EHS Management

Workplace Violence: Protecting Workers Who Care for Violent Clients

Sometimes the workers who care the most are at the highest risk. Violent injuries to workers in mental health facilities, assisted-living facilities, home health care, and other caring professions are often so commonplace that workers come to accept them as “part of the job.” But the Occupational Safety and Health Administration (OSHA) is less accepting, as a Nebraska employer discovered after a pregnant caregiver was assaulted by a client and ended up in the hospital.

OSHA investigated the incident and cited the employer under the General Duty Clause.

There May Not Be a Standard, but There Are Still Standards!

Integrated Life Choices (ILC) provides services to developmentally disabled individuals in Nebraska and Colorado, including assistance with meal preparation, household chores, and transportation and accompaniment to the store or to work. In 2015, a pregnant worker in the employer’s Lincoln, Nebraska, facility was bitten and kicked in the stomach by a client while she was attempting to use a therapeutic aggression control technique. The worker ended up in the hospital.

Although the employer failed to notify OSHA of the worker’s hospitalization, as required by OSHA’s reporting regulation, OSHA found out about the incident and conducted an investigation. OSHA’s investigation revealed that ILC’s workers were frequently exposed to punches, kicks, bites, and thrown objects from clients. A review of the company’s OSHA 300 logs identified multiple injury reports resulting from workplace violence incidents.

There is no specific standard for workplace violence, but that doesn’t mean work should be a client-vs.-caregiver free-for-all. OSHA cited ILC for a serious violation of the General Duty Clause for failing to “furnish employment and a place of employment which were free from recognized hazards that were causing or likely to cause death or serious physical harm to employees.”

Recommended Abatement Methods

OSHA recommended several abatement methods that ILC could or should have implemented, including:

Prohibiting violence. OSHA recommended that ILC create a policy stating that violence is not tolerated and ensure that policy is conveyed to clients and family members.

Safe work practices. OSHA recommended that ILC create procedures to enable workers to promptly respond to clients with a high incidence of physical outbursts or who have been very violent.

Quick response.  Emergency response procedures should ensure that appropriate staff members are on-site or available within a reasonable response time. In order to establish a reasonable response time, OSHA recommended that ILC conduct location-specific assessments, including proximity to emergency response services, proximity of responding staff members, and current client assessments.

Effective communication. OSHA recommended that the employer provide two-way radios, or similarly effective remote mechanisms, so that workers can summon emergency assistance.

Engineering controls. OSHA suggested mirrors in hallways and blind corners as possible preventive measures. Other measures include always having two exits from a room, removing throwable objects from therapy rooms and meeting rooms, and providing emergency buzzers for employees to use.

Records review. Employers should continuously evaluate reports (such as therapy logs, OSHA 300 logs, and first reports of injury) to identify violence-related injury trends, and the locations, employees, activities, and times of day that most often involve incidents of workplace violence.

Training. Training methods should be subject to ongoing review to ensure that they are appropriate for protecting workers from the types of incidents that are occurring. Before they begin work, appropriate training must be provided to all new workers that covers communication procedures and engineering controls. Training should also occur when significant changes are made to policies and procedures, and annual refresher training should be provided to all staff.

Tomorrow we’ll look at another employer that was cited for willfully placing workers at risk of violent assault.

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