Helpful Ideas

OSHA's New Blueprint for Health Care Worker Safety

Problem: Reports of violence against pharmacists and other health care workers seem to be on the rise. What can I do to provide the best possible protection for my employees-and myself?

Solution: New federal guidelines on violence prevention in health care settings lay out a step-by-step approach to implementing an effective, ongoing worker safety program.

You've probably heard of at least one pharmacist being assaulted-perhaps even killed-on the job, but you might be surprised to learn the full extent of the danger. Did you know that more violence-related deaths are reported among pharmacists than among any other category of health care worker? A total of 106 such deaths were reported from 1980 to 1990; the victims included 27 pharmacists, 26 physicians, 18 registered nurses, and 17 nurse aides.

Clearly, working around controlled substances and other drugs poses an inherent risk of robbery and assault. Heightening the risk are a variety of other factors-the high prevalence of handguns, lack of proper follow-up care for mentally ill patients, low staffing levels, solo work in remote locations, and lack of staff training in techniques for managing and defusing hostile behavior.

To help address this growing, multifaceted problem, the federal Occupational Safety and Health Administration recently issued comprehensive hazard control guidelines specifically targeting health care facilities and employees. These guidelines hold important tips and insights for consultant pharmacists, particularly those involved in caring for chemically dependent or mentally disturbed patients and those working in residential care settings.

The cornerstone of any effective safety program, OSHA says, is top-to-bottom organizational commitment coupled with ongoing employee involvement. "Management commitment, including the endorsement and visible involvement of top managers, provides the motivation and resources to deal effectively with workplace violence. . . ." Employee involvement and feedback can be achieved through establishment of formal complaint and suggestion procedures, prompt incident reporting, continuing education, and participation on teams or committees charged with coordinating all safety program components.

Once broad written policies are established, the next step is a detailed worksite analysis to identify current and potential problem areas and establish a baseline for measuring improvements. This thorough assessment might include: a review of all injury and workers' compensation records, as well as unit logs and police reports of violent incidents or near-incidents to spot patterns of violence; regular surveys or questionnaires to get employees' input and ideas on worker- or site-specific hazards; and periodic security evaluations and incident analyses.

This information-gathering process will provide the facility or employer with the tools to make positive changes. The OSHA guidelines offer dozens of nuts-and-bolts prevention tips and safety enhancement strategies (see sidebar, this page, for a sampling). Some relate to modification of the work environment-proper maintenance of all vehicles used for field work, for example, or steps to limit access to certain parts of the facility, particularly drug storage or pharmacy areas. Other strategies relate to modification of work procedures-for example, discouraging workers from wearing jewelry or carrying pens and other potential weapons; use of staff identification badges (preferrably first names only); and ensuring adequate staff coverage at all times, especially during high-risk times such as patient transfers, emergency situations, and meal times.

How Does Your Facility Rate?

According to OSHA, necessary environmental controls may include:

• Installed or hand-held metal detectors, where appropriate
• Properly maintained alarm systems and use of "panic buttons," hand-held alarms, and cellular phones, where appropriate
• Round-the-clock closed-circuit video recording ("Public safety is a greater concern than privacy," says OSHA)
• Convex observation mirrors at hallway intersections and other concealed areas
• Employee safe rooms for use during emergencies
• Multiple exits in counseling or patient care rooms
• Use of lightweight, preferrably anchored furniture without sharp corners or edges
• Bright, effective interior and exterior lighting
• Lockable, secure staff bathrooms separate from patient and visitor areas

For home care providers, OSHA recommends development of formal policies and specific guidance on handling the unexpected presence of others in the home and, under certain well-defined circumstances, refusing to provide services.

When violence occurs despite precautions, the facility's or employer's response is critical. Appropriate follow-up may include post-incident debriefing and education for victims and witnesses and efforts to address the psychological effects of violence, which can include fear of returning to work, changes in relationships with family and co-workers, fear of criticism by supervisors, and feelings of incompetence, guilt, and powerlessness. In some cases, professional counseling may be in order.

Meticulous record-keeping, continuous staff training, and regular evaluation of success in meeting safety objectives will keep the program going strong. In addition to prompt compliance with applicable OSHA reporting regulations, the employer should maintain records describing the circumstances of each incident (including verbal attacks or aggressive behavior that don't result in actual violence), as well as records of violence-related injuries or illnesses and planned corrective actions. These sorts of activities will let employees know their concerns are being addressed on a continuing basis, with concrete benefits accruing to the entire organization. As OSHA points out, "Effective safety and health programs are known to improve both morale and productivity and reduce workers' compensation claims."

OSHA's Guidelines for Preventing Workplace Violence for Health Care and Social Service Workers also includes: a sample detailed survey for assessing staff views on risk factors and prevention priorities; a workplace violence checklist; a sample policy for coordination of support services for victims of violence; sample incident report forms; and a listing of OSHA support programs and services. To order, contact the Government Printing Office at 202-512-1800.

David K. Buerger
Associate Editor