S-4449

AN ACT Relating to workplace safety in state hospitals; amending RCW 72.23.010; adding new sections to chapter 72.23 RCW; creating a new section; and prescribing penalties.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION. Sec. 1. The legislature finds that:

(1) Workplace safety is of paramount importance in state hospitals for patients and the staff that treat them;

(2) Based on an analysis of workers' compensation claims, the department of labor and industries reports that state hospital employees face high rates of workplace violence in Washington state;

(3) State hospital violence is often related to the nature of the patients served, people who are both mentally ill and too dangerous for treatment in their home community, and people whose behavior is driven by elements of mental illness including desperation, confusion, delusion, or hallucination;

(4) Patients and employees should be assured a reasonably safe and secure environment in state hospitals;

(5) The state hospitals have undertaken efforts to assure that patients and employees are safe from violence, but additional personnel training and appropriate safeguards may be needed to prevent workplace violence and minimize the risk and dangers affecting people in state hospitals; and

(6) Duplication and redundancy should be avoided so as to maximize resources available for patient care.

Sec. 2. RCW 72.23.010 and 1981 c 136 s 99 are each amended to read as follows:

((~~As used in this chapter, the following terms shall have the following meanings:~~)) The definitions in this section apply throughout this chapter, unless the context clearly requires otherwise.

(1) "Court" means the superior court of the state of Washington.

(2) "Department" means the department of social and health services.

(3) "Employee" means an employee as defined in RCW 49.17.020.

(4) "Licensed physician" means an individual permitted to practice as a physician under the laws of the state, or a medical officer, similarly qualified, of the government of the United States while in this state in performance of his or her official duties.

(5) "Mentally ill person" ((~~shall~~)) means any person who, pursuant to the definitions contained in RCW 71.05.020, as a result of a mental disorder presents a likelihood of serious harm to others or himself or herself or is gravely disabled.

(6) "Patient" ((~~shall~~)) means a person under observation, care, or treatment in a state hospital, or a person found mentally ill by the court, and not discharged from a state hospital, or other facility, to which such person had been ordered hospitalized.

(("Licensed physician" shall mean an individual permitted to practice as a physician under the laws of the state, or a medical officer, similarly qualified, of the government of the United States while in this state in performance of his official duties.))

(7) "Resident" means a resident of the state of Washington.

(8) "Secretary" means the secretary of social and health services.

(9) "State hospital" ((~~shall~~)) means any hospital, including a child study and treatment center, operated and maintained by the state of Washington for the care of the mentally ill.

(10) "Superintendent" ((~~shall~~)) means the superintendent of a state hospital.

((~~"Court" shall mean the superior court of the state of Washington.~~

~~"Resident" shall mean a resident of the state of Washington.~~))

(11) "Violence" or "violent act" means any physical assault or attempted physical assault against an employee or patient of a state hospital.

Wherever used in this chapter, the masculine shall include the feminine and the singular shall include the plural.

NEW SECTION. Sec. 3. (1) By November 1, 2000, each state hospital shall develop a plan, for implementation by January 1, 2001, to reasonably prevent and protect employees from violence at the state hospital. The plan shall be developed with input from the state hospital's safety committee, which includes representation from management, unions, nursing, psychiatry, and key function staff as appropriate. The plan shall address security considerations related to the following items, as appropriate to the particular state hospital, based upon the hazards identified in the assessment required under subsection (2) of this section:

(a) The physical attributes of the state hospital including access control, egress control, door locks, lighting, and alarm systems;

(b) Staffing, including security staffing;

(d) First aid and emergency procedures;

(e) Reporting violent acts, taking appropriate action in response to violent acts, and follow-up procedures after violent acts;

(f) Development of criteria for determining and reporting verbal threats;

(g) Employee education and training; and

(h) Clinical and patient policies and procedures including those related to smoking; activity, leisure, and therapeutic programs; communication between shifts; and restraint and seclusion.

(2) Before the development of the plan required under subsection (1) of this section, each state hospital shall conduct a security and safety assessment to identify existing or potential hazards for violence and determine the appropriate preventive action to be taken. The assessment shall include, but is not limited to analysis of data on violence and worker's compensation claims during at least the preceding year, input from staff and patients such as surveys, and information relevant to subsection (1)(a) through (h) of this section.

(3) In developing the plan required by subsection (1) of this section, the state hospital may consider any guidelines on violence in the workplace or in the state hospital issued by the department of health, the department of social and health services, the department of labor and industries, the federal occupational safety and health administration, medicare, and state hospital accrediting organizations.

(4) The plan must be evaluated, reviewed, and amended as necessary, at least annually.

NEW SECTION. Sec. 4. By July 1, 2001, and at least annually thereafter, as set forth in the plan developed under section 3 of this act, each state hospital shall provide violence prevention training to all its affected employees as determined by the plan. Initial training shall occur prior to assignment to a patient unit, and in addition to his or her ongoing training as determined by the plan. The training may vary by the plan and may include, but is not limited to, classes, videotapes, brochures, verbal training, or other verbal or written training that is determined to be appropriate under the plan. The training shall address the following topics, as appropriate to the particular setting and to the duties and responsibilities of the particular employee being trained, based upon the hazards identified in the assessment required under section 3 of this act:

(1) General safety procedures;

(2) Personal safety procedures and equipment;

(3) The violence escalation cycle;

(4) Violence-predicting factors;

(5) Obtaining patient history for patients with violent behavior or a history of violent acts;

(6) Verbal and physical techniques to de-escalate and minimize violent behavior;

(7) Strategies to avoid physical harm;

(8) Restraining techniques;

(9) Documenting and reporting incidents;

(10) The process whereby employees affected by a violent act may debrief;

(11) Any resources available to employees for coping with violence;

(12) The state hospital's workplace violence prevention plan;

(13) Use of the intershift reporting process to communicate between shifts regarding patients who are agitated; and

(14) Use of the multidisciplinary treatment process or other methods for clinicians to communicate with staff regarding patient treatment plans and how they can collaborate to prevent violence.

NEW SECTION. Sec. 5. Beginning no later than July 1, 2000, each state hospital shall keep a record of any violent act against an employee or a patient occurring at the state hospital. Each record shall be kept for at least five years following the act reported during which time it shall be available for inspection by the department of labor and industries upon request. At a minimum, the record shall include:

(1) Necessary information for the state hospital to comply with the requirements of chapter 49.17 RCW related to employees that may include:

(a) A full description of the violent act;

(b) When the violent act occurred;

(d) To whom the violent act occurred;

(e) Who perpetrated the violent act;

(f) The nature of the injury;

(g) Weapons used;

(h) Number of witnesses; and

(i) Action taken by the state hospital in response to the violence; and

(2) Necessary information for the state hospital to comply with current and future expectations of the joint commission on hospital accreditation related to violence perpetrated upon patients which may include:

(a) The nature of the violent act;

(b) When the violent act occurred;

(d) The nature and severity of any injury.

NEW SECTION. Sec. 6. Failure of a state hospital to comply with this chapter shall subject the hospital to citation under chapter 49.17 RCW.

NEW SECTION. Sec. 7. A state hospital needing assistance to comply with sections 3 through 5 of this act may contact the department of labor and industries for assistance. The state departments of labor and industries, social and health services, and health shall collaborate with representatives of state hospitals to develop technical assistance and training seminars on plan development and implementation, and shall coordinate their assistance to state hospitals.

NEW SECTION. Sec. 8. The department shall provide an interim report on the progress of the plan development to the legislature by July 1, 2000, and a copy of the completed plan by November 1, 2000. The department shall thereafter provide an annual report to the legislature on its efforts to reduce violence in the state hospitals not later than September 1st of each year.

NEW SECTION. Sec. 9. Sections 3 through 8 of this act are each added to chapter 72.23 RCW.