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Violence, opioids among top workplace fatality threats in healthcare

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February 1, 2018

Workplace fatalities rose for a third straight year in 2016, according to troubling data on fatal occupational injuries from the U.S. Bureau of Labor Statistics (BLS). Although the figures were lower than in other industries, healthcare facilities saw an uptick as well.

The agency’s annual report, released in December, revealed a total of 5,190 workplace fatalities across all industries in 2016, representing a 7% increase from 2015. The fatal injury rate also increased from 3.4 per 100,000 full-time equivalent workers to 3.6.

“[These] occupational fatality data show a tragic trend with the third consecutive increase in worker fatalities in 2016 -- the highest since 2008,” said Loren Sweatt, deputy assistant secretary for OSHA, in a statement. “America’s workers deserve better.”

Digging deeper into that data reveals that there were 109 fatal occupational injuries in the private and public healthcare industry last year, up from 104 in 2015 and 79 in 2014. That’s a relatively low rate compared to other industries such as construction and transportation. But even if most incidents do not result in death, it is clear hospitals, clinics, and other healthcare facilities are still dangerous places to earn a paycheck.

A dangerous workplace
According to another set of statistics released by the BLS late last year, no other private industry sector had more nonfatal occupational injuries in 2016 than healthcare and social assistance. The approximately 552,600 injuries were about 140,000 more than in manufacturing, which was second on the list.

And only manufacturing had more nonfatal occupational illnesses, with approximately 39,200 compared to only about 6,000 fewer in healthcare and social assistance.

“We need to be aware of the fatalities [in healthcare], but there are hundreds of thousands of people who are injured every year, with lost days and permanent disability and permanent loss of income,” says Marge McFarlane, PhD, MT(ASCP), CHSP, CHFM, HEM, MEP, CHEP, principal of Superior Performance in Eau Claire, Wisconsin.

Among the serious safety and health hazards that healthcare workers face on a daily basis are needlestick injuries, exposure to bloodborne pathogens and biological hazards, potential contact with chemicals and drugs, ergonomic hazards from lifting patients and doing repetitive medical tasks, and workplace violence.

“In healthcare, workers are more at risk for lost time -- which is very expensive,” McFarlane says. “You have to replace that person with another person, and in most states, workers’ compensation pays most of the medical bills and 2/3 of their salary. So you’re paying for 1-2/3 person to do one job every time a worker gets hurt.”

Still, even though workplace fatalities have not been overly abundant in healthcare, two alarming trends when it comes to on-the-job deaths are worth your attention. First, fatalities from workplace violence among all American workers spiked by 23% in 2016. Second, workplace violence was the second-leading cause of death -- behind only transportation incidents, which accounted for approximately two out of every five workplace fatalities.

The U.S. Bureau of Labor reported that 25 on-the-job homicides were committed against healthcare workers in 2016, as many as 2014 and 2015 combined. That was fewer than some other major industry sectors, most notably retail. But it is well-documented that healthcare workers are at an increased risk for workplace violence.

According to OSHA, incidents of serious workplace violence, which the agency defines as “those requiring days off for the injured worker to recuperate,” were four times more common from 2002 to 2013 in healthcare than in private industry on average. And that just takes into account the incidents that have been reported. Studies have shown that many workers do not report incidents to a manager for several reasons, including fear of retaliation.

“Workplace violence is a threat to all healthcare workers, and we do need to be careful of those people who bring in guns and shoot patients, doctors, healthcare workers, ER persons,” McFarlane says. “Workplace violence is a continuum from bullying to fatality, and it’s not a linear progression necessarily, but we need to make sure we focus on the initial escalations to de-escalate them so they don’t escalate into violence.”

While most instances of nonfatal workplace violence come from the hands of patients, threats to workers include angry family members and other vengeful visitors, gang violence spilling into the emergency department, and even coworkers.

“It’s not just the aggressive patient,” cautions McFarlane, recommending that “we have to think about the potential for training everyone to de-escalate” tension.

Educating all employees on hazard recognition and control, including what to do in an emergency, is among the five key components OSHA suggests for the implementation of an effective workplace violence prevention program. The others are management commitment and worker participation, worksite analysis and hazard identification, hazard prevention and control, and recordkeeping and program evaluation.

Opioid crisis hits healthcare workers
Another cause for concern in the eyes of OSHA is the nationwide opioid crisis.

More than 52,000 Americans died of drug overdoses in 2015, per the CDC. More than 60% of those involved a prescription drug or illicit opioid such as OxyContin™, Vicodin™, heroin, or fentanyl. Forbes recently reported that overdose deaths have quadrupled in the country since 1999 and, according to the New York Times, fatal overdoses have surpassed heart disease as the leading cause of death for Americans under the age of 55.

Meanwhile, the BLS statistics showed that drug overdoses on the job increased by 32% from 2015 to 2016, with the number of overdose fatalities rising at least 25% every year since 2012, according to a press release from OSHA.

“As President Trump recognized by declaring opioid abuse a Nationwide Public Health Emergency, the nation’s opioid crisis is impacting Americans every day at home and, as this data demonstrates, increasingly on the job,” stated Sweatt in the release. “The Department of Labor will work with public and private stakeholders to help eradicate the opioid crisis as a deadly and growing workplace issue.”

Healthcare workers are particularly prone, given their ability to access prescription pills and other controlled substances, and also given the high-stress nature of their jobs.

Mayo Clinic has estimated that up to 15% of healthcare workers struggle with an addiction to drugs or alcohol, a rate that is nearly double that of the general population. And in 2016, 21 workers died on the job from overdoses after nonmedical use of drugs or alcohol, the Bureau of Labor reported, up from 14 in 2014 and 13 in 2015.

“I think that speaks to the fact that no one is immune from addiction, and that includes those who can prescribe,” says Robert Morrison, the executive director of the National Association of State Alcohol and Drug Abuse Directors. “Wherever there’s access to drugs, there’s potential to develop an addiction and act upon that.”

Beyond harming themselves, drug users can put patients and coworkers in danger. Patients are threatened by users who treat them while under the influence of drugs or expose them to disease, such as in 2011 when David Kwiatkowski, a cardiovascular technician at Exeter (New Hampshire) Hospital, infected 33 patients with hepatitis C by injecting himself with fentanyl or other drugs, then refilling the syringes with his tainted blood.

Drug diversion
Coworkers who are tricked into unintentionally aiding a drug diverter probably have to worry more about their employment than their health. But they, too, are at risk of an accidental needlestick that could result in transmission of disease or a similar chance injury at the hands of a coworker who is high on drugs.

That's why setting up a diversion prevention program, if you haven't already, is essential for all healthcare facilities, says Kimberly New, JD, BSN, RN, the former president of the Tennessee chapter of the National Association of Drug Diversion Investigators and author of the HCPro book Drug Diversion Prevention in Healthcare.

She believes a strong program requires:

  • At least one full-time staffer solely dedicated to overseeing the program
  • Policies to prevent, detect, and properly report diversion
  • A method of observing processes and auditing drug transaction data for diversion
  • Prompt attention to suspicious audit results
  • A collaborative relationship with public health and regulatory officials
  • Diversion education for all staff members

"Every facility, every system needs to have a very consistent, formal, proactive approach," New says. "This is something that's not going away."




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