Facility Security

The Cal/OSHA Standard for Health Care Violence Prevention

Most patients view healthcare facilities as places they can go to ease their pain or repair their injuries. Unfortunately, for healthcare workers, the opposite is true: The facilities actually put them at risk of injury every single day. A standard implemented earlier this year in California seeks to protect these workers.

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According to the Bureau of Labor Statistics, the incidence rate for violence for healthcare and social assistance workers was more than triple the overall rate for all of private industry (14.4 version 4.0 per 10,000 full-time workers).

No federal law protects healthcare workers from assault, but many states have such laws. Some require public healthcare facilities to take precautions against violence; others make it a felony to assault a healthcare worker. This year, California became the first state to require all healthcare facilities to implement protective measures for workers who may be exposed to violence.

History of the Rule

Since the 2010 murder of psychiatric aide Donna Gross by a patient at Napa State Hospital, California has steadily increased protection for healthcare workers. In September 2014, the legislature amended the California Labor Code, requiring the Occupational Safety and Health Standards Board (OSHSB) to adopt enforceable violence prevention regulations for certain healthcare providers. The new Workplace Violence Prevention in Health Care rule, found in the General Industry Safety Orders (GISO) Section 3342, was proposed in October 2015, finalized in October 2016, and approved by the Office of Administrative Law in December 2016. It took effect on April 1, 2017.

Who’s Covered?

The new rule applies to all inpatient healthcare facilities and any outpatient clinics, off-site operations, or other operations covered under their license. In addition, it covers specific occupations that carry an increased risk of violence, namely:

  • Home health care and home-based hospice
  • Emergency medical services and medical transport
  • Drug treatment programs
  • Outpatient medical services for the incarcerated in correctional and detention settings

Reporting Violent Incidents

Cal/OSHA already required employers to report all serious work-related injuries or illnesses and all fatalities to DOSH within 8 hours. The newer rule imposed additional reporting requirements on hospitals.

Hospitals now must report to DOSH within 24 hours any incident that involves:

  • The use of physical force against an employee by a patient or a person accompanying a patient, regardless of whether the employee is injured; or
  • The use of a firearm or other dangerous weapon, regardless of whether the employee is injured.

What Else Is Required?

The new rule requires employers to create:

Written plans. As with many occupational safety and health regulations, the rule begins with a requirement that covered employers put a plan in writing. The required plan shares many elements with other Cal/OSHA-required plans, such as the job titles of responsible persons, procedures for involving employees in plan development, procedures for coordinating with other employers on the same site, and an annual review requirement.

Specific to violence prevention, the written plan must cover:

  • How workers can activate law enforcement response on all shifts;
  • Reporting procedures for violent incidents, threats, or other workplace violence concerns;
  • Communication with and among employees regarding the risk of violence to other employees and between shifts and units;
  • Investigation procedures, including how employees will be informed of the results of the investigation and any corrective actions;
  • How training will be developed and provided;
  • Risk assessment procedures for each facility, unit, service, or operation, including a review of all workplace violence incidents that occurred within the previous year, regardless of whether an injury occurred;
  • Procedures to identify and evaluate patient-specific risk factors and assess visitors or other persons who aren’t employees;
  • Procedures to correct workplace violence hazards in a timely manner; and
  • Procedures for postincident response and investigation.

Also, an employer’s written plan must prohibit any punitive or retaliatory actions against workers who report violent incidents or concerns or summon law enforcement.

Violent incident logs. Every incident, postincident response, and workplace violence injury investigation must be recorded in a violent incident log. In addition to the expected details about an incident (who, what, when, and where), the log must record the type of violence committed (customer/client, criminal intent, worker-on-worker, or domestic violence and what happened as a result—for example, was law enforcement called? Did the worker require medical treatment?

Training programs. All workers must receive training when the program is put in place or before beginning work. Retraining is required annually or when the plan is modified. Workers who are assigned to respond to alarms or required to confront or control aggressive or violent persons must receive additional training.