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Violence Prevention in Health Care Settings


... Care Settings. Background. Violence is escalating ... Background. Risk factors. Working with volatile people ... Background. RCW 49.19 was passed in 1999. ... – PowerPoint PPT presentation

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Title: Violence Prevention in Health Care Settings

Violence Prevention in Health Care Settings
  • Violence is escalating in health care
  • Recent BLS data shows an annual rate of 8.3
    assaults per 10,000 HCWs
  • Compared to a rate of 2 per 10,000 for all
    private-sector industries.
  • The actual incidence rate of violence in health
    care is likely to be greater due to lack of

  • Risk factors
  • Working with volatile people
  • Working with those under the influence of alcohol
    or drugs
  • Working when understaffed
  • Transporting patients
  • Long waits for service
  • Overcrowded, uncomfortable waiting rooms
  • Working alone
  • Inadequate security
  • Lack of staff training

  • RCW 49.19 was passed in 1999. This law requires
    health care settings to develop and implement
    plans to reasonably protect employees from

  • Hospitals
  • Home health
  • Hospice
  • Evaluation treatment facilities
  • Community mental health programs
  • Psychiatric hospitals and long-term care
    facilities (i.e., nursing homes) not included.
  • State Psychiatric facilities covered under RCW

Violence or Violent Act
  • Any physical assault or verbal threat
  • of physical assault against an employee of a
    health care setting

Workplace Violence Plan
  • Each health care setting shall develop and
    implement a plan to reasonably prevent and
    protect employees from violence

WPV Plan includes
  • Security and Safety Assessment
  • Physical attributes of setting
  • Staffing (including security)
  • Personnel policies
  • First aid emergency procedures
  • Reporting of violent acts
  • Education and training

WPV Plan security and safety assessment
  • Hazard assessment identifies causes and
    consequences of violent acts in preceding 5
    years, or for length that records are available
    in home care/hospice
  • Guidelines from any appropriate agency may be
    used for assessment

  • Provided to all affected employees within 90 days
    of hire.
  • On a regular basis thereafter.
  • Temporary workers employer must take into
    account unique circumstances.
  • May include classes, video, written materials as

Training Contents
  • General and personal safety procedures
  • Violence escalation cycle
  • Violence-predicting factors
  • Obtaining a patient history from a patient with
    violent behavior
  • Techniques to de-escalate violent acts
  • Strategies to avoid physical harm
  • elements included as appropriate

Training Contents (as appropriate)
  • Restraining techniques
  • Appropriate use of physical and chemical
  • Reporting of incidents
  • Debriefing procedures
  • Resources for employees for coping with violence
  • Facilitys WPV Plan

  • Records must be kept of any violent act against
    an employee, a patient, or a visitor
  • Setting name address
  • Date, time, specific location
  • Name, job title, department or ward, and staff id
    (if an employee)
  • Description of victim and perpetrator (i.e.,
    patient, visitor, employee, other)

Records (By July 1, 2000)
  • Description of violent act
  • Threat
  • Assault (with or without injury/death)
  • Body part injured
  • Weapon used
  • Number of employees in area
  • Actions taken by co-workers or facility in
    response to violent act
  • Records kept for 5 years and available to LI
    upon request

RCW 72.23 Violence Prevention in State
Psychiatric Hospitals
  • WPV Plan must be updated annually
  • Training must be given prior to assignment
  • Training must be provided annually
  • List of training elements required for inclusion
    is expanded
  • except for removal of a reference to the use of
    medications as chemical restraints.

  • WISHA enforces RCWs
  • Citations will use
  • Safe Place (WAC 296-24-020)
  • Accident Prevention Program (WAC 296-24-040)
  • Also see, WRD 5.05 Violence in the Workplace
  • http// wrd505.htm

Possible Citations (1)
  • Failure to develop violence prevention plan
  • Serious violations of WAC 296-24-040 where a
    related serious violation is cited or where a
    related serious hazard has been documented.
    Otherwise, cited as general.

Possible Citations (2)
  • Failure to provide training as required
  • Serious violations of WAC 296-24-020(1)(c),
    management responsibility to provide training,
    for failure to provide training necessary for
    safe job performance (referencing the statute)
    where a related serious hazard has been
    documented. Otherwise, cite general

Possible Citations (3)
  • Failure to implement features of the violence
    prevention plan other than training
  • Serious violations of WAC 296-24-020(1)(b)
    where a related serious hazard has been
    documented. Otherwise, cite general.

Possible Citations (4)
  • Citations for missing elements of the required
    plan will be handled in accordance with the
    description in Citation 1 - 3 above.

Prevention Strategies
  • Environmental designs
  • Alarms, metal detectors, cameras
  • Administrative controls
  • Staffing patterns, restrict public movement
  • Behavior modifications
  • Training

More Information
  • LI Consultation Program
  • Check the blue government section of the white
    pages or the LNI web page
  • Alan Lundeen
  • 360.902.5154
  • John Furman
  • 360.902.5666

More Information
  • WISHA/Policy and Technical Services Web Page on
    Violence Prevention
  • http//
  • Chose Workplace Violence Prevention from the
    Topics List
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