Hospice Safety Manual

What Should a Hospice Safety Manual Include?

The contents of a Hospice Safety Manual should reflect the services provided, employee duties, patient population, work locations, equipment, medications, and occupational exposures.

Depending on operations, the manual may address:

• Hospice safety responsibilities.
• Hazard assessments.
• Home safety assessments.
• Home and community visits.
• Working alone.
• After-hours and on-call visits.
• Workplace violence prevention.
• Safe patient handling.
• Ergonomics.
• Bloodborne Pathogens.
• Needlestick and sharps safety.
• Infectious disease exposure control.
• Respiratory protection.
• Personal Protective Equipment.
• Hazard Communication.
• Hazardous drugs.
• Oxygen safety.
• Medical equipment.
• Vehicle safety.
• Slips, trips and falls.
• Post-death employee safety.
• Occupational stress and fatigue.
• Emergency procedures.

Programs should be selected according to actual employee duties and workplace hazards rather than automatically adding programs unrelated to the services provided.

Hospice Safety Program

An effective Hospice Safety Program establishes responsibilities and procedures for identifying occupational hazards, evaluating patient-care environments, protecting employees during home and facility visits, controlling healthcare exposures, and responding to unsafe conditions and emergencies.

Management should provide employees with the equipment, training, PPE, communication systems, procedures, and other resources necessary to perform assigned work safely.

Managers, supervisors, and designated safety personnel should:

• Identify occupational hazards.
• Evaluate home and facility work environments.
• Maintain applicable written safety programs.
• Evaluate patient-handling hazards.
• Maintain workplace-violence prevention procedures.
• Evaluate blood and infectious-disease exposures.
• Provide required PPE.
• Maintain appropriate employee communication systems.
• Maintain equipment in safe condition.
• Investigate occupational injuries and exposures.
• Correct identified hazards where feasible.
• Provide employee training.
• Maintain applicable records.

Employees should follow established safety procedures, use required equipment and PPE, evaluate changing conditions, report unsafe environments, and promptly report injuries, exposures, threats, assaults, needlesticks, vehicle incidents, and other workplace hazards.

Hospice Hazard Assessments

The hospice agency should evaluate occupational hazards associated with employee duties and the environments in which services are provided.

Potential hazards may include:

• Patient lifting and repositioning.
• Blood and body fluids.
• Needles and sharps.
• Infectious diseases.
• Hazardous medications.
• Oxygen.
• Medical equipment.
• Workplace violence.
• Weapons.
• Drug or alcohol activity.
• Animals.
• Smoking.
• Poor lighting.
• Unsanitary conditions.
• Pests.
• Slippery surfaces.
• Extreme temperatures.
• Driving.
• Working alone.

Hazard assessments should be reviewed when patient conditions, services, equipment, medications, work locations, or other significant circumstances change.

Home Safety Assessments

The patient’s home becomes a workplace when hospice employees enter it to perform assigned duties.

Home safety assessments should consider conditions that may affect employee safety, including:

• Safe entry and exit.
• Neighborhood conditions.
• Lighting.
• Stairs and walkways.
• Available workspace.
• Electrical conditions.
• Smoking.
• Oxygen.
• Animals.
• Weapons.
• Drug activity.
• Aggressive individuals.
• Sanitation.
• Pests.
• Temperature.
• Patient-handling conditions.

Identified hazards should be communicated to employees who may visit the home.

Pre-Visit Hazard Assessment

Available information about a new patient and work location should be evaluated before the first visit when feasible.

Potential considerations include:

• Known history of violence.
• Aggressive family members.
• Weapons.
• Substance abuse.
• Dangerous animals.
• Neighborhood concerns.
• Patient mobility.
• Required lifting equipment.
• Infectious-disease precautions.
• Oxygen.
• Environmental conditions.

Information relevant to employee safety should be communicated without unnecessary disclosure of unrelated confidential information.

Home Hospice Visits

Employees providing hospice care in private residences may encounter hazards that are uncommon in controlled healthcare facilities.

Employees should remain alert to changing conditions and should not assume that a home that was safe during a previous visit remains safe.

Conditions involving residents, visitors, animals, weapons, drugs, sanitation, utilities, weather, or patient condition may change between visits.

Unsafe Home Conditions

Potentially unsafe conditions may include:

• Aggressive individuals.
• Weapons.
• Illegal drug activity.
• Dangerous animals.
• Severe infestation.
• Unsafe electrical conditions.
• Extreme temperatures.
• Structural hazards.
• Uncontrolled smoking around oxygen.
• Inadequate lighting.
• Blocked exits.
• Other immediately dangerous conditions.

Employees should report significant hazards according to agency procedures.

When a Visit Cannot Be Performed Safely

Employees should not be required to enter or remain in an environment presenting an unacceptable immediate safety risk.

Procedures should establish how employees can:

• Leave the location.
• Contact a supervisor.
• Obtain assistance.
• Reschedule or modify services when appropriate.
• Request another employee or security assistance.
• Contact emergency services when necessary.

Patient-care needs should be addressed through appropriate agency procedures without requiring an employee to accept an uncontrolled serious hazard.

Working Alone

Hospice employees frequently work without immediate assistance from coworkers.

Lone-worker procedures should consider:

• Visit schedules.
• Communication.
• Employee check-ins.
• High-risk locations.
• After-hours visits.
• Emergency assistance.
• Missed check-ins.
• Workplace violence.
• Vehicle problems.

Employees should have a reliable method for contacting the agency or emergency services.

Employee Check-In Procedures

Check-in procedures may be appropriate for employees working alone, particularly during higher-risk or after-hours visits.

Procedures may include:

• Scheduled check-ins.
• Arrival and departure notifications.
• Electronic applications.
• Phone calls.
• Supervisor contact.
• Escalation when contact is missed.

The system should be practical enough that employees actually use it.

Missed Check-In Procedures

The agency should establish what occurs when an employee fails to check in as expected.

Procedures may identify:

• Who attempts contact.
• How many contact attempts are made.
• When supervisors are notified.
• When emergency contacts or law enforcement may be appropriate.

Employees should understand the procedure before performing lone field work.

After-Hours and On-Call Visits

Hospice services may require evening, overnight, weekend, or emergency visits.

After-hours work may involve:

• Reduced staffing.
• Fatigue.
• Darkness.
• Unfamiliar locations.
• Limited immediate assistance.
• Increased security concerns.

Employees should have access to supervisory and emergency communication during these visits.

High-Risk Visits

When available information indicates increased risk, additional controls may be appropriate.

Depending on circumstances, these may include:

• Two-person visits.
• Security assistance.
• Modified visit times.
• Alternative meeting locations.
• Enhanced communication.
• Law-enforcement assistance where appropriate.

Employees should not be sent alone into a known dangerous situation merely because home visits are normally performed individually.

Parking and Arrival Safety

Employees should evaluate their surroundings when arriving at a patient’s residence.

Where feasible, employees should:

• Park in a well-lighted area.
• Avoid becoming blocked in.
• Maintain access to the vehicle.
• Observe surroundings before exiting.
• Avoid leaving valuables visible.
• Carry only necessary equipment.

Employees should leave the area and obtain assistance if conditions appear immediately dangerous.

Workplace Violence Prevention

Hospice employees may encounter violence or threatening behavior from patients, family members, visitors, neighbors, or other individuals.

A Workplace Violence Prevention Program should establish procedures for identifying, reporting, evaluating, and responding to threats and violence.

Potential risk factors include:

• Working alone.
• Unfamiliar environments.
• Weapons.
• Drug or alcohol activity.
• Domestic disputes.
• Emotional distress.
• Previous violent behavior.
• After-hours work.

Pre-Visit Security Assessment

Available information concerning previous threats, violence, weapons, dangerous animals, substance abuse, or other significant security concerns should be considered before assigning a visit.

Relevant safety information should be communicated to affected employees.

Weapons in the Home

Employees may encounter firearms or other weapons in patient residences.

Agency procedures should establish how employees should respond when weapons create a safety concern.

Employees should not handle or attempt to secure weapons unless doing so is specifically part of their authorized role and training.

Drug and Alcohol Activity

Illegal drug activity, intoxication, or substance abuse by patients, family members, or visitors can create unpredictable conditions.

Employees should report unsafe conditions and should withdraw when necessary to protect themselves from immediate danger.

Threatening or Aggressive Behavior

Employees should recognize warning signs such as:

• Threats.
• Yelling.
• Aggressive gestures.
• Intimidation.
• Blocking exits.
• Displaying weapons.
• Increasing agitation.
• Destruction of property.

Employees should obtain assistance before conditions escalate when feasible.

De-Escalation

Employees may use appropriate de-escalation techniques consistent with their training.

Employees should:

• Remain calm.
• Communicate respectfully.
• Avoid unnecessary confrontation.
• Maintain appropriate distance.
• Preserve access to an exit.
• Avoid allowing themselves to become trapped.
• Leave when necessary.

De-escalation does not require an employee to remain in an immediately dangerous environment.

Escape and Egress

Employees should remain aware of how they will exit a residence or other work location.

Equipment and work positioning should not unnecessarily block the employee’s path to an exit.

Employees should avoid allowing an aggressive person to position themselves between the employee and the only available exit when possible.

Violence Incident Reporting

Threats, assaults, stalking, harassment, near misses, and other workplace-violence events should be reported according to agency procedures.

Reported incidents should be evaluated for:

• Contributing factors.
• Repeat risks.
• Future visit restrictions.
• Need for two-person visits.
• Security assistance.
• Other preventive measures.

Safe Patient Handling and Mobility

Hospice employees may assist patients whose mobility is limited or deteriorating.

Patient lifting, transferring, repositioning, and mobility assistance can expose employees to musculoskeletal injuries.

Patient-handling procedures should consider:

• Patient mobility.
• Weight-bearing ability.
• Cognitive ability.
• Patient size and weight.
• Available equipment.
• Available assistance.
• Home layout.
• Available working space.

Employees should not attempt handling tasks that exceed their training, physical capability, available assistance, or available equipment.

Changing Patient Condition

A patient’s mobility may decline as illness progresses.

A transfer or repositioning technique that was previously appropriate may become unsafe.

Employees should reassess patient-handling needs when significant changes occur and obtain additional equipment or assistance when necessary.

Bedbound Patients

Employees caring for bedbound patients may perform frequent repositioning and personal-care activities.

Controls may include:

• Adjustable beds.
• Slide sheets.
• Repositioning devices.
• Mechanical lifts.
• Assistance from another employee.
• Appropriate bed height.

Employees should avoid unnecessary reaching and lifting across beds.

Patient Transfers

Transfers may include:

• Bed-to-chair.
• Chair-to-bed.
• Wheelchair transfers.
• Toilet transfers.
• Bathing transfers.
• Vehicle transfers.

The employee should evaluate the patient and environment before beginning the transfer.

Mechanical Lifting Equipment — When Available

Mechanical lifts can reduce employee exposure to manual lifting.

Where used, equipment should:

• Have adequate rated capacity.
• Be appropriate for the patient.
• Be maintained in safe condition.
• Be used according to manufacturer instructions.

Employees should receive appropriate training before independently using lift equipment.

Two-Person Assistance

When a patient-handling task requires two employees, appropriate assistance should be arranged.

Employees should not routinely attempt two-person tasks alone because scheduling makes assistance inconvenient.

Ergonomics

Hospice employees may experience ergonomic stress from:

• Patient handling.
• Bending over beds.
• Restricted working spaces.
• Carrying supplies.
• Moving equipment.
• Driving.
• Computer work.
• Repetitive tasks.

Equipment, work practices, and job organization should be evaluated to reduce unnecessary musculoskeletal stress.

Bloodborne Pathogens

Employees whose duties involve reasonably anticipated occupational exposure to human blood or other potentially infectious materials should be protected according to applicable Bloodborne Pathogens requirements.

Where applicable, the agency should maintain an appropriate Exposure Control Plan.

The program may address:

• Exposure determination.
• Universal Precautions.
• Engineering controls.
• Work-practice controls.
• PPE.
• Sharps safety.
• Hepatitis B vaccination.
• Exposure incidents.
• Post-exposure evaluation.
• Training.
• Recordkeeping.

Exposure Determination

The employer should identify job classifications and tasks where occupational exposure is reasonably anticipated.

Potential tasks may include:

• Injections.
• Wound care.
• Blood glucose testing.
• Infusion-related care.
• Catheter care.
• Handling contaminated sharps.
• Blood cleanup.

Exposure determination should reflect actual duties rather than job title alone.

Needlestick and Sharps Safety

Employees may encounter needles, lancets, syringes, and other sharps.

Employees should:

• Use appropriate safer devices where required.
• Dispose of sharps promptly.
• Avoid unnecessary recapping.
• Never reach blindly into waste.
• Report sharps injuries immediately.

Sharps Containers in Patient Homes

Appropriate sharps containers should be available when employees use or dispose of sharps during home care.

Containers should be:

• Closable.
• Puncture resistant.
• Leak resistant as appropriate.
• Maintained upright.
• Located where they can be safely used.

Employees should report missing, damaged, or overfilled containers.

Sharps Found in the Home

Employees may encounter improperly discarded sharps that were not generated by the hospice agency.

Employees should not:

• Pick up unidentified sharps with bare hands.
• Reach blindly into trash.
• Compress waste bags manually.
• Place loose sharps into personal bags or pockets.

Agency procedures should address safe response and disposal.

Exposure Incidents

Needlesticks, cuts, mucous-membrane splashes, and other potential occupational exposures should be reported immediately.

Applicable post-exposure evaluation procedures should begin promptly.

Employees working remotely should know how to obtain appropriate assistance without first returning to the office.

Infectious Disease Exposure Control

Hospice employees may be exposed to infectious diseases through close patient contact, respiratory secretions, blood, body fluids, contaminated surfaces, and other sources.

The agency should evaluate occupational exposure and establish appropriate controls.

These may include:

• Hand hygiene.
• PPE.
• Cleaning and disinfection.
• Exposure precautions.
• Respiratory protection where required.
• Employee training.
• Exposure reporting.

Respiratory Infections

Respiratory infections may create occupational exposure during close patient care.

Controls may include:

• Source control.
• Hand hygiene.
• Appropriate PPE.
• Ventilation measures where feasible.
• Respiratory protection when required.
• Exposure procedures.

Tuberculosis — When Applicable

The employer should evaluate employee exposure to tuberculosis based on patient populations, services, and other risk factors.

Where respirators are required for occupational TB exposure, applicable Respiratory Protection requirements should be followed.

Respiratory Protection — When Required

When respirators are necessary to protect employees from occupational respiratory hazards, the agency should maintain an appropriate Respiratory Protection Program.

Applicable elements may include:

• Hazard evaluation.
• Respirator selection.
• Medical evaluation.
• Fit testing.
• Training.
• Inspection.
• Maintenance.
• Program evaluation.

Hand Hygiene

Employees should perform hand hygiene at appropriate times, including before and after patient care and after glove removal.

Home environments may not always provide adequate handwashing facilities.

The agency should establish appropriate procedures and provide necessary supplies for field employees.

Personal Protective Equipment

PPE should be selected according to employee exposures.

Depending on duties, PPE may include:

• Examination gloves.
• Chemical-resistant gloves.
• Safety glasses.
• Goggles.
• Face shields.
• Protective clothing.
• Respiratory protection.
• Protective footwear.

Employees should carry sufficient PPE for anticipated field activities.

Hospice Bag Safety

Employees who carry clinical supplies into patient homes should maintain their bags and supplies in a manner that reduces contamination and ergonomic hazards.

Where feasible:

• Bags should be placed on a clean, stable surface.
• Supplies should be organized to minimize unnecessary bending and reaching.
• Clean and contaminated materials should be appropriately separated.
• Bags should not be placed where animals, children, or other individuals can access hazardous items.

Hazard Communication

Hospice employees may use hazardous chemicals for cleaning, disinfection, equipment care, or other work activities.

Where applicable, the employer should maintain a Hazard Communication Program addressing:

• Chemical inventories.
• Safety Data Sheets.
• Container labeling.
• Employee training.
• Field use of chemicals.
• Non-routine tasks.

Hazardous Drugs — When Applicable

Some hospice employees may handle medications classified as hazardous drugs.

Where occupational exposure is reasonably foreseeable, controls may address:

• Receiving.
• Transport.
• Storage.
• Preparation.
• Administration.
• Crushing or manipulating medications.
• Spills.
• Waste.
• Contaminated patient materials.

The program should reflect the actual medications and employee duties involved.

Crushing or Manipulating Medications — When Applicable

Crushing, splitting, opening, or otherwise manipulating certain hazardous medications can increase employee exposure.

Employees should follow established procedures and use appropriate controls and PPE when required.

Hazardous Drug Spill Response

Employees who may encounter hazardous-drug spills should understand applicable spill procedures.

Appropriate spill supplies and PPE should be available where necessary.

Employees should not attempt cleanup beyond their training and available protection.

Oxygen Safety

Supplemental oxygen is commonly encountered in hospice care and can significantly increase fire severity.

Employees should evaluate oxygen-related hazards in patient-care environments.

Procedures should address:

• Smoking.
• Open flames.
• Heat sources.
• Oxygen equipment.
• Cylinder storage.
• Electrical equipment.
• Emergency response.

Home Oxygen and Smoking

Smoking around oxygen can create a serious fire hazard.

Employees should follow agency procedures when patients, household members, or visitors smoke in an environment where oxygen is being used or stored.

Employees should report uncontrolled conditions that prevent work from being performed safely.

Oxygen Concentrators

Oxygen concentrators should be positioned and operated according to manufacturer instructions.

Employees should consider:

• Ventilation.
• Electrical condition.
• Placement.
• Extension-cord use.
• Heat sources.
• Emergency power loss.

Damaged equipment should be reported.

Compressed Oxygen Cylinders

Cylinders should be appropriately secured and protected from damage.

Employees assigned to transport or handle cylinders should understand safe:

• Storage.
• Movement.
• Valve protection.
• Vehicle transport.
• Regulator use.

Medical Equipment Safety

Hospice employees may use or work around:

• Hospital beds.
• Oxygen concentrators.
• Suction equipment.
• Infusion equipment.
• Wheelchairs.
• Patient lifts.
• Nebulizers.
• Other medical devices.

Equipment should be used according to manufacturer instructions and agency procedures.

Electrical Safety in Patient Homes

Employees may encounter electrical systems that are not maintained to the standards of a healthcare facility.

Potential hazards include:

• Damaged receptacles.
• Overloaded outlets.
• Extension cords.
• Damaged cords.
• Improper power strips.
• Exposed wiring.
• Water near electrical equipment.

Employees should report unsafe conditions and should not perform electrical repairs unless authorized and qualified.

Power Failure

Loss of electrical power can affect oxygen concentrators, beds, suction equipment, and other medical devices.

Employees should understand applicable emergency procedures for equipment used in patient care.

Pets and Animals

Employees may encounter dogs, cats, birds, and other animals in patient homes.

Potential hazards include:

• Bites.
• Scratches.
• Tripping.
• Allergens.
• Animal waste.
• Interference with patient care.
• Interference with sharps handling.

Employees should request that aggressive or interfering animals be appropriately controlled during visits.

Animal Bites and Scratches

Animal bites and scratches should be promptly reported.

Employees should obtain appropriate first aid and medical evaluation according to agency procedures.

The circumstances should be evaluated before future visits.

Smoking and Secondhand Smoke

Employees may be exposed to tobacco smoke or other airborne contaminants in patient homes.

The agency should establish procedures for addressing conditions that interfere with safe patient care or employee health.

Additional precautions may be necessary when oxygen is present.

Unsanitary Home Conditions

Employees may encounter:

• Human or animal waste.
• Mold.
• Excessive clutter.
• Garbage.
• Contaminated surfaces.
• Insects.
• Rodents.
• Lack of running water.

Employees should report conditions that prevent safe performance of assigned duties.

Bedbugs and Other Pests

Hospice employees may encounter bedbugs, fleas, cockroaches, rodents, or other pests.

Procedures should address:

• Recognition.
• Personal-item protection.
• Equipment handling.
• Reporting.
• Decontamination where appropriate.
• Follow-up before future visits.

Slips, Trips and Falls

Home and facility environments may contain:

• Loose rugs.
• Clutter.
• Cords.
• Oxygen tubing.
• Poor lighting.
• Stairs.
• Wet floors.
• Uneven walkways.
• Ice and snow.

Employees should remain alert to changing walking-surface hazards.

Restricted Working Spaces

Patient homes may provide limited space around beds and equipment.

Employees should avoid unsafe lifting or awkward positioning merely because furniture or other items restrict access.

Where feasible, the work area should be modified before performing higher-risk patient-handling tasks.

Vehicle Safety

Driving between patient locations may represent a substantial portion of a hospice employee’s workday.

Vehicle-safety procedures should address:

• Authorized drivers.
• Seat belts.
• Distracted driving.
• Vehicle condition.
• Fatigue.
• Severe weather.
• Accident reporting.
• Transporting equipment and supplies.

Driving Between Visits

Employees should allow sufficient travel time between visits.

Schedules should not encourage speeding, distracted driving, or other unsafe practices to remain on time.

Employees should safely park before making calls, entering information, or performing other tasks that require attention away from driving.

Fatigue and Driving

Employees performing after-hours or on-call work may experience fatigue.

Employees should recognize when fatigue may impair safe driving and follow agency procedures for obtaining assistance.

Severe Weather

Employees may travel and work during:

• Heavy rain.
• Snow.
• Ice.
• Extreme heat.
• Extreme cold.
• Wildfire conditions.
• Other severe weather.

The agency should establish procedures for delaying, modifying, or canceling travel when conditions create unacceptable risk.

Transporting Equipment and Supplies

Medical equipment, oxygen cylinders, medications, and other supplies should be secured appropriately during vehicle transport.

Heavy equipment should be positioned to reduce manual-handling hazards.

Hazardous materials should be transported according to applicable requirements.

Post-Death Employee Safety

Some hospice employees may have responsibilities following a patient’s death.

Employee-safety procedures should address the occupational hazards associated with assigned post-death activities without replacing applicable clinical, legal, or facility-specific procedures.

Handling the Deceased

Employees assisting with movement or repositioning of a deceased patient may face significant manual-handling hazards because the individual cannot assist with movement.

Employees should use appropriate equipment and obtain assistance when necessary.

Unsafe manual lifting should be avoided.

Blood and Body-Fluid Precautions After Death

Applicable bloodborne-pathogen precautions should continue when employees may contact blood or OPIM.

Employees should use appropriate PPE and follow established procedures.

Sharps and Medical Devices

Sharps or medical devices remaining near or associated with the patient can create employee exposure hazards.

Employees should follow authorized procedures for handling or disposal.

Employees should not remove devices unless doing so is within their assigned responsibilities and training.

Coordination with Funeral Homes and Other Providers

When funeral-home personnel or other outside providers enter the work environment, responsibilities should be coordinated as appropriate.

Known employee-safety hazards should be communicated when necessary.

Occupational Stress

Hospice work can involve repeated exposure to death, dying, grieving families, difficult interactions, on-call demands, workplace violence, and emotionally challenging circumstances.

Work organization should consider the potential effects of occupational stress and fatigue on employee safety.

Emotionally Demanding Work

Employees should have appropriate methods for reporting work-related safety concerns associated with excessive workload, fatigue, threatening behavior, or traumatic events.

Workplace support following a serious incident may be appropriate.

Grieving and Distressed Family Members

Family members may experience intense emotional distress.

Employees should use appropriate communication and de-escalation techniques while maintaining personal safety.

Threatening or abusive behavior should be reported and managed according to workplace-violence procedures.

On-Call Work and Fatigue

On-call work may disrupt normal sleep and increase fatigue.

The agency should consider the effects of scheduling, extended work hours, and overnight calls on:

• Driving.
• Patient handling.
• Decision-making.
• Employee alertness.

Inpatient Hospice Safety — When Applicable

Hospice organizations operating inpatient facilities should evaluate hazards associated with facility-based healthcare operations in addition to field work.

Potential programs may address:

• Safe patient handling.
• Bloodborne Pathogens.
• Sharps.
• Infectious diseases.
• Workplace violence.
• Housekeeping.
• Laundry.
• Medical equipment.
• Oxygen.
• Slips and falls.
• Emergency procedures.
• Fire prevention.

Facility-specific programs should reflect the actual services and departments present.

Emergency Communication

Field employees should have a reliable method for contacting supervisors, coworkers, emergency services, or other assistance.

Employees should know whom to contact for:

• Workplace violence.
• Medical emergencies.
• Vehicle emergencies.
• Exposure incidents.
• Unsafe homes.
• Severe weather.
• Equipment failures.

Emergency Action Procedures

Emergency procedures should reflect both office/facility operations and field work.

Potential emergencies include:

• Fire.
• Workplace violence.
• Medical emergencies.
• Chemical spills.
• Severe weather.
• Vehicle accidents.
• Power failures.
• Oxygen-related emergencies.

Employees should understand their responsibilities and available communication methods.

Fire Prevention

Fire-prevention procedures should address hazards associated with:

• Oxygen.
• Smoking.
• Electrical equipment.
• Heating equipment.
• Flammable materials.
• Patient-home conditions.

Employees should report conditions that create serious fire hazards.

First Aid and Employee Injuries

Employees should promptly report occupational injuries and illnesses.

Particular attention should be given to:

• Needlesticks.
• Blood exposure.
• Patient-handling injuries.
• Animal bites.
• Slips and falls.
• Chemical exposure.
• Workplace violence.
• Vehicle incidents.

Prompt reporting allows appropriate evaluation and helps identify hazards requiring corrective action.

Incident Investigation

Occupational injuries, exposures, vehicle incidents, threats, assaults, near misses, and other significant safety events should be evaluated.

Investigations should focus on contributing factors and corrective actions.

Potential corrective actions may involve:

• Equipment.
• Visit procedures.
• Staffing.
• Communication.
• Training.
• Scheduling.
• PPE.
• Patient handling.
• Future visit restrictions.

Contractor and Third-Party Coordination

Hospice employees may work alongside:

• Home-health providers.
• Nursing-facility employees.
• Assisted-living employees.
• Medical-equipment suppliers.
• Funeral-home personnel.
• Emergency responders.
• Other service providers.

Relevant employee-safety hazards should be communicated and responsibilities coordinated where appropriate.

Hospice Safety Training

Safety training should reflect each employee’s assigned duties and occupational exposures.

Depending on responsibilities, training may address:

• Home-visit safety.
• Working alone.
• Workplace violence.
• Safe patient handling.
• Bloodborne Pathogens.
• Needlestick prevention.
• Infectious diseases.
• PPE.
• Respiratory protection.
• Hazardous drugs.
• Oxygen.
• Medical equipment.
• Vehicle safety.
• Emergency procedures.

Employees should receive task-specific training before independently performing higher-hazard work.

New Employee Safety Orientation

New employees should receive appropriate safety orientation before independently performing assigned work.

Orientation may address:

• General hospice hazards.
• Home-visit safety.
• Working alone.
• Workplace violence.
• Patient handling.
• Bloodborne Pathogens.
• Sharps.
• Infectious diseases.
• PPE.
• Oxygen.
• Driving.
• Emergency procedures.
• Injury reporting.

Hospice JSA/JHA

Hospice agencies may use JSAs/JHAs to document safe work practices for selected tasks.

Potential Hospice JSAs/JHAs include:

• Home visits.
• Patient transfers.
• Patient repositioning.
• Blood and body-fluid cleanup.
• Sharps handling.
• Oxygen-cylinder handling.
• Medical-equipment transport.
• Post-death patient handling.
• Driving between visits.

Hospice Safety Meetings

Periodic safety meetings can reinforce safe work practices and address current field concerns.

Potential topics include:

• Home-visit hazards.
• Working alone.
• Workplace violence.
• Patient handling.
• Sharps.
• Infectious diseases.
• Oxygen.
• Driving.
• Severe weather.
• Emergency communication.

Recordkeeping

Hospice agencies should maintain occupational safety and health records required for their operations.

Records may include:

• Employee training.
• Injury and illness records.
• Bloodborne Pathogens records.
• Sharps injuries.
• Workplace-violence incidents.
• Respiratory Protection records.
• Exposure records.
• Vehicle incidents.
• Safety assessments.
• Incident investigations.

Confidential employee medical information should be maintained according to applicable requirements.

Additional Safety Programs

Depending on hospice operations and employee exposures, additional safety programs may be necessary for:

• Safe Patient Handling.
• Ergonomics.
• Workplace Violence Prevention.
• Workplace Security.
• Working Alone.
• Bloodborne Pathogens.
• Needlestick & Sharps Safety.
• Infectious Disease Exposure Control.
• Tuberculosis Exposure Control.
• Respiratory Protection.
• Personal Protective Equipment.
• Hazard Communication.
• Chemical Safety.
• Hazardous Drugs.
• Compressed Gas Cylinders.
• Vehicle Safety.
• Slips, Trips & Falls.
• Walking-Working Surfaces.
• Manual Lifting & Material Handling.
• Heat Stress Prevention.
• Cold Stress.
• Emergency Action Plan.
• Fire Prevention.
• First Aid.
• Spill Prevention & Response.
• Hazardous Waste Management.

These programs should be included when employee duties, services, equipment, medications, chemicals, or workplace hazards make them applicable.

Building a Hospice Safety Manual

A useful Hospice Safety Manual should reflect the organization’s actual care model rather than simply adapting a generic home-health or healthcare manual.

A hospice agency providing primarily home-based services may require a different combination of programs than an organization operating an inpatient hospice facility or routinely providing services in nursing homes and assisted-living facilities.

The manual should consider:

• Care settings.
• Home visits.
• After-hours services.
• Lone work.
• Patient mobility.
• Workplace-violence risks.
• Blood and sharps exposure.
• Infectious diseases.
• Medications.
• Oxygen.
• Medical equipment.
• Driving.
• Post-death activities.
• Emergency operations.

Selecting the appropriate programs creates a comprehensive manual without filling it with procedures unrelated to the work employees actually perform.

Customized Hospice Safety Manuals

A Hospice Safety Manual can be developed around the organization’s care settings, employee duties, home visits, after-hours services, patient-handling requirements, workplace-violence risks, blood and sharps exposures, infectious diseases, medications, oxygen equipment, driving, post-death activities, and other occupational hazards.

The finished manual may incorporate applicable programs for Safe Patient Handling, Ergonomics, Workplace Violence Prevention, Working Alone, Bloodborne Pathogens, Needlestick and Sharps Safety, Infectious Disease Exposure Control, Respiratory Protection, PPE, Hazard Communication, Hazardous Drugs, Compressed Gas Cylinders, Vehicle Safety, Emergency Action Planning, Fire Prevention, and other hazards present within the operation.

This provides hospice and end-of-life care employers with a practical safety manual organized around the work their employees actually perform.