OSHA Updates Guidance for Preventing Workplace Violence in Healthcare, Social Service

According to the Bureau of Labor Statistics (BLS), more than 70 percent of the 23,000 significant injuries due to assault at work in 2013 occurred in healthcare and social service settings. BLS data also indicate that 27 of the 100 fatalities in these settings that same year were due to assaults or violent acts.

The significant risk of violence faced by workers in these industries has prompted OSHA to update its 1996 and 2004 voluntary guidelines on workplace violence in healthcare and social service. The updated guidance is intended to cover a broad range of workers, including those working in hospitals, psychiatric facilities, pharmacies, community-care centers, and in field settings such as residences.
OSHA recommends that employers develop a written workplace violence prevention program. The updated guidance discusses management commitment and worker participation; worksite analysis and hazard identification; hazard prevention and control; health and safety training; and recordkeeping and program evaluation.
While healthcare workers experience less than 20 percent of all workplace injuries, they suffer more than 50 percent of workplace assaults, according to BLS data. Assaults in the healthcare industry comprise approximately 11 percent of workplace injuries involving days away from work, compared to 3 percent for all private sector employees. But research indicates that assaults are underreported, and OSHA notes that actual rates may be much higher.
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The settings that present the highest risks of violence are inpatient and acute psychiatric services, geriatric long-term care facilities, high-volume urban emergency departments, and residential social services. Risk factors for workplace violence in healthcare and social service settings include tasks such as transporting patients and clients, working alone, and working directly with patients who have a history of violence or who abuse drugs and alcohol. Other risk factors are poor lighting and workplace design that may block employees’ vision or impede their escape. Inadequate staffing, high turnover, lack of security personnel, and long waits for patients are among the organizational risk factors that contribute to workplace violence. 

To prevent workplace violence, OSHA’s guidance recommends applying the industrial hygiene steps of substitution, engineering controls, and administrative and work practice controls. An example of substituting a safer workplace practice would be transferring a patient with a history of violence from a therapeutic environment to a more appropriate facility. Engineering controls include use of barriers, guards, and door locks; metal detectors; panic buttons; improved lighting; and more accessible exits. OSHA identifies several work practices that can help abate violence, such as tracking patients with a history of violence and removing objects that could be used as weapons.
OSHA also emphasizes the importance of workplace training. For employees, training should cover the policies and procedures for particular facilities and techniques for de-escalation and self-defense, including ways to recognize situations that may lead to assaults, ways to prevent or diffuse aggressive behavior, proper use of safe rooms, and a standard action plan for responding to violent situations. Supervisors and managers should be trained to recognize high-risk situations and should encourage workers to report violent incidents.
The updated guidance is available on OSHA’s website. Additional information and resources can be found on OSHA’s Workplace Violence Topic Page.
While healthcare workers experience less than 20 percent of all workplace injuries, they suffer more than 50 percent of workplace assaults.