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I work in a 65 bed hospital, on occasion when a male pt. becomes combative maintenance is called into assist with security & including helping contain pt's for medical procedures, like drawing lab, changing a foley, once a spinal tap,injections anyway these men have been no telling where doing their job in dirty areas, besides they are untrained non medical people what if they hurt a pt. during a struggle or get hurt themself. Is this a violation? I don't see why the men from x-ray, lab, resp, and other male nurses can't be called instead. Once I thought one of the maintenance men was going to pass out himself and one even commented that he personally felt traumatized himself .Thanks
OSHA and the hospital's workers comp carrier might take a different view than the one you've expressed.
Workman's Comp is insurance. They may not cover an injury sustained by employee acting outside their stated job description, but they have no regulatory or enforcement authority.
As I understand OSHA (and admittedly, I am not an expert), their purpose is to ensure that work environments are safe, free of hazards, and receive basic health & safety training. I am not aware of any OSHA enforcement of roles of various employees at a hospital. If I'm incorrect, I'd love to see a reference. It'd be good to know if I'm violating the law.
If the maintenance person isn't HIPAA trained, then the institution is violating the law every time he walks through a patient care area, so this aspect is kind of moot point.Last I checked, there was no special certification that made someone "trained" to be a security guard in a hospital. I have worked in hospitals where security was specially-assigned officers trained at the State Police Academy. I have also worked in hospitals where security jobs were farmed out to private companies that paid minimum wage.
Neither does assisting in a bedside procedure require any special training or certification. I have used security guards and hospital volunteers to help position patients, especially when they are drunk or immobile. Once in a while when I can't get help, I'll have parents pin their kids down while I work on them. The only person liable in situations like this is the physician, whose license is on the line for any complications resulting from their assistance.
It may not be the greatest idea in the world, but there is nothing illegal about it.
As to the HIPAA violation, I addressed that above: it's important to verify the reality, otherwise I agree.
Everybody knows they need to do a tax return but does everybody do one? Defects happen.
In many states an individual performing security duties for compensation would need to be certified by the appropriate state authority. Right off the top I can mention Virginia and Connecticut as states requiring a hospital's in house security people to be licensed. In Virginia this is managed by the Department of Criminal Justice Services. The security companies that provide contract services are also licensed. I am not aware of a state requiring a specific certification in hospital security. However, a quick search of the net showed that hospital security best practices are out there. The days of the minimally functional "rent-a-cop" are fading. I think the drive for background checking and training of security personnel is one unexpected outcome from 9-11.
I'm not disagreeing about what is done in a pinch, either. The OP was expressing concerns about regular occurrences. I would agree that the physician gets to make the call, however, for the best defense in case the decision is challenged (and it happens all the time) it's better for the physician and the hospital to show that trained personnel were used.
I think that "we were in a hurry, so we got the janitor to help us hold the patient still" might not play well with a jury.
Again, I'm not at all arguing with any of the posters in this thread. But I'm also in favor of recognizing the realities that the OP is concerned about. These are costs of doing business in today's world. Kinda sad at times to see the old ways going, but what can we do?
Workman's Comp is insurance. They may not cover an injury sustained by employee acting outside their stated job description, but they have no regulatory or enforcement authority.As I understand OSHA (and admittedly, I am not an expert), their purpose is to ensure that work environments are safe, free of hazards, and receive basic health & safety training. I am not aware of any OSHA enforcement of roles of various employees at a hospital. If I'm incorrect, I'd love to see a reference. It'd be good to know if I'm violating the law.
Yes, workers' comp is insurance. I mentioned the facility's workers' comp *insurance* carrier and OSHA as 2 organizations who might take exception to the practice of using any available male personnel to restrain a combative patient or position a patient for a procedure. I did not say that doing so was "illegal."
As a regulatory agency established by the OSHA Act of 1970, OSHA does have enforcement powers. I'm no OSHA expert either, but here's a link.
http://www.osha.gov/comp-links.html
More reading than either you or I are likely to do, but there are sections of the website that detail OSHA's inspection duties, power to initiate civil action if a workplace is found to be imminently dangerous, and civil monetary penalties which can be assessed against employers.
Let's picture Maintenance Worker A who assists with restraining a combative patient. During the fray, Maintenance Worker A ("MWA") is kicked. He later complains of pain and signs in to the ER for eval. When MWA's health insurance carrier is billed for his ER visit & Percocet script, utilization review immediately churns out a letter to the patient requesting more info about how injury was sustained. Claim is turfed to workers comp carrier. Hmmm... review of claim reveals MWA utilized by his employer to assist with patient. Interesting detail, maintenance workers having patient care responsibilities with all of their inherent exposure risks, which will be reflected in next year's workers' comp insurance premium for the facility.
MWA is really, really ticked off about the incident. He complains to OSHA. At a minimum, OSHA issues a "request for information" or some other such legalese that HR, the maintenance department, and hospital administration must now respond to.
Combative patient later claims injury sustained while being restrained. Restraint documentation reveals 5 staff present during restraint process. Who were they? RN 1, MD 1, tech 1, security 1 and MWA. Why was MWA there? Personal injury lawyer goes to bed that night smiling -- he has a case. He envisions himself relating to a jury how this untrained maintenance worker harmed his client and why the hospital is responsible.
Illegal to have maintenance having patient contact? Probably not. But is it worth it? The paperwork spent explaining it could be better spent documenting the lack of appropriately trained staff in positions appropriate for patient care so that staffing can be improved.
Wow, what concept.
The only person liable in situations like this is the physician, whose license is on the line for any complications resulting from their assistance.
I know of nothing that would prevent claims of liability or claims of criminal assault or battery being made against an unlicensed individual assisting a physician if the individual chooses to assist a physician when he/she is not appropriately trained to do so. The hospital would also certainly be liable in such a case as it is the hospital, not the MD, who is responsible to make staff work assignments.
We always call the police to help with combative patients. After the procedure is finished they get a free ride to jail!
Also, we have one security guard who works the night shift. It is a part of their job description that they respond to disturbances and help with combative patients and situations that get out of hand.
Every employee at our hospital has HIPAA training, including the un-paid volunteers. It is a pre-employment requirement. It would be just as likely to find someone in patient care who wasn't HIPAA trained as someone in dietary, maintenance, or housekeeping.
Illegal to have maintenance having patient contact? Probably not. But is it worth it? The paperwork spent explaining it could be better spent documenting the lack of appropriately trained staff in positions appropriate for patient care so that staffing can be improved.
Honestly, that just sounds like a lot of supposition about what various organizations and lawyers would think about doing. In the places I have trained, these things are done routinely and without apparent intervention by higher authorities.
And I don't know about you, but I haven't received any special training in appropriately pinning down combative patients. I talk to some of my maintenance guys; if I needed a combative patient taken down hard, the people I would want helping (in order of preference) would be (1) Psych Ward Tech, (2) Security, (3) Maintenance Guys, and (4) every other nurse, MD, and CNA in the hospital.
I just don't think that the things we're talking about here fall under the category of needing special licensure or training to do.
And I don't know about you, but I haven't received any special training in appropriately pinning down combative patients.
That's unfortunate. At both hospitals where I have worked, biannual training & recertification in nonviolent crisis intervention has been required for nurses and techs in the ED, psych & OB, and for all security staff. Several emergency MDs and a handful of others regularly attend as well, though they are not required to do so. The training includes both verbal strategies and physical, hands-on skills in restraint without harm.
Here's a link to a widely-used program. http://www.crisisprevention.com/
I agree that there are things we all do that *haven't caused a problem yet* and so we keep doing them. However, restraining patients is an area fraught with potential for harm to patients and staff, the potential for litigation, and subject to excrutiating review by JCAHO and state departments of health. So perhaps it's smarter to address this high-risk area as a system problem, instead of with a piecemeal, whatever works approach.
I agree that there are things we all do that *haven't caused a problem yet* and so we keep doing them. However, restraining patients is an area fraught with potential for harm to patients and staff, the potential for litigation, and subject to excrutiating review by JCAHO and state departments of health. So perhaps it's smarter to address this high-risk area as a system problem, instead of with a piecemeal, whatever works approach.
Fair enough.
I have worked a several facilities that do required maintance and male employees to respond to several code situations. Mostly they looked for missing patient, secured doors, or helped move heavy equiptment or furniture. Once a obese patient(over 500 lbs) needed moved from ICU to a private room, several men from different departments needed to help move the bed and equiptment, they were never responsible for any type of hands on care.
Combative patients usually did calm down once several men showed up on the floor asking if anyone needed any help. Never one time did any of these male employees actually have to do more than be present for awhile for the situation to calm down. One patient even remarked, well I guess I'll shut up now. I have been lucky, and I know it.
This doesn't make sense when I have seen sitters not be allowed to do any patient care because they were not trained.
Doesn't seem right. Unless they are using maintenance in place of correcting staffing issues. Maybe we should be grateful??
Never heard of this before. Risk Management? Peers??
Altra, BSN, RN
6,255 Posts
OSHA and the hospital's workers comp carrier might take a different view than the one you've expressed.