Comprehensiveness of Workplace Violence Prevention Programs. in Home Health and Hospice Care
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1 Comprehensiveness of Workplace Violence Prevention Programs in Home Health and Hospice Care 2011 Joint Meeting Safe States Alliance, SAVIR, CDC Core I & II 1
2 Collaborators University of North Carolina at Chapel Hill (Carri Casteel and Maryalice Nocera) University of Iowa (Corinne Peek-Asa) California Department of Public Health (Robert Harrison) University of California, San Francisco (Suzi Goldmacher and Robert Kosnik) 2
3 Background Home health care projected to be fourth fastest growing industry in U.S. ( ) Nonfatal assault rate for home health workers exceeds workforce by nearly 50% Violence hazards include aggressive patients and provision of care in uncontrolled settings 3
4 Cal/OSHA Guidelines Provide recommendations for developing a comprehensive security program to protect health care workers from violence Management commitment and employee involvement Worksite analysis Hazard prevention and control Safety and health training Recordkeeping and program evaluation 4
5 Objective Identify which Cal/OSHA guideline recommendations exist in home health care agency workplace violence prevention programs 5
6 Target Population Six home health and hospice care agencies in Northern California Agency control: for-profit (n=2), nonprofitprivate (n=2), nonprofit-public (n=2) Branches within agencies: n=43 In-home patient care workers: n=1,460 6
7 Recruitment Branch Managers Recruited by phone with approval from agency administrators 40 of 43 (93%) branch managers participated Branches: Home health (n=25), hospice (n=13), both home health and hospice (n=2) 7
8 Data Collection Self-Administered Survey Branch-level workplace violence prevention policies, procedures and training Phone Interview Detail about branch-level strategies to protect workers from violence, with focus on multiple hazard levels: patient, patient s home, patient s neighborhood 8
9 Workplace Violence Prevention (WVP) Programs 9
10 Workplace Violence Prevention Programs Branch has a WVP program 22 (55.0) Among branches with a program (n=22): Branch has a written WVP program 20 (90.9) Program is reviewed and updated at least annually 14 (63.6) 10
11 Management Commitment and Employee Involvement Agency has a safety committee that addresses WVP Among branches with safety committee: Home health/hospice workers serve on committee Regularly scheduled meetings to discuss WVP with senior administrators 33 (82.5) 31 (93.9) 4 (10.0) 11
12 Assessment of Hazards Before First Visit At first Visit Other Time Patient History of violent behavior History of mental illness History of substance abuse 22 (59.5) 27 (73.0) 23 (62.2) 11 (29.7) 10 (27.0) 19 (51.4) 6 (16.2) 3 (8.1) 8 (21.6) 12
13 Assessment of Hazards (cont d) Before First Visit At first Visit Other Time Household Violence Substance use Guns Pets 6 (16.2) 7 (18.9) 15 (40.5) 23 (62.2) 20 (54.1) 17 (46.0) 15 (40.5) 18 (48.7) 8 (21.6) 5 (13.5) 3 (8.1) 8 (21.6) Neighborhood Criminal activity 9 (2.3) 3 (8.1) 0 13
14 WVP Policies and Procedures Policies and procedures to protect workers from: o Violent or aggressive patients o Violent or aggressive household members and visitors o Violence in the community 31 (77.5) 24 (60.0) 20 (50.0) 14
15 WVP Policies and Procedures (cont d) Policies and procedures to protect workers from: o Violence perpetrated by other workers in the agency o Intimate partner violence while on the job 28 (70.0) 3 (7.5) 15
16 Safety and Health Training Training to new hires Ongoing training to employees 18 (45.0) 22 (55.0) All frontline workers trained Registry / Contract staff trained New 3 (16.7) 4 (33.3) Ongoing 3 (13.6) 4 (33.3) 16
17 Safety and Health Training (cont d) Training Content Factors predicting violence and aggression Characteristics of aggressive and violent patients and families Characteristics of hazardous households Characteristics of hazardous neighborhoods New 11 (61.1) 12 (66.7) 10 (55.6) 10 (55.6) Ongoing 11 (50.0) 13 (59.1) 13 (59.1) 12 (54.6) 17
18 Safety and Health Training (cont d) Training Content (cont d) Verbal methods to diffuse aggressive behavior Physical maneuvers to diffuse or avoid aggressive behavior Self-defense if preventive action does not work Policies and methods for reporting a violent event Resources available for victims of workplace violence New 11 (61.1) 8 (44.4) 10 (55.6) 15 (83.3) 16 (88.9) Ongoing 14 (66.7) 12 (54.6) 9 (42.9) 16 (72.7) 16 (72.7) 18
19 Recordkeeping and Program Evaluation Branch maintains system for reporting violent events Strategies evaluated following a violent event o Identify factors that may have contributed to event o Monitor trends in violent incidents o Evaluate effectiveness of existing measures in reducing or eliminating violent events 35 (87.5) 21 (8.3) 17 (6.7) 16 (6.3) 19
20 Conclusions Home health and hospice care branches have gaps in their workplace violence prevention programs About half did not have programs About half did not train all workers who see patients in the home Program content focused more on hazards related to the patient care than household or community hazards 20
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