Page 8 • DNA Reporter November, December 2017, January 2018 VOTING IS NOW OPEN! Are you are a Delaware RN and have a friend or colleague worthy of recognition? Please take a moment to vote and tell your fellow RNs to vote! VOTING IS OPEN TO DELAWARE RNs Now through February 5, 2018 VISIT: WWW.DENURSES.ORG and look under PROGRAMS for Delaware Today Top Nurses! Please join us we celebrate the honorees: Delaware Today’s Excellence in Nursing May 17, 2018 • Bella Vita at Cavalier’s Country Club in Newark For tickets and information, visit DelawareToday.com.
November, December 2017, January 2018 DNA Reporter • Page 9 Healthcare Worker Safety in Home and Community Health Beth Redfield, OTR/L Gale Moore Bucher, MSN, RN, CPHQ, COS-C, FABC employee anonymity. Since beginning the process to increase employee awareness of risks and colleagues’ injuries, the time between injury occurrences has doubled. Beth Redfield is a Quality Specialist at Christiana Care Visiting Nurse Association and has been an occupational therapist for 28 years. Beth’s responsibilities include employee safety and performance improvement. She is currently working with Christiana Care’s Operational Excellence Department on a project to reduce employee injuries. Beth is an alumnus of the University of New Hampshire. Beth can be reached at firstname.lastname@example.org or at her desk 302- 327-5272. Gale Moore Bucher is the Director of Quality and Risk Management at Christiana Care Visiting Nurse Association. Gale is an alumnus of the University of Delaware where she also serves as adjunct faculty. Gale can be reached at gbucher@ christianacare.org or at her desk 302-327-5341. Beth Redfield Gale Moore Bucher Community Violence Home healthcare workers may be exposed to potentially serious or even life-threatening events in the community. Traditional safety measures used in institutional settings cannot be implemented in patients’ homes. In 2016, CCVNA convened a town hall meeting for employees to share their concerns about safety communities they serve. Concerns included: • Parking time limits • Street violence • Substance abuse within the home The Delaware Association of Home and Community Care (DAHCC) reached out with agencies to city police departments and mayors to discuss ways to reduce risk while providing care in the community. As a result, hangtags for the rearview mirror were developed with the DAHCC logo (a large red heart) and provided to employees working in the city areas. Jennifer Rittereiser, MPH, Branch Director, shared, “City police know to look for vehicle hang tags and will provide additional surveillance in neighborhoods at high risk for violence” (May 23, 2017). Police will also be more lenient with parking time restrictions, understanding that a start of care assessment may take more than two hours. In addition, staff was made aware of the following safety measures: • Exit the home if you feel threatened, fearful or unsafe. • Wear uniforms and identification badges. • If you are being verbally abused, ask the abuser to stop. If the abuse doesn’t stop, leave the home and notify your manager. • Change visit schedule to a safer time of day. Safety is a concern for all nurses; however, home and community health nurses have unique vulnerabilities and concerns. More than 500 Christiana Care Visiting Nurse Association (CCVNA) nurses, therapists, home health aides and medical social workers provide healthcare in patients’ residences throughout the state of Delaware. CCVNA staff provided more than 300,000 visits in 2016. Knowledge of strategies for personal safety is important as well as understanding how an employee’s attitude about safety influences their risk for injury. Per the U.S. Bureau of Labor Statistics, in 2015 the recordable injury incident rate for education and health services was 4.0; the rate represents the number of injuries and illnesses per 100 full time workers. Half of these workplace injuries resulted in days away from work or transfer to another position. Workplace injury can result in pain, potential loss of income and inability to participate in work and family activities, and workplace injuries are costly to the employer. There are direct costs associated with the medical treatment of injuries, and indirect costs including loss of productivity, manager investigation time, and office resources as illustrated in Table 1. Staff members who experience a physical injury can have emotional repercussions, including traumatic stress disorder, anxiety, fear of future violence, and depression (McPhaul, Lipscomb, & Johnson, 2010). Staff who cannot reconcile these feelings may change jobs, further impacting agency cost. Table 1: According to the Occupational Safety & Health Administration [OSHA] (2015), the average costs associated per injury type are listed below: Injury Type Direct Cost Indirect Cost Total Cost Contusion $ 27,511 $ 30,262 $ 57,773 Mental Stress $ 30,947 $ 34,041 $ 64,988 Strain $ 33,140 $ 36,454 $ 69,594 The Pet Threat Even the friendliest pets can become aggressive to a healthcare worker laying hands on their owner. CCVNA has had success in reducing injuries caused by animals from seven to one in three years, using a multi-pronged plan. A pet securement policy was drafted and shared with staff and patients. It states, “Pets must be secured during VNA staff visits,” regardless of the temperament of the animal. Central Intake staff began asking if there were pets in the home during pre-admission calls and communicating that the expectation is for pets to be secured during staff visits. Employees were provided with information regarding the number of dog bites to increase awareness. In all instances, increased knowledge of potential dangers leads to heightened safety awareness. Personal Ownership of Safety Awareness and ownership of personal safety are at the forefront of safety awareness training in the industrial setting. The literature illustrated that employees’ safety awareness is one of the most important pillars of any successful safety system (Ismail, Doostdar, & Harunl, 2012). Without healthy employees, the work does not get done and customer needs are not met. Putting staff safety first is a challenge for both manager and employee, but is imperative. It has become the standard at CCVNA to inform employees when there is an employee incident by any cause. Post injury “huddles” are completed to discuss the events leading up to and during the incident with the purpose to look for lessons learned. An email format entitled “VNA Learning” is used to share these lessons with effort to be engaging while still informative and maintaining • Weapons and pets must be secured during the visit. • Keep your cell phone and car keys in your pocket. • Be aware of exits and bathrooms. If unable to exit the home, staff may lock themselves in a bathroom while they call 911. McPhaul et al. (2010) pointed out that the Home Visit Risk Scale can be used to assess risk for violence in home healthcare. The HVRS was developed based on three dimensions to predict risk: Decision latitude, psychological demands or workload, and social support. In this context, a healthcare worker’s ability to make safety decisions, such as leaving or not entering a home reduces the risk of being a victim. Safety meetings to discuss hazards and prevention provide social support that further reduces risk and associated stress. Approaching Safety Culture Key components of a safety culture are management commitment and worker participation. A robust safety program should include: • Employee surveys to identify areas of risk and obtain feedback on current practices • Prioritization of hazards • Policies and procedures, reporting and tracking of injuries and near misses • Safety training • Social support such as a safety committee • Functional communication devices • Analysis of injuries to mitigate harm and identify prevention strategies • Annual program evaluation (OSHA, 2016) Conclusion Based on literature reviewed and the agency’s experiences, leadership commitment to safety programming is critical to reduce injury risk and incidence. Injury rates fall when employees place personal value on safety habits and care for one’s self and others. We encourage you to consider your own habits and attitudes regarding safety culture at your workplace. We hope these ideas will help you achieve a healthier safety culture. References Bureau of Labor Statistics. (2016). Incidence rates of nonfatal occupational injuries and illnesses by major private industry sector and selected case types 2013-15. Retrieved from https://www.bls.gov/news.release/osh.t07.htm Ismail, Z., Doostdar, S., & Harun, Z. (2012). Factors influencing the implementation of safety management system for construction sites. Safety Science, 50 (3), 418-423. McPhaul, K., Lipscomb, J., & Johnson, J. (2010, May). Assessing risk for violence on home health visits. Home Healthcare Nurse: 28 (5), 278-289. Occupational Safety and Health Administration [OSHA]. (2015). Guidelines for preventing workplace violence for health care and social service workers. Retrieved from https:// www.osha.gov/Publications/osha3148.pdf
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