Comprehensiveness of Workplace Violence Prevention Programs. in Home Health and Hospice Care

Comprehensiveness of

Workplace Violence Prevention Programs

in Home Health and Hospice Care

2011 Joint Meeting Safe States Alliance, SAVIR, CDC Core I & II

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

Background



Home health care projected to be fourth

fastest growing industry in U.S. (2008-2018)



Nonfatal assault rate for home health workers

exceeds workforce by nearly 50%



Violence hazards include aggressive patients

and provision of care in uncontrolled settings

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

Objective



Identify which Cal/OSHA guideline

recommendations exist in home health care

agency workplace violence prevention

programs

Target Population



Six home health and hospice care agencies in

Northern California

 Agency control: for-profit (n=2),

nonprofit-private (n=2), nonprofit-public (n=2)

 Branches within agencies: n=43

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)

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

9

Workplace Violence Prevention (WVP)

Programs

Workplace Violence Prevention Programs

N (%)

 Branch has a WVP program

Among branches with a program (n=22):

22 (55.0)

 Branch has a written WVP program 20 (90.9)  Program is reviewed and updated at

Management Commitment and

Employee Involvement

11

N (%)

 Agency has a safety committee that

addresses WVP 33 (82.5)

Among branches with safety committee:

 Home health/hospice workers serve

on committee 31 (93.9)

 Regularly scheduled meetings to

Assessment of Hazards

Before First Visit N (%) At first Visit N (%) Other Time N (%) Patient

•

History of violent behavior

•

History of mental illness 22 (59.5) 27 (73.0) 11 (29.7) 10 (27.0) 6 (16.2) 3 (8.1)

Assessment of Hazards (cont’d)

Before First Visit N (%) At first Visit N (%) Other Time N (%) Household

•

Violence

•

Substance use

•

Guns

•

Pets Neighborhood

•

Criminal activity 6 (16.2) 7 (18.9) 15 (40.5) 23 (62.2) 9 (2.3) 20 (54.1) 17 (46.0) 15 (40.5) 18 (48.7) 3 (8.1) 8 (21.6) 5 (13.5) 3 (8.1) 8 (21.6) 0 13

WVP Policies and Procedures

N (%)

 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)

15

WVP Policies and Procedures (cont’d)

N (%)

 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)

Safety and Health Training

New

N (%) Ongoing N (%)

 All frontline workers trained 3 (16.7) 3 (13.6) N (%)

 Training to new hires

 Ongoing training to employees

18 (45.0) 22 (55.0)

17

Training Content N (%)New Ongoing N (%)

 Factors predicting violence and aggression

 Characteristics of aggressive and violent patients and

families  Characteristics of hazardous households  Characteristics of hazardous neighborhoods 11 (61.1) 12 (66.7) 10 (55.6) 10 (55.6) 11 (50.0) 13 (59.1) 13 (59.1) 12 (54.6)

Training Content (cont’d) N (%)New Ongoing N (%)

 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

11 (61.1) 8 (44.4) 10 (55.6) 15 (83.3) 14 (66.7) 12 (54.6) 9 (42.9) 16 (72.7)

19

Recordkeeping and Program Evaluation

N (%)

 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)

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