Institute for Quality, Safety & Injury Prevention
Committee Report to State Council
Safety Evidence-based Topic—Active Shooter Preparedness in the ED, Trauma Triage. Articles reviewed: 1) Sanchez, L., Young, V. B., & Baker, M. (2018). Active Shooter Training in the Emergency Department: A Safety Initiative. Journal of Emergency Nursing,44(6), 598-604. doi:10.1016/j.jen.2018.07.002, and 2) New England Journal of Medicine: Journal Watch; Review of Assistant Secretary for Preparedness and Response: Mass Casualty Trauma Triage Paradigms & Pitfalls. Additional supporting articles: ENA Topic Brief: Active Shooter Preparedness in the Emergency Department (2016) • Discussion related to the two mass shooting in week before meeting. Review of evidence based articles with discussion related to strategies various facilities are utilizing (e.g. metal detectors, additional security personnel etc.), what seems to be successful and those that don’t seem to be helpful. Group consensus that active shooter drills are valuable for staff but some institutions are “hesitant” to opening “drill”—relaying concerns with how the public might perceive the drill and implication that the institution is “not safe”. Highlights of the ENA Topic Brief: 1) Develop a communication plan, 2) establish processes and procedures to ensure patient and employee safety, 3) train and drill employees, 4) plan for post-event activities. Participants shared strategies to drill, locate emergency supplies such as additional stretchers etc.
Reviewed the many resources available on the national ENA webpage related to Lantern Award. Committee walked through the individual resources available to plan and submit the Lantern Application. Individuals shared their experiences and advice related to both successful and unsuccessful applications.
CA ENA “Violence in Healthcare” Toolkit
“OSHA” stands for the Occupational Safety and Health Administration of the United States Department of Labor, formed by the Occupational Safety and Health Act of 1970. Cal/OSHA stands for the California Occupational Safety and Health Administration. The Division of Occupational Safety and Health of California (DOSH, but more commonly known as Cal/OSHA) is an agency of the Government of California established by the California Occupational Safety & Health Act of 1973. The Cal/OSHA standards, while inclusive of Federal OSHA standards, are one of the most stringent set of standards in the United States.
Cal/OSHA’s Violence Prevention in Healthcare standard became effective April 1, 2017 and is included in the California Code of Regulations as Title 8, Section 3342. According to information provided on the California Department of Industrial Relations website, the standard applies to the following:
- Health facilities, as defined in subsection b of the standard
- Home health care and home-based hospice
- Emergency medical services and medical transport, including these services when provided by firefighters and other emergency responders
- Drug treatment programs
- Outpatient medical services to the incarcerated in correctional and detention settings
Navigating the Cal/OSHA Standard can be overwhelming. The purpose of this toolkit, offered by the California Emergency Nurses Association, is to assist you in implementing the requirements of Title 8, Section 3342.
There are subsections within the standard that must be implemented by specific dates:
- April 1, 2017
- Subsection (d) Violent Incident Log
- Subsection (h) Recordkeeping
- July 1, 2017
- Subsection (g) Reporting Violent Incidents to Cal/OSHA begins
- April 1, 2018
- Subsection (c) Workplace Violence Prevention Plan
- Subsection (e) Review of the Workplace Violence Prevention Plan
- Subsection (f) Training
The Workplace Violence Prevention in Healthcare Standard can be challenging to navigate. The Cal/OSHA Healthcare Workplace Violence Standard Resources section below contains links to specific Cal/OSHA and California Hospital Association sites regarding Title 8, Section 3342 Standard.
Additionally, in an effort to provide assistance to you in navigating the requirements within the standard, the CA ENA has created an excel spreadsheet that lists every item within each section of the standard. The spreadsheet can be used for informational purposes or as a working document. The excel spreadsheet is located in the Cal/OSHA Healthcare Workplace Violence Standard Resources section below.
You will also find a section called Additional Healthcare Workplace Violence Resources, which includes more general healthcare workplace violence guidelines and information.
Cal/OSHA Healthcare Workplace Violence Standard (Title 8, Section 3342) Resources
- Cal/OSHA WPV Standard Checklist: excel spreadsheet (KLA)
- Cal/OSHA Workplace Violence Prevention in Healthcare website (Includes overview of regulatory requirements)
- Cal/OSHA Healthcare Workplace Violence Prevention Regulation: Title 8, Section 3342
- Cal/OSHA WPV Incident Reporting System for Hospitals
- Workplace Violence Incident Reporting FAQ (Doc)
- Cal/OSHA Injury and Illness Prevention Program Regulation
- Title 8, California Code of Regulations, Section 3203
- California Hospital Association’s publication, “Healthcare Workplace Violence Prevention: How to Comply with the Cal/OSHA’s Regulation,” explains Cal/OSHA’s new regulation and offers practical implementation tips (available for purchase).
Additional Healthcare Workplace Violence Resources
- ENA Workplace Violence Toolkit
- Hazard ID Assessment Checklist Toolkit
- OSHA Guidelines for Preventing Workplace Violence for Healthcare Social Service Workers
- OSHA Healthcare Roadmap
- California Hospital Association Workplace Violence Prevention Resources