《医疗和社会服务工作者预防工作场所暴力指南》（下）（美国劳工部职业安全与健康署制定）

上部分见：
《医疗和社会服务工作者预防工作场所暴力指南》（上）（美国劳工部职业安全与健康署制定）
这是下部分：
References

California State Department of Industrial Relations, Cal/OSHA. (1998). Guidelines for Security and Safety of Health Care and Community Service Workers. www.dir.ca.gov/dosh/dosh%5Fpublications/hcworker.html

Centers for Disease Control and Prevention, National Institute for Occupational Health. (2002). Occupational Hazards in Hospitals. DHHS (NIOSH) Pub. No. 2002-101. www.cdc.gov/niosh/2002-101.html

U.S. Department of Justice, Bureau of Justice Statistics. (2001). National Crime Victimization Survey. Violence in the Workplace, 1993-99. www.ojp.gov/bjs/pub/pdf/vw99.pdf

U.S. Department of Labor, Bureau of Labor Statistics. (2002). Census of Fatal Occupational Injuries, 2001. www.bls.gov/iif/oshwc/cfoi/cfnr0008.pdf

U.S. Department of Labor, Bureau of Labor Statistics. (2001). Survey of Occupational Injuries and Illnesses, 2000. www.bls.gov/iif/oshwc/osh/os/osnr0013.pdf

Washington, Department of Labor and Industries. Workplace Violence: Awareness and Prevention for Employers and Employees, 2000. www.lni.wa.gov/ipub/417-140-000.htm

OSHA assistance

OSHA can provide extensive help through a variety of programs, including technical assistance about effective safety and health programs, state plans, workplace consultations, voluntary protection programs, strategic partnerships, training and education and more. An overall commitment to workplace safety and health can add value to your business, to your workplace and to your life.

Safety and Health Program Management Guidelines

Effective management of worker safety and health protection is a decisive factor in reducing the extent and severity of work-related injuries and illnesses and their related costs. In fact, an effective safety and health program forms the basis of good worker protection and can save time and money (about $4 for every dollar spent) and increase productivity and reduce worker injuries, illnesses and related workers' compensation costs.

To assist employers and employees in developing effective safety and health programs, OSHA published recommended Safety and Health Program Management Guidelines(54 Federal Register (16): 3904-3916, January 26, 1989). These voluntary guidelines apply to all places of employment covered by OSHA.

The guidelines identify four general elements critical to the development of a successful safety and health management program:

• Management leadership and employee involvement.
• Work analysis.
• Hazard prevention and control.
• Safety and health training. The guidelines recommend specific actions, under each of these general elements, to achieve an effective safety and health program. The Federal Registernotice is available online at www.osha.gov.

• Is there demonstrated organizational concern for employee emotional and physical safety and health as well as that of the patients?
• Is there a written workplace violence prevention program in your facility?
• Did front-line workers as well as management participate in developing the plan?
• Is there someone clearly responsible for the violence prevention program to ensure that all managers, supervisors, and employees understand their obligations?
• Do those responsible have sufficient authority and resources to take all action necessary to ensure worker safety?
• Does the violence prevention program address the kinds of violent incidents that are occurring in your facility?
• Does the program provide for post-assault medical treatment and psychological counseling for health-care workers who experience or witness assaults or violence incidents?
• Is there a system to notify employees promptly about specific workplace security hazards or threats that are made? Are employees aware of this system?
• Is there a system for employees to inform management about workplace security hazards or threats without fear of reprisal? Are employees aware of this system?
• Is there a system for employees to promptly report violent incidents, "near misses," threats, and verbal assaults without fear of reprisal?
• Is there tracking, trending, and regular reporting on violent incidents through the safety committee?
• Are front-line workers included as regular members and participants in the safety committee as well as violence tracking activities?
• Does the tracking and reporting capture all types of violence— fatalities, physical assaults, harassment, aggressive behavior, threats, verbal abuse, and sexual assaults?
• Does the tracking and reporting system use the latest categories of violence so data can be compared?
• Have the high-risk locations or jobs with the greatest risk of violence as well as the processes and procedures that put employees at risk been identified?
• Is there a root-cause analysis of the risk factors associated with individual violent incidents so that current response systems can be addressed and hazards can be eliminated and corrected?
• Are employees consulted about what corrective actions need to be taken for single incidents or surveyed about violence concerns in general?
• Is there follow-up of employees involved in or witnessing violent incidents to assure that appropriate medical treatment and counseling have been provided?
• Has a process for reporting violent incidents within the facility to the police or requesting police assistance been established?

• Incident report forms
• Workers' compensation reports of injury
• OSHA 300 injury and illness logs
• Security logs
• Reports to police
• Safety committee reports
• Hazard inspection reports
• Staff termination records
• Union complaints

• How many incidents occurred in the last 2 years?
• What kinds of incidents occurred most often (assault, threats, robbery, vandalism, etc.)?
• Where did incidents most often occur?
• When did incidents most often occur (day of week, shift, time, etc.)?
• What job task was usually being performed when an incident occurred?
• Which workers were victimized most often (gender, age, job classification, etc.)?
• What type of weapon was used most often?
• Are there any similarities among the assailants?
• What other incidents, if any, are you aware of that are not included in the records?
• Of those incidents you reviewed, which one or two were most serious?

• Are there any important patterns or trends among the incidents?
• What do you believe were the main factors contributing to violence in your workplace?
• What additional corrective measures would you recommend to reduce or eliminate the problems you identified?
  

• What do they see as risk factors for violence?
  • The most important risk factors in their work areas
  • Aspects of the physical environment that contribute to violence
  • Dangerous situations or "near misses" experienced
  • Assault experiences—past year, entire time at facility
  • Staffing adequacy
• How are current control measures working?
  • Hospital practices for handling conflict among staff and patients
  • Effectiveness of response to violent incidents
  • How safe they feel in the current environment
• What ideas do employees have to protect workers?
  • Highest priorities in violence prevention
  • Ideas for improvements and prevention measures
• How satisfied are they in their jobs?
  • With managers/fellow workers
  • Adequacy of rewards and praise
  • Impact on health

• Are safety and security issues specifically considered in the early stages of facility design, construction, and renovation?
• Does the current violence prevention program provide a way to select and implement controls based on the specific risks identified in the workplace security analysis? How does this process occur?

• Do crime patterns in the neighborhood influence safety in the facility?
• Do workers feel safe walking to and from the workplace?
• Are entrances visible to security personnel and are they well lit and free of hiding places?
• Is there adequate security in parking or public transit waiting areas?
• Is public access to the building controlled, and is this system effective?
• Can exit doors be opened only from the inside to prevent unauthorized entry?
• Is there an internal phone system to activate emergency assistance?
• Have alarm systems or panic buttons been installed in high-risk areas?
• Given the history of violence at the facility, is a metal detector appropriate in some entry areas? Closed-circuit TV in high-risk areas?
• Is there good lighting?
• Are fire exits and escape routes clearly marked?
• Are reception and work areas designed to prevent unauthorized entry? Do they provide staff good visibility of patients and visitors? If not, are there other provisions such as security cameras or mirrors?
• Are patient or client areas designed to minimize stress, including minimizing noise?
• Are drugs, equipment, and supplies adequately secured?
• Is there a secure place for employees to store their belongings?
• Are "safe rooms" available for staff use during emergencies?
• Are door locks in patient rooms appropriate? Can they be opened during an emergency?
• Do counseling or patient care rooms have two exits, and is furniture arranged to prevent employees from becoming trapped?
• Are lockable and secure bathrooms that are separate from patient-client and visitor facilities available for staff members?

• Are identification tags required for both employees and visitors to the building?
• Is there a way to identify patients with a history of violence? Are contingency plans put in place for these patients—such as restricting visitors and supervising their movement through the facility?
• Are emergency phone numbers and procedures posted or readily available?
• Are there trained security personnel accessible to workers in a timely manner?
• Are waiting times for patients kept as short as possible to avoid frustration?
• Is there adequate and qualified staffing at all times, particularly during patient transfers, emergency responses, mealtimes, and at night?
• Are employees prohibited from entering seclusion rooms alone or working alone in emergency areas of walk-in clinics, particularly at night or when assistance is unavailable?
• Are broken windows, doors, locks, and lights replaced promptly?
• Are security alarms and devices tested regularly?

• Is comprehensive treatment provided to victimized employees as well as those who may be traumatized by witnessing a workplace violence incident? Required services may include trauma-crisis counseling, critical incident stress debriefing, psychological counseling services, peer counseling, and support groups.

• Does the violence prevention program require training for all employees and supervisors when they are hired and when job responsibilities change?
• Do agency workers or contract physicians and house staff receive the same training that permanent staff receive?
• Are workers trained in how to handle difficult clients or patients?
• Does the security staff receive specialized training for the health-care environment?
• Is the training tailored to specific units, patient populations, and job tasks, including any tasks done in the field?
• Do employees learn progressive behavior control methods and safe methods to apply restraints?
• Do workers believe that the training is effective in handling escalating violence or violent incidents?
• Are drills conducted to test the response of health-care facility personnel?
• Are workers trained in how to report violent incidents, threats, or abuse and obtain medical care, counseling, workers' compensation, or legal assistance after a violent episode or injury?
• Are employees and supervisors trained to behave compassionately toward coworkers when an incident occurs?
• Does the training include instruction about the location and operation of safety devices such as alarm systems, along with the required maintenance schedules and procedures?

• Up-to-date recording in the OSHA Log of Work-Related Injury and Illness (OSHA 300)?
• Records of all incidents involving assault, harassment, aggressive behavior, abuse, and verbal attack with attention to maintaining appropriate confidentiality of the records?
• Training records?
• Workplace walkthrough and security inspection records?
• Keeping records of control measures instituted in response to inspections, complaints, or violent incidents?
• A system for regular evaluation of engineering, administrative, and work practice controls to see if they are working well?
• A system for regular review of individual reports and trending and analysis of all incidents?
• Employee surveys regarding the effectiveness of control measures instituted?
• Discussions with employees who are involved in hostile situations to ask about the quality of post-incident treatment they received?
• A provision for an outside audit or consultation of the violence programs for recommendations on improving safety?