25 Tex. Admin. Code § 135.31

Current through Reg. 49, No. 45; November 8, 2024
Section 135.31 - Workplace Violence Prevention
(a) In accordance with Texas Health and Safety Code (HSC) §331.002, an ambulatory surgical center (ASC) shall establish a workplace violence prevention committee or authorize an existing ASC committee to develop a workplace violence prevention plan.
(b) An ASC shall ensure the committee includes at least:
(1) one registered nurse who provides direct care to the ASC's patients;
(2) one physician licensed to practice medicine in Texas who provides direct care to the ASC's patients; and
(3) one ASC employee who provides security services for the ASC if any and if practicable.
(c) A health care system that owns or operates more than one facility, as that term is defined by HSC §331.001, which includes an ASC, may establish a single workplace violence prevention committee for all of the system's facilities if:
(1) the committee develops a violence prevention plan for implementation at each facility in the system; and
(2) data related to violence prevention remains distinctly identifiable for each facility in the system.
(d) An ASC shall adopt, implement, and enforce a written workplace violence prevention policy to protect health care providers and employees from violent behavior and threats of violent behavior occurring at the ASC. In accordance with HSC §331.003, the policy shall:
(1) require the ASC to:
(A) provide significant consideration of the violence prevention plan recommended by the ASC's committee; and
(B) evaluate any existing ASC violence prevention plan;
(2) encourage health care providers and employees to provide confidential information on workplace violence to the committee;
(3) include a process to protect from retaliation health care providers or employees who provide information to the committee; and
(4) comply with HHSC rules relating to workplace violence.
(e) An ASC shall adopt, implement, and enforce a written workplace violence prevention plan developed by the committee. In accordance with HSC 331.004, the plan shall:
(1) be based on an ASC setting;
(2) adopt a definition of "workplace violence" that includes:
(A) an act or threat of physical force against a health care provider or employee that results in, or is likely to result in, physical injury or psychological trauma; and
(B) an incident involving the use of a firearm or other dangerous weapon, regardless of whether a health care provider or employee is injured by the weapon;
(3) require the ASC to at least annually provide workplace violence prevention training or education that may be included in other required training or education provided to the ASC's health care providers and employees who provide direct patient care;
(4) prescribe a system for responding to and investigating violent incidents or potentially violent incidents at the ASC;
(5) address physical security and safety;
(6) require the ASC to solicit information from health care providers and employees when developing and implementing a workplace violence prevention plan;
(7) allow health care providers and employees to report workplace violence incidents through the ASC's existing occurrence reporting systems; and
(8) require the ASC to adjust patient care assignments, to the extent practicable, to prevent a health care provider or employee from treating or providing services to a patient who has intentionally physically abused or threatened the provider or employee.
(f) The written workplace violence prevention plan may satisfy the requirements of subsection (e) of this section by referencing other internal ASC policies and documents.
(g) At least annually after the date an ASC adopts a written workplace violence prevention plan required by subsection (e) of this section, the committee shall:
(1) review and evaluate the workplace violence prevention plan; and
(2) report the results of the evaluation to the ASC's governing body.
(h) Each ASC shall make available on request an electronic or printed copy of the ASC's workplace violence prevention plan to each health care provider or ASC employee. If the committee determines the plan contains information that would pose a security threat if made public, the committee may redact that information before providing the plan.
(i) In accordance with HSC §331.005, after an incident of workplace violence occurs, an ASC shall offer immediate post-incident services, including any necessary acute medical treatment for each ASC health care provider or employee who is directly involved in the incident.
(j) In accordance with HSC §331.005, an ASC may not discourage a health care provider or employee from exercising the provider's or employee's right to contact or file a report with law enforcement regarding a workplace violence incident.
(k) In accordance with HSC §331.005, an ASC shall prohibit ASC personnel from disciplining, including by suspension or termination of employment, discriminating against, or retaliating against another person who:
(1) in good faith reports a workplace violence incident; or
(2) advises a health care provider or employee of the provider's or employee's right to report a workplace violence incident.

25 Tex. Admin. Code § 135.31

Adopted by Texas Register, Volume 49, Number 41, October 11, 2024, TexReg 8381, eff. 10/21/2024