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January 27, 2016
OSHSB proposes regulation to prevent violence in health care

People who go into the health professions—nurses, physicians, psychiatrists, and others—generally believe they are in a "caring profession."

Sadly, many of them soon find that they have instead entered a danger zone where frequent violent assault by the people they are supposed to be caring for has come to be accepted as “part of the job.” Healthcare workers in psychiatric hospitals and emergency departments are the most likely to witness violent assaults, but healthcare workers in all settings are at risk.

In September 2014, the state legislature passed Senate Bill (S.B.) 1299, which created California Labor Code Section 6401.8, requiring California’s hospitals to create workplace violence prevention plans as part of their injury and illness prevention programs. Under the new law, the Occupational Safety and Health Standards Board (OSHSB) is required to adopt standards regulating these programs by July 1, 2016.

The OSHSB issued a proposed regulation on October 30, 2015. Read on to learn what’s in the proposal.

Labor Code requirements

Labor Code Section 6401.8 includes specific requirements that will be incorporated into the Cal/OSHA regulation. The provision requires covered healthcare facilities to:

  • Develop workplace violence prevention plans in conjunction with affected employees;
  • Orient all temporary personnel to the workplace violence prevention plan;
  • Document all violent incidents, and retain those records for a minimum of 5 years; and
  • Report most violent incidents to Cal/OSHA within 24 hours.

This law also prohibits hospitals from retaliating against employees who call police or other emergency services during a violent incident.

The reach of the proposed reg

The OSHSB’s proposed regulation will create a new Section 3342, Workplace Violence Prevention in Health Care, in Article 7 of the General Industry Safety Orders (Miscellaneous Safe Practices). All or part of the proposed regulation will apply to:

  • Inpatient healthcare facilities and any outpatient operations that exist within those facilities;
  • Outpatient medical offices and clinics;
  • Home health care and home-based hospice;
  • Paramedic and emergency medical services, including when provided by firefighters and other emergency responders;
  • Field operations such as mobile clinics, dispensing operations, medical outreach services, and other off-site operations;
  • Drug treatment programs; and
  • Ancillary healthcare operations, such as retail clinics and school nurse offices.

Labor Code Section 6401.8 exempts hospitals operated by the California Department of State Hospitals, Department of Developmental Services, and the Department of Corrections and Rehabilitation from the requirement to establish a workplace violence prevention plan. However, the law doesn’t prohibit the OSHSB from applying its standard to these facilities, and the board has stated that its new rule will apply to them.

Practice Tip

The reporting requirement would apply only to general acute care hospitals, acute psychiatric hospitals, and special hospitals.

Overview of the proposed reg

The proposed rule requires covered employers to address workplace violence much as any occupational safety and health issue is addressed—by identifying hazards and creating a plan to minimize them. Required elements include:

A written violence prevention plan. Each covered employer must establish, implement, and maintain a workplace-specific violence prevention plan. As with most written programs, employers must:

  • Include the names and job titles of individuals who are responsible for the plan;
  • Specifically address the involvement of affected employees in the development and maintenance of the written plan; and
  • Cover how each required element of the plan will be implemented.
  • The plan must be reviewed annually.

    A record of violent incidents. Covered employers must keep a Violent Incident Log with detailed information about all violent incidents, including:

    • Where and when each incident occurred;
    • The employees involved;
    • The nature of the attack;
    • If a weapon was used; and
    • Whether the incident involved harassment or other intimidating behavior, was sexual in nature, or involved an animal.

    Employers must also record any consequences of the incident, such as medical treatment, lost worktime, continuing threats, and whether security or other personnel were involved.

    Training. Workers must be trained in specific violence-prevention topics; there is no specific interval for retraining. Training provided for healthcare workers must be integrated with that given to security personnel, so each group understands its roles and responsibilities in response to violent incidents.

    Reporting. Within 24 hours, general acute care hospitals, acute psychiatric hospitals, and special hospitals must report any incident that results in an injury, involves use of a firearm or other weapon, or presents an urgent or emergent threat to the welfare, health, or safety of hospital personnel.

    Incidents that don’t meet those criteria but involve use of physical force against a hospital employee by a patient or a person accompanying a patient that results in—or has a high likelihood of resulting in—psychological trauma or stress must be reported within 72 hours.

    Recordkeeping. Covered employers must keep records of their hazard identification, evaluation, and correction efforts as well as training records and the Violent Incident Log.

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