from senior management, operations, employee assistance, security, occupational safety and health, legal, and human resources staff. In addition to reviewing reported incidents, the team may conduct periodic employee surveys and may hire security experts or other professionals to identify risk factors.
Hazard prevention and control
Engineering controls to reduce hazards include panic buttons and alarm systems, metal detectors, enclosed nurses’ stations, patient care rooms with two exits, and bright lighting. The guidelines offer numerous suggestions about changes in work practices and administrative procedures. For example, OSHA suggests establishing a list of "restricted visitors" for patients with a history of violence and developing a contingency plan for treating patients who are making verbal or physician attacks or threats. OSHA notes that the areas of greatest risk are the admission units and crisis and acute care units. OSHA also emphasizes reporting of incidents and "a comprehensive post-incident evaluation, including psychological as well as medical treatment, for employees who have been subjected to abusive behavior."
Safety and health training
"Every employee should understand the concept of Universal Precautions for Violence,’ i.e., that violence should be expected but can be avoided or mitigated through preparation," the guidelines state. OSHA recommends conducting "required training" of employees at least annually, and more frequently (monthly or quarterly) in large facilities. Training includes information on risk factors, early warning signs, methods to diffuse escalating behavior, and response plans for violent situations.
(Editor’s note: A copy of the Guidelines for Preventing Workplace Violence for Health Care and Social Service Workers is available at www.osha-slc.gov/SLTC/workplaceviolence/guideline.html.)