AD #299Workplace SecurityApril 30, 2015

Policy

Goal of policy: To foster a work environment free of violence

“DSH-Napa is committed to the prevention of, and appropriate response to, all incidents involving a violent or criminal act by a current or former employee, by anyone who has an employment-related involvement with DSH-Napa, by a recipient of a service provided by DSH-Napa, or by a person with no legitimate relationship to the workplace.”

PolicyThreatening behavior includes any behavior that is harassing, provoking or unsafe, which could be interpreted by a reasonable person as intent to cause physical harm to another patient.

May or may not include physical force With or without a weapon Toward another patient

All types and levels of violence in the workplace are prohibited.

Any employee, manager, or supervisor who commits an act of violence or retaliation, or who threatens by word or deed to commit an act of violence or retaliation, will be subject to appropriate disciplinary action and/or criminal proceedings.

Roles and Responsibilities

Executive Director: Responsible for appointing members to the Workplace Security

Assessment CommitteeWorkplace Security Assessment Committee:

Monitors potential threats to workplace security and creating preventive, corrective and educational recommendations to the Executive Director; meets on a regular basis

Immediate (First-Line) Supervisor: Maintains a high commitment level to workplace safety by

reacting quickly to reported incidents of actual or potential violence or threats of violence and using a management style that minimizes conflicts in the workplace.

Roles and Responsibilities

Every employee is required to: Appropriately maintain cooperative, professional, and effective

interactions with other employees, patients and the public. Be accountable for his/her own behavior Report to his/her supervisor threatening situations involving

employees, non-employees, and unauthorized patients in the workplace

Report all threats, violent acts, harassment, bizarre behavior or any other behavior which is out of character for an employee and which poses a potential threat to others.

Cooperate with management to provide evidence of events of behavior which she/he personally witnesses or has knowledge which may impact hospital security or which may have a disruptive effect on hospital operations.

Types of Violent Crimes

Type A: Unrelated to work environment or by perpetrator who has no relationship to the workplace

Type B: By perpetrators who are recipients of services, or their families/friends

Type C: Violence, crimes/incidents by current or former employees, or their families or friends

Violence in workplace takes many forms, not just physical. Also includes verbal abuse, threats and intimidation.

Level One Incidents

Behaviors in this category:• Refusing to cooperate/arguing with immediate supervisors/co-

workers

• Spreading rumors or gossiping to harm others

• Belligerence toward patients and others

• Angry/hostile attitude toward policies and procedures

• Frequent displays/signs of anger: clenched fists, red face, tight jaw, etc.

• Verbal abuse

Actions for Level One• Supervisor should meet with employee

• Determine the reason for the behavior• Take appropriate action to correct the behavior

• Refer to Employee Assistance Program (EAP)

• Prepare counseling memo

• Grant time off

• Notify EEO and/or Special Investigations

• Notify Chairperson of the WSAC if any reasonably perceived threat or incident of workplace violence is evident

Level Two IncidentsBehaviors in this category:• Arguing increasingly with co-workers/management

• Consistently acting out anger: slamming doors, punch walls, instigating fights, etc.

• Sending notes to others of a violent and/or sexual nature

• Persistent and non-mutual displays of affection

• Making suicidal threats/gestures

• Refusing to follow hospital policy and procedures

• Sabotaging equipment/stealing property for revenge

• Verbalizing wishes of violence to others

• Verbalizing perception as a victim (me against them)

Actions for Level Two• If lesser invention has been unsuccessful, dial “7” for

emergency service and request Hospital Police arrive at site

• Immediate supervisor will then:• Notify the program director, department head or their designee

and EEO of the incident

• At discretion of Executive Director, employee may be placed on Administrative Leave for an investigation, adverse action and/or Fitness for Duty exam

• If returned to work, offer EAP and monitor closely

Level Three Incidents

Behaviors in this category:• Attempted suicide• Destruction of property• Utilization/display of weapon(s) to harm• Physical Assault (spitting, hitting, murder, rape, arson,

mayhem, use of weapons)

Actions for Level Three• Upon witnessing, immediate supervisor is to dial “7” for

emergency services

• Hospital Police will arrive at the site, assess situation and notify Special Investigation (may include outside law enforcement)

• After emergency notification:• Management should also notify the Chairperson of the WSAC to

review and follow-up on the situation• Notify the Program Director, Department Head, or designee of

the incident

Staff Compliance

Supervisors:• Charged with communicating and supporting the policy, assuring

that all employees are knowledgeable about the policy and their responsibilities

• Also responsible for promoting safe, secure work environment and enforcing all policies regarding workplace violence

Employees:• Employees shall report any reasonably perceived threat or

incidence of violence to their supervisor• Charged with employing practices that support and promote a

safe, secure and violence free environment. All employees will be held accountable for adhering to the Workplace Security Policy

PUREED SCRAMBLED EGG PREPARATION

Quick Background• Recent meal observation in A3 by nursing

• Noticed texture of the pureed scrambled eggs was a little hard, too cooked for diet

• Dietitian for those units was in agreement after observation

• Discussed with speech therapist who had same observation

• RD emailed ADDs of production and presentation expressing concern

• Triggered investigation and small experiment….

The ExperimentSample ‘A’:• Assistant director of foodservice collected random scrambled

egg sample from trayline in A1 dining room• Found to be well-cooked and fluffy texture

Sample ‘B’:• Two interns took a sample of scrambled eggs (fully cooked)

from main kitchen and pureed• Took sample out to dining room to re-therm, simulating entire

production process

• The results….• Both egg samples given to assistant director of presentation who

correctly chose the pureed egg sample as the correct texture

Next Steps

Current method of preparing ‘pureed’ scrambled eggs:• Not fully cooking the eggs, leaving a little runny• Let the re-therm process in the dining rooms finish the

cooking and dining room staff mechanically alter through mixing

The problem: • Eggs are over-cooked for pureed diet, mixing does not

adequately puree the eggs• Final texture is not compliant with the National

Dysphagia Diet Guidelines

New Method• Scrambled eggs will be fully cooked in the Main Kitchen just as

they are for the Regular texture diets

• The quantity needed for the pureed diets will be pureed with the immersion blender

• Do not know which patients truly have dysphagia, have to be safe and not pose choking hazard(s)

• Start date for new method: May 6th

Questions?