2/7/2014 Presented by MIOSHA Consultation Education and Training - PDF document

2/7/2014 Presented by MIOSHA Consultation Education and Training (517) 322-1809  Identify the most prevalent occupational injuries and illnesses within nursing and residential care facilities.  Compare Michigan occupational injury and illness data with National data.  Develop strategies to reduce occupational injuries and illnesses. “ OSHA recently took notice when it came to our attention that that one in every five U.S. workers injured in the private sector is a healthcare worker. ” “ These workers should not be forced to risk injury while caring for others .” “It is not acceptable for these workers to continue getting hurt at such high rates. “ Remarks by Dr. David Michaels Assistant Secretary of Labor Occupational Safety and Health Administration(OSHA) Seventh EU/US Joint Conference on Occupational Safety and Health Brussels, Belgium July 11, 2012 1

2/7/2014 2012 National Rates Chart 1 Distribution of Total Injury and Illness Cases by Industry Division Michigan, Private Sector 2012 (Total Cases 105,500) 35,000 30,000 25,000 20,000 15,000 10,000 5,000 0 Chart 1 Distribution of Total Injury and Illness Cases by Industry Division Michigan, Private Sector 2011 (Total Cases 97,400) 30,000 25,000 20,000 15,000 10,000 5,000 0 2

2/7/2014 Michigan Data: Industry ry NAICS Recordi ding Total Cases es with days away from work, job transfer, fer, or Other r Code year Recorda dabl ble restri riction recorda rdabl ble e cases es Total Cases with days Cases with job transfer away from work or restriction Nursing and 623 2012 9.6 5.8 2.4 3.4 3.8 Residential Care 2011 8.7 5.1 2.5 2.6 3.6 National Data: Industry NAICS S Recording Total Cases with days away from om work, job transfer, or Other Code Year Recordable restriction on recor ordable cases Total Cases with days Cases with job transfer away from work or restriction Nursing and 623 2012 7.6 4.7 2.4 2.3 2.9 Residential Care 2011 10.2 7.1 3.8 - 3.1 Rates based on calculation: (# cases/Emp. Hours) X 200,000 Total Recordable Case Rate (per 100 employees) 14 12 10 8 6 2010 4 2011 2 2012 0 Manufacturing: Manufacturing: Healthcare: Beverage and Primary Metal Nursing and Tobacco Products Residential Care Facilities Total Recordable Case Rate (per 100 employees) 12 10 8 6 2012 4 2011 2 2010 0 Michigan - National - Michigan - National - NAICS 623 NAICS 623 All Industries All Industries only only NAICS 623 = Nursing and Residential Care 3

2/7/2014 2012 2012 Michiga higan n Cases es Violence and other injuries by persons or animal (22%) 2% 2% Falls, slips, trips (20%) 22% 22% Exposure to harmful substances or environments (2%) 45% 45% Contact with object, equipment (9%) 20% 20% Overexertion and bodily reaction (45%) 2% 2% All other (2%) 9% 9% 2011 2011 Michiga higan n Cases es Violence and other injuries 2% 2% by persons or animal (21%) 21% 21% Transportation incidents (4%) Falls, slips, trips (20%) 42% 42% 4% 4% Exposure to harmful substances or environments (3%) Contact with object, equipment (8%) Overexertion and bodily 20% 20% reaction (42%) All other (2%) 3% 3% 8% 8% Nursing and Residential Care:  Ergonomic stressors in patient/resident lifting  Workplace violence  Slips, trips, and falls  Bloodborne pathogens  Tuberculosis 4

2/7/2014  Most prevalent source of employee injury: ◦ Musculoskeletal/Ergonomic stress ◦ Workplace violence (assaults by residents or others) ◦ Slips, trips, falls  Bloodborne pathogens (most frequently cited standard)  Tuberculosis: ◦ Per CDC, among facilities at highest risk for exposure. ◦ Due to case rate among > 65 age group.  Note - There are no MIOSHA standards that specifically address: ◦ Ergonomics ◦ Workplace Violence ◦ Tuberculosis  Material handling ◦ Laundry ◦ Kitchen ◦ Maintenance  Resident handling ◦ Mobility and lift assist requirements noted in care plan?  Failure to use lifts and lift devices ◦ Lack of training ◦ Time constraints ◦ Too few devices ◦ Employee fails to recognize the need to use  More information to be covered in separate program Healthcare and social services: 1. ◦ Psychiatric facilities Hospital emergency departments ◦ ◦ Community mental health clinics Drug abuse treatment clinics ◦ ◦ Pharmacies Community-care facilities ◦ ◦ Residential facilities and Long-term care facilities. ◦ Late-night Retail Settings 2. 5

2/7/2014  1. Type 1 — Criminal Intent Violent acts by people who enter the workplace to commit a robbery or other crime — or current or former employees who enter the workplace with the intent to commit a crime.  2. Type 2 — Customer/Client/Patients Violence directed at employees by customers, clients, patients, students, inmates or any others to whom the employer provides a service.  3. Type 3 — Co-worker Violence against co-workers, supervisors, or managers by a current or former employee, supervisor, or manager.  4. Type 4 — Personal Violence in the workplace by someone who does not work there, but who is known to, or has a personal relationship with, an employee.  Management commitment  Employee involvement  Worksite analysis  Hazard prevention and control  Safety and health training  Recordkeeping and program evaluation 6

2/7/2014  Equal concern and commitment for safety and health of residents and employees.  Allocation of resources and authority to those responsible to violence prevention program.  Establish comprehensive program for medical and psychological counseling with debriefing for employees experiencing or witnessing an assault or other violent incidents.  Understand and comply with violence prevention program.  Actively participate on safety committee.  Report all instances promptly and accurately.  Participate in training programs.  Threat assessment team ◦ Management, employees, security, maintenance, human resources  Evaluate existing or potential hazards for workplace violence ◦ Procedures and operations ◦ Specific vulnerable locations (reception, parking lot, resident room, shower room)  Review of injury data  Implement screening survey to document experiences of employees  Evaluate effectiveness of existing security and protective measures 7

2/7/2014 Engineering controls remove or reduce the hazard:  Physical barriers between the hazard and the employee ◦ Locked doors ◦ Safe rooms and enclosures ◦ Deep counters and shatter-proof glass  Alarms or panic buttons  Mirrors to see end of hallway  Video surveillance in high risk areas (i.e. reception)  Policies and procedures for employees, residents, visitors and delivery personnel  Local law enforcement involvement  Reporting and documenting all incidents  Trained response team  Control access: ◦ Facility ◦ Medication storage  Determine behavioral history for transfers  Include information related to assaultive and abusive behavior in resident care plan  Employee dress code (i.e. no necklaces/lanyards)  Remove loose (easily thrown objects) from environment  Train employees: ◦ Policies, procedures and elements of the plan ◦ When/what/how to report ◦ Ways to protect themselves ◦ Location and operation of protective devices  Recordkeeping: ◦ MIOSHA/OSHA Log of Work-related Injuries and Illnesses (300 and 301) ◦ Employee medical records ◦ Incident including near-miss documents/reports ◦ Resident abusive or assaultive behavior 8

2/7/2014  Verbal and Physical  Resistive Behaviors: Aggression ◦ Pulling away from ◦ Cursing and name- the caregiver calling ◦ Fleeing ◦ Inflicting pain on caregiver or self: Biting,  Vocal agitation hitting, scratching, ◦ Crying pinching ◦ Yelling or other loud ◦ Pushing away ◦ Destruction of property exclamations  Resident to self  Resident to resident  Resident to care giver  Resident to guest  Guest to resident or care giver Physical comfort and pain  Emotional well-being  Sense of competency  Need for socialization  Ability to find one’s way  Desire to be understood  Desire to communicate effectively  Michigan Dementi tia Coaliti tion, , Knowle wledg dge and Skills Needed d for Dementi tia Care A Guide de for Direct ct Care Workers 2006 2006 9

2/7/2014  Leave if threatened  Position for easy exit  Retreat into safe area  Use 2 staff members (avoid more than 2 as this may escalate fear and aggression)  Notify supervisor immediately if they are injured or assaulted at work  OSHA's "Guidelines for Preventing Workplace Violence for Health Care & Social Service Workers" resource is available online at http://www.osha.gov/Publications/OSHA314 8/osha3148.html.  Additional information on workplace violence is available at http://www.osha.gov/SLTC/workplaceviolenc e/index.html. Kitchen, dining, hallways, laundry, bathing areas, points of entry/egress:  Floors (wet, uneven, cluttered, poor lighting)  Floor openings (unguarded)  Damaged or inadequate stairways  Elevated work areas w/o guardrails  Inadequate aisles  Improper use of ladders and/or stepstools 10