Guidelines for Preventing Workplace Violence for
Health Care & Social Service Workers

OSHA: 医疗和社会服务工作者防止工作场所暴力指南

Notice

These guidelines are not a new standard or regulation. They are advisory in nature, informational in content and intended to help employers establish effective workplace violence prevention programs adapted to their specific worksites. The guidelines do not address issues related to patient care. They are performance-oriented, and how employers implement them will vary based on the site's hazard analysis.
本指南意在帮助雇主建立有效地工作环境，防止特定工作场所的暴力事件，不涉及与病人护理相关的问题。

Workplace violence affects health care and social service workers.

工作场所暴力影响医疗和社会服务工作者

The National Institute for Occupational Safety and Health (NIOSH) defines workplace violence as "violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty."⁽⁴⁾ This includes terrorism as illustrated by the terrorist acts of September 11, 2001 that resulted in the deaths of 2,886 workers in New York, Virginia and Pennsylvania. Although these guidelines do not address terrorism specifically, this type of violence remains a threat to U.S. workplaces.

关于工作场所暴力定义“针对在工作和执行任务者的暴力行为（包括身体的攻击和威胁使用攻击）” 包括导致纽约、弗吉尼亚、宾夕法尼亚2886位工作人员死亡的恐怖行为诶。

For many years, health care and social service workers have faced a significant risk of job-related violence. Assaults represent a serious safety and health hazard within these industries. OSHA's violence prevention guidelines provide the agency's recommendations for reducing workplace violence, developed following a careful review of workplace violence studies, public and private violence prevention programs and input from stakeholders. OSHA encourages employers to establish violence prevention programs and to track their progress in reducing work-related assaults. Although not every incident can be prevented, many can, and the severity of injuries sustained by employees can be reduced. Adopting practical measures such as those outlined here can significantly reduce this serious threat to worker safety.

OSHA 鼓励雇主建立暴力方法项目，并持续记录减少工作相关攻击方面的进展。尽管不是每个事件都可以被防止，但至少对雇员的伤害程度可以被降低。采用实践措施能够大幅降低对工作者安全伤害的严重程度。

The risk factors
危险因素
Health care and social service workers face an increased risk of work-related assaults stemming from several factors. These include:

医疗和社会服务工作者面临日益增长的与工作相关的攻击。主要因素如下

The prevalence of handguns and other weapons among patients, their families or friends;

The increasing use of hospitals by police and the criminal justice system for criminal holds and the care of acutely disturbed, violent individuals;

The increasing number of acute and chronic mentally ill patients being released from hospitals without follow-up care (these patients have the right to refuse medicine and can no longer be hospitalized involuntarily unless they pose an immediate threat to themselves or others);

The availability of drugs or money at hospitals, clinics and pharmacies, making them likely robbery targets;

Factors such as the unrestricted movement of the public in clinics and hospitals and long waits in emergency or clinic areas that lead to client frustration over an inability to obtain needed services promptly;

The increasing presence of gang members, drug or alcohol abusers, trauma patients or distraught family members;

Low staffing levels during times of increased activity such as mealtimes, visiting times and when staff are transporting patients;

Isolated work with clients during examinations or treatment;

Solo work, often in remote locations with no backup or way to get assistance, such as communication devices or alarm systems (this is particularly true in high-crime settings);

Lack of staff training in recognizing and managing escalating hostile and assaultive behavior; and

Poorly lit parking areas.

Violence Prevention Programs

暴力防止计划

A written program for job safety and security, incorporated into the organization's overall safety and health program, offers an effective approach for larger organizations. In smaller establishments, the program does not need to be written or heavily documented to be satisfactory.

关于工作安全和保卫的计划，结合组织的整体安全和健康。

At a minimum, workplace violence prevention programs should:

Create and disseminate a clear policy of zero tolerance for workplace violence, verbal and nonverbal threats and related actions. Ensure that managers, supervisors, coworkers, clients, patients and visitors know about this policy.

不容忍工作场所暴力，无论口头或非口头威胁和相关行为。保证所有员工了解这项规定

Ensure that no employee who reports or experiences workplace violence faces reprisals

保证员工报告工作场所暴力不受到任何报复

Encourage employees to promptly report incidents and suggest ways to reduce or eliminate risks. Require records of incidents to assess risk and measure progress.

鼓励员工及时报告事件和提出减少、消除风险的建议。记录这项改进

Outline a comprehensive plan for maintaining security in the workplace. This includes establishing a liaison with law enforcement representatives and others who can help identify ways to prevent and mitigate workplace violence.

保持工作场所安保的综合计划。

Assign responsibility and authority for the program to individuals or teams with appropriate training and skills. Ensure that adequate resources are available for this effort and that the team or responsible individuals develop expertise on workplace violence prevention in health care and social services.

为个人或团队提供必要的培训。保证其防止工作场所暴力的专业能力

Affirm management commitment to a worker-supportive environment that places as much importance on employee safety and health as on serving the patient or client.

管理层重视员工安全和健康，与为患者或客户服务同等重要

Set up a company briefing as part of the initial effort to address issues such as preserving safety, supporting affected employees and facilitating recovery.

内部通报，作为保证安全、帮助受害员工和场所恢复的第一项努力

Elements of an effective violence prevention program

有效防止暴力的计划

The five main components of any effective safety and health program also apply to the prevention of workplace violence:

Management commitment and employee involvement; 管理层的支持和员工参与

Worksite analysis; 工作场所分析

Hazard prevention and control; 危险防止和控制

Safety and health training; and 安全和健康培训

Recordkeeping and program evaluation. 记录和项目评价

Management Commitment and Employee Involvement

管理层的支持和员工参与

Management commitment and employee involvement are complementary and essential elements of an effective safety and health program. To ensure an effective program, management and frontline employees must work together, perhaps through a team or committee approach. If employers opt for this strategy, they must be careful to comply with the applicable provisions of the National Labor Relations Act.

Management commitment, including the endorsement and visible involvement of top management, provides the motivation and resources to deal effectively with workplace violence. This commitment should include:

Demonstrating organizational concern for employee emotional and physical safety and health;

Exhibiting equal commitment to the safety and health of workers and patients/clients;

Assigning responsibility for the various aspects of the workplace violence prevention program to ensure that all managers, supervisors and employees understand their obligations;

Allocating appropriate authority and resources to all responsible parties;

Maintaining a system of accountability for involved managers, supervisors and employees;

Establishing a comprehensive program of medical and psychological counseling and debriefing for employees experiencing or witnessing assaults and other violent incidents; and

Supporting and implementing appropriate recommendations from safety and health committees.

Employee involvement and feedback enable workers to develop and express their own commitment to safety and health and provide useful information to design, implement and evaluate the program.

Employee involvement should include:

Understanding and complying with the workplace violence prevention program and other safety and security measures;

Participating in employee complaint or suggestion procedures covering safety and security concerns;

Reporting violent incidents promptly and accurately;

Participating in safety and health committees or teams that receive reports of violent incidents or security problems, make facility inspections and respond with recommendations for corrective strategies; and

Taking part in a continuing education program that covers techniques to recognize escalating agitation, assaultive behavior or criminal intent and discusses appropriate responses.

Worksite Analysis

工作场所分析
Value of a worksite analysis

A worksite analysis involves a step-by-step, commonsense look at the workplace to find existing or potential hazards for workplace violence. This entails reviewing specific procedures or operations that contribute to hazards and specific areas where hazards may develop. A threat assessment team, patient assault team, similar task force or coordinator may assess the vulnerability to workplace violence and determine the appropriate preventive actions to be taken. This group may also be responsible for implementing the workplace violence prevention program. The team should include representatives from senior management, operations, employee assistance, security, occupational safety and health, legal and human resources staff.

The team or coordinator can review injury and illness records and workers' compensation claims to identify patterns of assaults that could be prevented by workplace adaptation, procedural changes or employee training. As the team or coordinator identifies appropriate controls, they should be instituted.

Focus of a worksite analysis

工作场所分析关注

The recommended program for worksite analysis includes, but is not limited to:

Analyzing and tracking records;

分析和追踪记录

Screening surveys; and

选择性访谈

Analyzing workplace security.

工作场所安保分析

Records analysis and tracking

记录分析和追踪

This activity should include reviewing medical, safety, workers' compensation and insurance records—including the OSHA Log of Work-Related Injury and Illness (OSHA Form 300), if the employer is required to maintain one—to pinpoint instances of workplace violence. Scan unit logs and employee and police reports of incidents or near-incidents of assaultive behavior to identify and analyze trends in assaults relative to particular:

Departments;

Units;

Job titles;

Unit activities;

Workstations; and

Time of day.

Tabulate these data to target the frequency and severity of incidents to establish a baseline for measuring improvement. Monitor trends and analyze incidents. Contacting similar local businesses, trade associations and community and civic groups is one way to learn about their experiences with workplace violence and to help identify trends. Use several years of data, if possible, to trace trends of injuries and incidents of actual or potential workplace violence.

Value of screening surveys

筛选调查的价值

One important screening tool is an employee questionnaire or survey to get employees' ideas on the potential for violent incidents and to identify or confirm the need for improved security measures. Detailed baseline screening surveys can help pinpoint tasks that put employees at risk. Periodic surveys—conducted at least annually or whenever operations change or incidents of workplace violence occur—help identify new or previously unnoticed risk factors and deficiencies or failures in work practices, procedures or controls. Also, the surveys help assess the effects of changes in the work processes. The periodic review process should also include feedback and follow-up.

Independent reviewers, such as safety and health professionals, law enforcement or security specialists and insurance safety auditors, may offer advice to strengthen programs. These experts can also provide fresh perspectives to improve a violence prevention program.

Conducting a workplace security analysis
工作场所安保分析
The team or coordinator should periodically inspect the workplace and evaluate employee tasks to identify hazards, conditions, operations and situations that could lead to violence.

To find areas requiring further evaluation, the team or coordinator should:

Analyze incidents, including the characteristics of assailants and victims, an account of what happened before and during the incident, and the relevant details of the situation and its outcome. When possible, obtain police reports and recommendations.

安全事件分析，包括攻击者和受害人特征，事件发生前和发生过程以及相关环境的细节和结果。有可能，争取拿到警察报告并听取建议。

Identify jobs or locations with the greatest risk of violence as well as processes and procedures that put employees at risk of assault, including how often and when.

发现暴力风险高的岗位和场所。

Note high-risk factors such as types of clients or patients (for example, those with psychiatric conditions or who are disoriented by drugs, alcohol or stress); physical risk factors related to building layout or design; isolated locations and job activities; lighting problems; lack of phones and other communication devices; areas of easy, unsecured access; and areas with previous security problems.

注意高风险因素例如特殊患者或客户；建筑场所的风险；隔离的地点和工作；照明问题；通讯工具；不安全的地方和有过安全问题的地点

Evaluate the effectiveness of existing security measures, including engineering controls. Determine if risk factors have been reduced or eliminated and take appropriate action.

评估现存的安防措施，包括工程控制。风险是否降低或解除。

Hazard Prevention and Control
危险防止和控制

After hazards are identified through the systematic worksite analysis, the next step is to design measures through engineering or administrative and work practices to prevent or control these hazards. If violence does occur, post-incident response can be an important tool in preventing future incidents.

Engineering controls and workplace adaptations to minimize risk

工程控制和工作场所调整减少风险

Engineering controls remove the hazard from the workplace or create a barrier between the worker and the hazard. There are several measures that can effectively prevent or control workplace hazards, such as those described in the following paragraphs. The selection of any measure, of course, should be based on the hazards identified in the workplace security analysis of each facility.

工程控制减少工作场所危险或在工作人员与危险之间建立隔离。以下有效措施。选择依据是基于对工作场所安全危险因素的了解。

Among other options, employers may choose to:

Assess any plans for new construction or physical changes to the facility or workplace to eliminate or reduce security hazards.

评价新建或改建工作场所，减少安全威胁

Install and regularly maintain alarm systems and other security devices, panic buttons, hand-held alarms or noise devices, cellular phones and private channel radios where risk is apparent or may be anticipated. Arrange for a reliable response system when an alarm is triggered.

安装和定期维护报警系统和其他安全设施，如报警钮、手持报警器，移动通讯步话机等。建立报警的有效反应系统

Provide metal detectors—installed or hand-held, where appropriate—to detect guns, knives or other weapons, according to the recommendations of security consultants.

提供金属探测器，安装或手持，以发现枪支、刀具或其他武器。

Use a closed-circuit video recording for high-risk areas on a 24-hour basis. Public safety is a greater concern than privacy in these situations.

24小时使用内部监控。公共区域尤为重要

Place curved mirrors at hallway intersections or concealed areas.

在走廊交叉口设置凸镜。

Enclose nurses' stations and install deep service counters or bullet-resistant, shatter-proof glass in reception, triage and admitting areas or client service rooms.

护士站的安全

Provide employee "safe rooms" for use during emergencies.

紧急时员工“安全房间”

Establish "time-out" or seclusion areas with high ceilings without grids for patients who "act out" and establish separate rooms for criminal patients.

Provide comfortable client or patient waiting rooms designed to minimize stress.

为病人提供舒适的等待区减少紧张

Ensure that counseling or patient care rooms have two exits.

保证患者的治疗区有两个出口

Lock doors to staff counseling rooms and treatment rooms to limit access.

锁上员工心理咨询室，限制出入。

Arrange furniture to prevent entrapment of staff.

调整家具，防止员工被困

Use minimal furniture in interview rooms or crisis treatment areas and ensure that it is lightweight, without sharp corners or edges and affixed to the floor, if possible. Limit the number of pictures, vases, ashtrays or other items that can be used as weapons.

尽量减少危机处理区域的家具；保证是重量轻没有尖锐角固定在地面；减少装饰画、花瓶、烟灰缸或其他可用作武器的物品

Provide lockable and secure bathrooms for staff members separate from patient/client and visitor facilities.

提供可锁的、安全的员工卫生间

Lock all unused doors to limit access, in accordance with local fire codes.

符合消防规定的情况下，锁住所有未使用的门，限制出入，

Install bright, effective lighting, both indoors and outdoors.

室内外安装明亮、有效的照明系统

Replace burned-out lights and broken windows and locks.

更换不良的灯或破损的窗户、锁具

Keep automobiles well maintained if they are used in the field.

保持野外使用的车辆的完好

Lock automobiles at all times.

记得随时锁车

Administrative and work practice controls to minimize risk

行者和工作实践控制将危险最小化

Administrative and work practice controls affect the way staff perform jobs or tasks. Changes in work practices and administrative procedures can help prevent violent incidents. Some options for employers are to:

State clearly to patients, clients and employees that violence is not permitted or tolerated.

清晰地向患者、客户和员工申明不允许或不容忍暴力

Establish liaison with local police and state prosecutors. Report all incidents of violence. Give police physical layouts of facilities to expedite investigations.

与当地警察局建立联系。报告所有暴力事件。给警察所有场所的平面图，加快调查。

Require employees to report all assaults or threats to a supervisor or manager (for example, through a confidential interview). Keep log books and reports of such incidents to help determine any necessary actions to prevent recurrences.

要求员工向其主管或经理包告所有攻击或威胁（例如，通过保密的访谈）。记录和登记事件有利于决定是否采取必要措施防止再发生。

Advise employees of company procedures for requesting police assistance or filing charges when assaulted and help them do so, if necessary.

敦告员工公司申请警察帮助的步骤要求

Provide management support during emergencies. Respond promptly to all complaints. 紧急时提供管理支持。对投诉及时回复。

Set up a trained response team to respond to emergencies. 建立受训的紧急反应队伍

Use properly trained security officers to deal with aggressive behavior. Follow written security procedures.

用良好受训的安全官处理过分行为。遵守书面的安全步骤。

Ensure that adequate and properly trained staff are available to restrain patients or clients, if necessary.

保证有充足的良好受训的员工必要时身体约束患者或客户

Provide sensitive and timely information to people waiting in line or in waiting rooms. Adopt measures to decrease waiting time.

有同情的、及时的向等待区、排队的人群提供信息

Ensure that adequate and qualified staff are available at all times. The times of greatest risk occur during patient transfers, emergency responses, mealtimes and at night. Areas with the greatest risk include admission units and crisis or acute care units.

保证有充足、合格的员工。患者转移、急诊抢救、就餐和夜间是高风险时段。高风险区域包括住院部、抢救和重症区。

Institute a sign-in procedure with passes for visitors, especially in a newborn nursery or pediatric department. Enforce visitor hours and procedures.

设立访客签到和通行证制度，特别是新生儿或儿科。执行访客时间限定和程序

Establish a list of "restricted visitors" for patients with a history of violence or gang activity.

Make copies available at security checkpoints, nurses' stations and visitor sign-in areas. 建立有暴力记录的患者“限制访客”名单，发放给安全巡查点、护士站和访客签到处。

Review and revise visitor check systems, when necessary. Limit information given to outsiders about hospitalized victims of violence.

必要时变更访客检查系统。

Supervise the movement of psychiatric clients and patients throughout the facility.

在机构内移动精神病客户或患者时密切监督

Control access to facilities other than waiting rooms, particularly drug storage or pharmacy areas.

控制等待区外的场所出入，尤其是药品存储区域

Prohibit employees from working alone in emergency areas or walk-in clinics, particularly at night or when assistance is unavailable. Do not allow employees to enter seclusion rooms alone.

防止员工独立在急诊去工作，尤其是夜间。别让员工独立进入隐秘的房间。

Establish policies and procedures for secured areas and emergency evacuations.

建立安全区域和紧急撤离区域制度和步骤

Determine the behavioral history of new and transferred patients to learn about any past violent or assaultive behaviors.

了解患者的行为史是否有暴力或攻击倾向

Establish a system—such as chart tags, log books or verbal census reports—to identify patients and clients with assaultive behavior problems. Keep in mind patient confidentiality and worker safety issues. Update as needed.

建立一个发现有攻击性行为问题患者或客户的系统，例如表格、登记本或口头询问。牢记患者隐私和工作人员安全问题。

Treat and interview aggressive or agitated clients in relatively open areas that still maintain privacy and confidentiality (such as rooms with removable partitions).

在相对开放同时保持私密性的地方治疗或询问有过激或被激怒的客户，例如有可移动隔板的房间。

Use case management conferences with coworkers and supervisors to discuss ways to effectively treat potentially violent patients.

与同事或主管讨论潜在暴力的客户的案例管理

Prepare contingency plans to treat clients who are "acting out" or making verbal or physical attacks or threats. Consider using certified employee assistance professionals or in-house social service or occupational health service staff to help diffuse patient or client anger.

准备 “意外事件应对方案，应对行为过激，有口头或身体攻击或危险的客户。考虑使用受训的专业人员帮助平息患者或客户的怒气。

Transfer assaultive clients to acute care units, criminal units or other more restrictive settings.

将有攻击行为的客户移到限制性区域。

Ensure that nurses and physicians are not alone when performing intimate physical examinations of patients.

保证护士或医生不单独对患者进行私密的身体检查。

Discourage employees from wearing necklaces or chains to help prevent possible strangulation in confrontational situations. Urge community workers to carry only required identification and money.

不鼓励员工带项链，防止冲突时可能被绞扼。

Survey the facility periodically to remove tools or possessions left by visitors or maintenance staff that could be used inappropriately by patients.

定期巡查场所，去除可能被不当使用的工具或物品。

Provide staff with identification badges, preferably without last names, to readily verify employment.

为员工准备工作卡，最好不是全名，但能确认其身份

Discourage employees from carrying keys, pens or other items that could be used as weapons.

Provide staff members with security escorts to parking areas in evening or late hours. Ensure that parking areas are highly visible, well lit and safely accessible to the building.

为员工提供夜间安全护送到停车场。保证停车场显眼、照明和安全。

Use the "buddy system," especially when personal safety may be threatened. Encourage home health care providers, social service workers and others to avoid threatening situations.

使用“陪伴系统”，尤其是个人安全受到威胁时。鼓励家庭病床医护人员、社会服务工作者避免被威胁。

Advise staff to exercise extra care in elevators, stairwells and unfamiliar residences; leave the premises immediately if there is a hazardous situation; or request police escort if needed.

告诫员工不要在电梯、楼梯间或不熟悉的地方过于停留。如有危险迅速离开。

Develop policies and procedures covering home health care providers, such as contracts on how visits will be conducted, the presence of others in the home during the visits and the refusal to provide services in a clearly hazardous situation.

建立保证家庭病床医护人员安全的规定和措施。例如家庭访视如何实行，访视时他人在场和拒绝在危险环境提供服务的措施。

Establish a daily work plan for field staff to keep a designated contact person informed about their whereabouts throughout the workday. Have the contact person follow up if an employee does not report in as expected.

建立日常工作计划，为野外工作员工提供指定联系人，保证全天了解他们的情况。如果员工未按规定及时报告应迅速主动跟进。

Employer responses to incidents of violence

雇主对暴力事件的反应

Post-incident response and evaluation are essential to an effective violence prevention program. All workplace violence programs should provide comprehensive treatment for employees who are victimized personally or may be traumatized by witnessing a workplace violence incident. Injured staff should receive prompt treatment and psychological evaluation whenever an assault takes place, regardless of its severity. Provide the injured transportation to medical care if it is not available onsite.

事件发生后的反应和评估是建立有效暴力防止计划的核心。所有工作场所暴力计划应该为收到伤害的个人或者工作暴力事件目击者提供综合的治疗。受伤的员工应该及时得到质量和心理评估，无论攻击的严重程度。

Victims of workplace violence suffer a variety of consequences in addition to their actual physical injuries. 工作场所暴力受害者会在身体伤害之外很多其他后果These may include:

Short- and long-term psychological trauma;

长期和短期心理重创

Fear of returning to work;

害怕回到工作

Changes in relationships with coworkers and family;

与同事和家庭的关系的改变

Feelings of incompetence, guilt, powerlessness; and

感到不称职、有罪、没有能力

Fear of criticism by supervisors or managers.

害怕主管或经理的批评

Consequently, a strong follow-up program for these employees will not only help them to deal with these problems but also help prepare them to confront or prevent future incidents of violence.

Several types of assistance can be incorporated into the post-incident response. For example, trauma-crisis counseling, critical-incident stress debriefing or employee assistance programs may be provided to assist victims. Certified employee assistance professionals, psychologists, psychiatrists, clinical nurse specialists or social workers may provide this counseling or the employer may refer staff victims to an outside specialist. In addition, the employer may establish an employee counseling service, peer counseling or support groups.

Counselors should be well trained and have a good understanding of the issues and consequences of assaults and other aggressive, violent behavior. Appropriate and promptly rendered post-incident debriefings and counseling reduce acute psychological trauma and general stress levels among victims and witnesses. In addition, this type of counseling educates staff about workplace violence and positively influences workplace and organizational cultural norms to reduce trauma associated with future incidents.

Safety and Health Training

安全和健康培训

Training and education ensure that all staff are aware of potential security hazards and how to protect themselves and their coworkers through established policies and procedures.

Training for all employees

为所有员工培训

Every employee should understand the concept of "universal precautions for violence"— that is, that violence should be expected but can be avoided or mitigated through preparation. Frequent training also can reduce the likelihood of being assaulted.

每个员工理解“暴力防范通用法则”，即暴力时间无法预计被预计，但可以被避免或减缓。训练可以减少被攻击的发生。

Employees who may face safety and security hazards should receive formal instruction on the specific hazards associated with the unit or job and facility. This includes information on the types of injuries or problems identified in the facility and the methods to control the specific hazards. It also includes instructions to limit physical interventions in workplace altercations whenever possible, unless enough staff or emergency response teams and security personnel are available. In addition, all employees should be trained to behave compassionately toward coworkers when an incident occurs.

面临安全隐患的员工应该受到正式的指导。

The training program should involve all employees, including supervisors and managers.

培训应该包括所有员工

New and reassigned employees should receive an initial orientation before being assigned their job duties. Visiting staff, such as physicians, should receive the same training as permanent staff. Qualified trainers should instruct at the comprehension level appropriate for the staff. Effective training programs should involve role playing, simulations and drills.

新员工入职培训应该包括这项内容。可以做角色演练和演习。

Topics may include management of assaultive behavior, professional assault-response training, police assault-avoidance programs or personal safety training such as how to prevent and avoid assaults. A combination of training programs may be used, depending on the severity of the risk.

内容包括攻击行为管理，职业攻击反应训练等等。

Employees should receive required training annually. In large institutions, refresher programs may be needed more frequently, perhaps monthly or quarterly, to effectively reach and inform all employees.

员工应受到年度培训

What training should cover

The training should cover topics such as:

The workplace violence prevention policy;

Risk factors that cause or contribute to assaults;

Early recognition of escalating behavior or recognition of warning signs or situations that may lead to assaults;

Ways to prevent or diffuse volatile situations or aggressive behavior, manage anger and appropriately use medications as chemical restraints;

A standard response action plan for violent situations, including the availability of assistance, response to alarm systems and communication procedures;

Ways to deal with hostile people other than patients and clients, such as relatives and visitors;

Progressive behavior control methods and safe methods to apply restraints;

The location and operation of safety devices such as alarm systems, along with the required maintenance schedules and procedures;

Ways to protect oneself and coworkers, including use of the "buddy system;"

Policies and procedures for reporting and recordkeeping;

Information on multicultural diversity to increase staff sensitivity to racial and ethnic issues and differences; and

Policies and procedures for obtaining medical care, counseling, workers' compensation or legal assistance after a violent episode or injury.

Training for supervisors and managers

Supervisors and managers need to learn to recognize high-risk situations, so they can ensure that employees are not placed in assignments that compromise their safety. They also need training to ensure that they encourage employees to report incidents.

Supervisors and managers should learn how to reduce security hazards and ensure that employees receive appropriate training. Following training, supervisors and managers should be able to recognize a potentially hazardous situation and to make any necessary changes in the physical plant, patient care treatment program and staffing policy and procedures to reduce or eliminate the hazards.

Training for security personnel

Security personnel need specific training from the hospital or clinic, including the psychological components of handling aggressive and abusive clients, types of disorders and ways to handle aggression and defuse hostile situations.

The training program should also include an evaluation. At least annually, the team or coordinator responsible for the program should review its content, methods and the frequency of training. Program evaluation may involve supervisor and employee interviews, testing and observing and reviewing reports of behavior of individuals in threatening situations.

Recordkeeping and Program Evaluation How employers can determine program effectiveness

Recordkeeping and evaluation of the violence prevention program are necessary to determine its overall effectiveness and identify any deficiencies or changes that should be made.

Records employers should keep

Recordkeeping is essential to the program's success. Good records help employers determine the severity of the problem, evaluate methods of hazard control and identify training needs. Records can be especially useful to large organizations and for members of a business group or trade association who "pool" data. Records of injuries, illnesses, accidents, assaults, hazards, corrective actions, patient histories and training can help identify problems and solutions for an effective program.

Important Records:

OSHA Log of Work-Related Injury and Illness (OSHA Form 300). Employers who are required to keep this log must record any new work-related injury that results in death, days away from work, days of restriction or job transfer, medical treatment beyond first aid, loss of consciousness or a significant injury diagnosed by a licensed health care professional. Injuries caused by assaults must be entered on the log if they meet the recording criteria. All employers must report, within 24 hours, a fatality or an incident that results in the hospitalization of three or more employees.⁽⁸⁾

Medical reports of work injury and supervisors' reports for each recorded assault. These records should describe the type of assault, such as an unprovoked sudden attack or patient-topatient altercation; who was assaulted; and all other circumstances of the incident. The records should include a description of the environment or location, potential or actual cost, lost work time that resulted and the nature of injuries sustained. These medical records are confidential documents and should be kept in a locked location under the direct responsibility of a health care professional.

Records of incidents of abuse, verbal attacks or aggressive behavior that may be threatening, such as pushing or shouting and acts of aggression toward other clients. This may be kept as part of an assaultive incident report. Ensure that the affected department evaluates these records routinely. (See sample violence incident forms in Appendix B.)

Information on patients with a history of past violence, drug abuse or criminal activity recorded on the patient's chart. All staff who care for a potentially aggressive, abusive or violent client should be aware of the person's background and history. Log the admission of violent patients to help determine potential risks.

Documentation of minutes of safety meetings, records of hazard analyses and corrective actions recommended and taken.

Records of all training programs, attendees and qualifications of trainers.

Elements of a program evaluation

As part of their overall program, employers should evaluate their safety and security measures. Top management should review the program regularly, and with each incident, to evaluate its success. Responsible parties (including managers, supervisors and employees) should reevaluate policies and procedures on a regular basis to identify deficiencies and take corrective action.

Management should share workplace violence prevention evaluation reports with all employees. Any changes in the program should be discussed at regular meetings of the safety committee, union representatives or other employee groups.

All reports should protect employee confidentiality either by presenting only aggregate data or by removing personal identifiers if individual data are used.

Processes involved in an evaluation include:

Establishing a uniform violence reporting system and regular review of reports;

Reviewing reports and minutes from staff meetings on safety and security issues;

Analyzing trends and rates in illnesses, injuries or fatalities caused by violence relative to initial or "baseline" rates;

Measuring improvement based on lowering the frequency and severity of workplace violence;

Keeping up-to-date records of administrative and work practice changes to prevent workplace violence to evaluate how well they work;

Surveying employees before and after making job or worksite changes or installing security measures or new systems to determine their effectiveness;

Keeping abreast of new strategies available to deal with violence in the health care and social service fields as they develop;

Surveying employees periodically to learn if they experience hostile situations concerning the medical treatment they provide;

Complying with OSHA and State requirements for recording and reporting deaths, injuries and illnesses; and

Requesting periodic law enforcement or outside consultant review of the worksite for recommendations on improving employee safety.