Violence and Aggression by Patients Consumers or …health.act.gov.au/sites/default/files/new_policy_and_plan... · Web viewBeing accompanied by people who have a history of violent

DGD15-019

Standard Operating ProcedureViolence and Aggression by Patients, Consumers or Visitors.

PurposeTo provide ACT Health staff with clear information on:

How to reduce the risk of violence and aggression in their workplace environment When an immediate response to actual or potential high risk violence and aggression

incidents by patients, consumers or visitors, is required and Managing onging issues

ScopeThis SOP applies to all Divisions and provides staff with information on:

The risk management process of the environment and workplace. Early intervention, immediate response and Post incident response and Management of ongoing issues, including warnings and agreements.

Local areas should develop further SOPs that comply with this document to cover situations unique to their area.

ProceduresThe following table of contents relates to procedures for 3 areas of violence and aggression:

1. Environmental and Workplace Risk Management Page 21.1 Hazard identification1.2 Risk assessment of identified hazards1.3 Implementation of control measures1.4 Evaluation and review of the effectiveness of control measures, and1.5 Consultation with all parties affected by changes to the workplace.

2. Managing an Incident Page 5 2.1 Prevention and Early Intervention2.2 Immediate Response to Actual or Potential Patient, Consumer or Visitor Violence or

Aggression 2.3 Post Incident Response

3. Managing ongoing issues Page 83.1 Verbal warning3.2 Written warning 3.3 Conditional Treatment Agreement, with or without 3.4 Alternative treatment arrangement, and3.5 Withholding Treatment with or without alternative treatment arrangement. 3.6 A Workplace Protection Order (WPO) 3.7 Behaviour Management Plan

Document Number Version

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Issue Date Review Date Area Responsible

DGD15-019 V1 May 2015 May 2018 Workplace Safety

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

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DGD15-019

Procedure 1- Environmental and Worplace Risk Management

Divisions must take a risk management approach to managing violence and aggression in the workplace through a continuous process of:

1.1 Hazard identification1.2 Risk assessment of identified hazards1.3 Implementation of control measures1.4 Evaluation and review of the effectiveness of control measures, and1.5 Consultation with all parties affected by changes to the workplace.

1.1 Hazard IdentificationIn considering workplace safety hazards managers should look at the:

Nature and location of work Types of patients or consumers being treated Hours of operation and/or opening Access to the service or facility Design of the facility, and Staffing levels skill mix and qualifications.

Managers and Executives may gather information through a range of mechanisms including: Local workplace meetings Tiers 2 and 3 Health and Safety Committee meetings Health Safety Representative and Area Manager workplace inspections. (See the

Violence and Aggression Hazard Prompt List on the ACT Health Work Health and Safety Management System (WHSMS) Intranet web page).

Review of monthly Riskman and SAIR Reports provided by Workplace Safety, of incidents of violence and aggression

Accident incident reports First aid reports from the local area, and Workers’ compensation claims available from managers or the Workplace Health

Advisory Unit.

1.2 Risk AssessmentManagers and Executives to ensure a risk assessment of identified hazards to be completed to provide a risk rating for each hazard to prioritise risk and ensure the implementation of controls to eliminate, reduce or minimise each hazard.

Documentation of all risk assessments is required to meet the ACT Work Health & Safety Act 2011.

1.3 Implementation of Control MeasuresControls eliminate or reduce risk to health and safety. If risks are unable to be eliminated, the ACT Work Health & Safety Act 2011 requires all risks to be reduced as far as is reasonably practicable using a risk management approach. When implementing controls it is recommended that the following hierarchy of control measures be considered and applied in descending order. Higher level control options are more effective; a combination of measures may be required.


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The hierarchy of controls are listed in order of effectiveness - highest to lowest, and applied in descending order. See below:

Elimination at the source of risk – Highest Control. For example: Removing or changing the activity that precipitates the risk; Removing potential missiles/weapons.

Substitute the risk with something posing a lower risk. For example: Changes to patient, consumer contact arrangements, such as telephone contact,

video intercoms at night entrances.

Isolate the risk from staff. For example: Security glass or metal screens to protect staff in high risk situations; Secure retreat areas for staff, and Secure waiting room chairs and wall-mounted televisions in high incident areas such

as the Emergency Department.

Engineering control of risks through the appropriate use of equipment and design. Forexample:

Timely maintenance and repair of equipment Dual access and exit points to eliminate potential entrapment in interview rooms Use of available technology and other security measures, and Wherever possible design out risks in equipment, workplaces and systems. (Design is

identified as more effective in reducing risk than relying on work procedures or training alone.

Administration controls to prevent and manage violence and aggression and as the second lowest level of control, is used in conjunction with the previous controls. It is rarely used as the only form of control. For example:

Ensure adequate staff are trained in local response to incidents involving violence, aggression and weapons

Localised SOPs and action plans for attending codes, including code blacks, evacuations and internal disasters; specific patient, consumer care plans; violence and aggression procedures in consultation with staff and service user

Job rotation/work reorganisation/changing work schedules to reduce frequency and exposure to risk e.g. staff alone at night where there is a risk of violence

Support and counselling is available for all staff involved in incidents, and Signage Ensuring staff are in de-escalation procedures

Personal Protective Equipment (PPE) is considered the last defence in risk control and mitigation and sits at the bottom of the hierarchy of risk control as the least effective control. It is used in addition to other controls. Examples of personal protective equipment are goggles, visors, masks, gloves, hats, ear protection, overalls, gown, and footwear.

1.4 Evaluation and review of Control MeasuresReview the new controls for effectiveness and reduction of risk.


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DGD15-019If there is remaining risk (residual risk), the process continues until the risk is minimised so far as is reasonably practicable.

Regular monitoring and consultation is important to assess whether the new controls have actually reduced the risk.

1.5 ConsultationConsultation between employers, employees and Health and Safety Representatives is required to determine the methods to be used in managing and controlling risks. The risk matrix used by ACT Health is to be used to conduct the risk assessment. The level of risk identified and previous controls implemented will determine the control to be used.

The risk matrix and risk assessment template can be found on the ACT Health Work Health and Safety Management System (WHSMS) Intranet web page).

DocumentationEach stage of this risk management approach should be documented and stored in appropriate places, for example in workplace safety reports and administrative files.

EvaluationOutcome Measures

Potential environmental and workplace risks are identified, assessed and reduced through appropriate control measures;

Risk management controls are regularly monitored and assessed for their effectiveness;

Management of environmental and workplace risk is documented, and Increased number of staff have attended e-Learning Personal Safety and Conflict

Awareness Training.

Method Case by case review of incidents of workplace violence and aggression, from SAIR and

Riskman reports, by Workplace Safety; Monitoring of WorkPlace Safety reports by the Tier 1 Work Health and Safety

Committee; and Monitoring of Executive Directors Tier 2 Health and Safety reports.


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Procedure 2 - Managing an Incident

2.1 Prevention and Early InterventionIt is important to recognise potential for violence and aggression that may be due to treatment, social factors, illness/health issues, and put strategies in place to manage risk. Rapid assessment and early intervention can prevent or reduce the risk of harm in a violent or aggressive incident. See Attachment 1 – Common signs of violent or aggressive behaviour.

2.2 Immediate Response to Actual or Potential Patient, Consumer or Visitor Violence or Aggression

At all times staff safety and the safety of patients, consumers and the public is paramount. The response to violence and aggression should be proportionate to the level of violence and aggression being displayed. Options for action include:

Attempting to de-escalate the situation where possible using defusing techniques learnt in the ACT Health Training e.g. e-Learning Personal Safety and Conflict Awareness Training

Involving a carer or support person in de-escalation if available and as appropriate Consideration of review of the patient or consumer by a clinician e.g. violence due to

pain, impairment. If restraint of a violent or aggressive patient or consumer is being considered: Refer to the ACT Health’s Restraint of Patients Policy and Procedure

Advise the violent person that assistance has been requested and seek support from other staff, and

If the person is a visitor, or not an inpatient, request that the person leave the immediate area.

If unable to de-escalate the situation:1. Staff located on the Canberra Hospital campus:

Press <Duress Button> if available and safe to do so If no <Duress Button> available, Dial 8 and call Code Black Provide details of the incident Wait for Security to respond and to make an assessment if the Australian Federal

Police (AFP) are required to attend to the incident. The TCH Switchboard Operators will contact emergency services (Fire Brigade, Ambulance, Police) if directed by Security personnel.

2. The Canberra Hospital Campus Refer to specific arrangements made by your area with ACT Health Security

personnel for situations involving incidents of violence and aggression Provide details of the incident

3. ACT Health locations in Canberra On an external phone line dial 000 for Australian Federal Police (AFP) assistance Provide details of the incident

Note: For any location and incident where weapons are suspected or verified the AFP must be notified.


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DGD15-019Information to be provided if unable to de-escalate the situation

Provide details of o Exact location of the incident i.e.: ward/department/Location e.g.: Building 2,

level 10, Ward A. o why assistance is required

Remove all patients, consumers, visitors and staff from the immediate danger and retreat to a safe location

Staff should not position themselves where they may be accessible by the person Secure the area by locking any doors between the violent person and staff, other

patients, consumers or visitors if possible. This should only be a short term measure. Long term confinement is considered to be environmental restraint. (Refer to: ACT Health Restraint of Patients Policy and Procedure).

Wait for the AFP or Code Black Team in a safe location away from the person and maintain visual contact if able

Provide to the AFP or Code Black Team all relevant information requested, including information regarding weapons or suspected weapons

Follow the direction of the AFP or Code Black Team until the situation is resolved, and

Advise the line manager and other staff as soon as possible of the situation. This will include the appropriate Executive staff responsible for the area.

2.3 Post Incident Response

Injury

Patient, consumer, visitor or staff injuries should be treated promptly by: Provision of First Aid At a non-hospital location; dial 000 on an external line for an Ambulance At the Canberra Hospital Dial 8 to activate a medical emergency response known

as Code Blue and state ‘Code Blue’

ReportingAll incidents of violence and aggression are to be reported to:

Riskman, SAIR or on the paper based ACT Government Accident Incident Report Form

In the patient’s, consumer’s clinical record, and Consider whether the criteria for reporting to WorkSafe are met. If so, the

manager of the area is to submit a report.

Who was present at the time the incident occurred should be included in reporting of the incident. This information will be used in incident assessment and to provide information to the AFP where necessary.

In addition to reporting on SAIR, all incidents of assault, theft, robbery or damage to ACT Health property are to be reported to the AFP.

Debriefing and ReviewInformal or formal debriefing, depending on the severity of the incident, for staff involved or witness to an incident should be provided through:


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DGD15-019 Senior staff on duty at the time of the incident Individual staff counselling offered to staff through the Employee Assistance

Program (EAP), and Group counselling for staff facilitated by a senior staff member as soon as

possible. Contact EAP through People Strategy and Services (PSS) to arrange group debriefing if required.

The manager responsible for addressing the SAIR incident report may elect to interview those patients, consumers, visitors and staff involved in the incident to explore possible causes of the incident. This information can then be used to inform further preventative actions.

A post incident review should be undertaken by the manager within 72 hours to: Support staff and others Learn lessons, and Evaluate and monitor the immediate post incident actions.

Clinical Evaluation of Patient or ConsumerFollowing an initial episode of violence and aggression the patient or consumer must undergo thorough clinical assessment by their treating team to identify whether there are underlying cause(s) of violent or aggressive behaviour including physical, medical, psychological, emotional, social and environmental considerations.

For patients or consumers whose violent and aggressive behaviour is identified as intentional, correction of underlying issues may rule out the need for further action. For example, addressing issues of pain, discomfort and frustration that may trigger violent and aggressive behaviour may prevent, or assist de-escalation of, future episodes. These patients, consumers should be referred as necessary to:

The Pain Management Team, and/or A Psychologist.

For ongoing management strategies, including risk assessment and options for protecting staff refer to Violence and Aggression by Patients, Consumers or Visitors: Managing Ongoing Issues SOP 3.

Legal Options Workplace Protection Order requested by ACT Health Manager. Police charges laid by person assaulted.

EvaluationOutcome Measures

Reported incidents are reviewed and inform further preventative measures, where appropriate.

Reduction in the number of staff injuries related to incidents. Repeated incidents of violence or aggression are managed in accordance with this

SOP. MethodRiskman and SAIR incidents related to violence and aggression are reviewed by Workplace Safety and results reported to:

Area ManagersDocument Number Version

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DGD15-019 ACT Health Executive, and Tier 1 Work Health and Safety Committee, when appropriate.

Procedure 3 - Managing Ongoing Issues

The ACT Health response to each additional episode of violence or aggression by the patient or consumer escalates in consequence and is actioned in the following order of escalation:

3.1 Verbal warning3.2 Written warning 3.3 Conditional Treatment Agreement, with or without 3.4 alternative treatment arrangement, and3.5 Withholding Treatment with or without alternative treatment arrangement. The

decision for withholding treatment is made by Director-General only. 3.6 A Workplace Protection Order (WPO) may be necessary in some instances to

manage the violent and aggressive behaviour of a patient or consumer against a specific staff member(s). A WPO is made through the ACT Health Insurance and Legal Liaison Unit (ILLU)

3.7 Behaviour Management Plan (visitors only)

3.1 Verbal WarningsA verbal warning is a first formal action before use of written warnings, conditional treatment agreements and the withholding of treatment. The patient, consumer or visitor must be advised of their right to name an advocate and have them present during the verbal warning.

Verbal warnings are planned and given by a manager of the area with: Approval of senior management, and Advice from the patient’s, consumer’s consultant or senior member of the treating

team.

Verbal warnings may only be given if the patient, consumer or visitor is: Able to understand the issues associated with their behaviour and has the ability to

change their behaviour, Able to understand English or there is an appropriate translator present, and Advised that they are able to have an advocate or support person present when they

are given the warning.

A verbal warning given to the patient, consumer or visitor must clearly explain: The behaviours that are of concern and unwanted The effect the behaviour has on staff, other patients, consumers and visitors exposed

to the behaviour The effect the behaviour has on the ability of ACT Health to provide patient and

consumer care and ensure a safe Workplace, and Identify the preferred and expected behaviours of persons receiving treatment in ACT

Health.


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DGD15-019Following the verbal warning, the patient, consumer or visitor should be given the opportunity to respond.Managers should ask the patient, consumer or visitor to stop the unwanted violent or aggressive behaviour and:

Identify the behaviour that is preferred and appropriate Inform the patient or consumer of potential consequences if they continue to be

violent or aggressive. E.g. written warning, conditional treatment agreement or the withholding of treatment, and

Inform the patient or consumer of ACT Health Violence and Aggression by Patients, Consumers or Visitors: Prevention and Management Policy and SOPs. A copy may be given to the consumer at this time.

The verbal warning must be documented in the patient or consumer’s clinical record and include a full summary of the discussion and the information provided to the patient or consumer during the discussion and any agreed outcomes. A senior member of staff must witness that the verbal warning has been given and co-sign the clinical record.The verbal warning must also be documented in the Riskman Staff Accident and InjuryReport (SAIR) that is related to the incident that triggered the warning.

3.2 Written WarningsA written warning is given when a patient, consumer or visitor has not changed their violent or aggressive behaviour following a verbal warning. A written warning letter template is provided at Attachment 3.

Written warnings are signed by the Executive Director of the Division and given in person to the patient or consumer by a manager of the area following consultation with:

Senior management of the treating unit, and Advice from the patient’s, consumer’s consultant or senior member of the treating

team.Patients, consumers and visitors need to be advised that they are to receive a written warning and that they are entitled to bring an advocate or support person to the meeting if they choose. If the consumer has a nominated General Practitioner (GP) they are to be notified of the intention to provide a written warning.

Before giving a written warning it must be confirmed that: Staff have made previous attempts to discuss concerns with the patient, consumers

or visitors and have asked them to stop the unwanted violent or aggressive behavior The patient, consumer or visitor has been informed of the ACT Health Violence and

Aggression by Consumers and Visitors: Prevention and Management Policy and 3 SOPs and a copy has been given to them

The patient, consumer or visitor is able to understand the issues associated with their behaviour and has the ability to change their behavior

The patient, consumer or visitor is able to read and understand English or there is an appropriate translator available when the written warning is given, and

The threat or risk of violence and aggression to others is significant enough to require further action.


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DGD15-019Written warnings are to be polite, respectful and intended to inform. Language used must be simple, non-blaming and non-judgemental. A written warning must clearly explain:

The patient, visitor or consumer behaviours that are of concern and unwanted The effect the unwanted behaviour has on staff, other patients, consumers and

visitors exposed to the behavior The effect the unwanted behaviour has on the ability of ACT Health to provide care

and ensure a safe Workplace That a written warning is being given because other actions to stop the unwanted

behaviour have failed, e.g. verbal warning That the patient, visitor or consumer is being asked to stop the unwanted violent or

aggressive behaviour The behaviour that is preferred and appropriate, and The potential consequences if the patient, consumer or visitor continues to be violent

or aggressive. e.g. Conditional treatment agreement or the withholding of treatment.

A signed original is to be given to the patient, consumer or visitor or their delegate. Copies are to be provided to the:

Patient or consumer’s treating consultant Patient or consumer’s nominated GP Director Workplace Safety.

Following the written warning, the patient, consumer or visitor should be given the opportunity to respond and agree to a timeframe for reviewing the warning (which will be no longer than three months). The written warning is to be reviewed when the patient or consumer’s circumstances change, e.g. the patient or consumer’s behaviour improves or they are moved to a different treating area.A copy of the written warning is to be documented in the patient’s, consumer’s clinical record and should include:

A description of the incident that required the written warning The witnesses to the incident, The rationale for the written warning, and Statements by the patient or consumer or their advocate explaining their behaviour.

A senior member of staff must witness that the written warning has been given and co-sign the clinical record.

3.3 Alternative Treatment Arrangements (patients and consumers only)At any time an alternative treatment arrangement can be considered. It may be possible for the patient or consumer to be treated elsewhere. Initially, this is to be discussed with the area’s Executive Director and the ACT Health Director-General. Consultation with the patient or consumer and their advocate should then occur to determine: The facility and location where the treatment will be provided, and The specified time/s for treatment.

A record of the alternative treatment arrangements must be kept in the patient’s, consumer’s clinical record and incident report.


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3.4 Conditional Treatment Agreements (CTAs) (patients and consumers only)A CTA clearly states the conditions on which ACT Health will provide a service to an individual. A CTA may be made when a patient or consumer continues violent or aggressive behaviour following verbal and written warnings. (See CTA template at Attachment 4)

CTAs may be required in situations where the patient or consumer has a history of violence and aggression including but not limited to:

Threatening or carrying out violence against staff, patients, consumers or visitors in ACT Health facilities

Use of alcohol or other drugs, during treatment in an ACT Health facility, that leads to violent, aggressive or disruptive behaviour

Being accompanied by people whose behaviour is disruptive, and Being accompanied by people who have a history of violent behaviour towards

others.

Written CTAs are signed by the Executive Director of the Division and given in person to the patient or consumer by a manager of the area following consultation with:

Senior management of the treating unit, and Advice from the patient’s, consumer’s consultant or senior member of the

treating team.

The patient’s, consumer’s nominated General Practitioner (GP), must be notified of the intention to give a CTA.

CTA’s are to be negotiated with the patient or consumer as far as possible. The patient or consumer must be advised of their right to nominate an advocate or support person and have them present when the CTA is given.

Written advice of the CTA should include and clearly explain: The patient or consumer behaviours that are of concern and unwanted The effect the unwanted behaviour has on staff, other patients, consumers and

visitors exposed to the behaviour The effect the unwanted behaviour has on the ability of ACT Health to provide care

and ensure a safe Workplace That a CTA is being given because other actions to stop the unwanted behaviour have

failed, e.g. verbal and written warnings That the patient or consumer is being asked to stop the unwanted violent or

aggressive behaviour The behaviour that is preferred and appropriate The options for alternative treatment arrangements, and The potential consequences if the patient or consumer does not comply with the CTA

through continuation of the behaviour during the specified timeframe may lead to all but emergency treatment being withheld and alternative health care arrangements being recommended.


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DGD15-019The signed original CTA is to be given to the patient or consumer or their delegate and a copy included in the clinical record. Copies are also provided to:

Patient or consumer’s treating consultant Patient or consumer’s nominated GP ACT Health Director-General Officer, and Director of Workplace Safety.

Patient, consumers must be: Advised that they have the right to seek a review of this decision and can seek the

ACT Health Director-General review of the CTA decision, and/or make a complaint to the Health Services Commissioner, Human Rights Commissioner and the Public Advocate of the ACT. Contact details for these two areas should be provided.

Given the opportunity to respond and agree to a timeline for review of the warning that does not exceed 3 months, or review when consumer circumstances change, e.g. the consumer’s behaviour improves or they are moved to a different treating area.

Documentation includes: The CTA letter and notice is to be documented in the patient’s, consumer’s clinical

record and should include: A description of the incident/s that required the CTA The witnesses to the incident The rationale for the CTA, and The alternative treatment arrangements, if any.

A senior member of staff must witness that the CTA have been given and co-sign the clinical record.

The Staff Accident Incident Report relating to the incident/s of violence and/or aggression should be updated with details of CTA.

3.5 Withholding of Treatment (patients and consumers only)The decision to withhold treatment is a serious one resting with the Director-General, and is determined on a case by case basis. It is only considered for exceptional circumstances.

A request to withhold treatment to the Director-General from an Executive Director must include:

A clinical assessment supporting the proposal from the relevant senior manager and the consultant or senior member of the treating medical team.

Documentation of the history of incidents and other ACT Health strategies to manage violence and aggression have been tried and failed, in the clinical record and SAIR system (including written warnings and any conditional treatment agreements).

Evidence that continuing to provide care is a significant risk to staff and others. Wherever possible details of alternative treatment arrangements by another

organisation or provider.Note: treatment cannot be withheld for a period of more than three months without review.

Withholding of treatment is not appropriate if a patient, consumer:


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DGD15-019 Is not competent in the opinion of the relevant expert clinician to take responsibility

for their actions e.g. as a result of a disability, illness or injury Requires urgent medical treatment Is under 18 years of age Is subject to the provisions of the Mental Health Act 2015, and Aggression and violence is aimed at property only.

A notice of intent to withhold treatment must also be sent to the patient’s, consumer’s treating doctor(s) and nominated GP at the same time as the letter being forwarded to the patient or consumer to advise them of the intention to withhold treatment.

The withholding of treatment notice should: Identify that the decision to withhold treatment follows verbal and written warnings

and a conditional treatment agreement Indicate alternative arrangements for treatment of non-urgent healthcare needs

during the period of the agreement (no more than 3 months without review) Clear information that the consequences of returning to the health facility in any

circumstances other than an emergency will result in Security staff or the Police being called immediately, and

Advise that appeals can be made through: The Director-General The Health Services Commissioner, Human Rights Commissioner and the

Public Advocate Seeking judicial review.

Once signed by the Director-General, the Withholding of Treatment notice is sent to the patient or consumer or their delegate. A copy is included in the clinical record and provided to the Director Workplace Safety.

3.6 Workplace Protection Orders (WPOs)A WPO is a legal option to manage the violent and aggressive behaviour of a consumer against a specific staff member. It is not to deny the patient or consumer treatment by ACT Health.

Before making a WPO, serious consideration must be given to the outcome that is hoped to be achieved. While a WPO is effective in preventing violence in some cases, it may not be appropriate in all circumstances. The success of the WPO is dependent on the consumer subject to the order having the capacity and inclination to comply with it.

Given that the issuing of a WPO to an individual(s)is legally enforceable and breaching one may lead to a criminal offence, it may not be appropriate to seek an order where the consumer lacks capacity to comply with it. Similarly, where it is not intended to restrain a consumer from attending the Workplace a WPO may have very little practical effect.

The Director-General, as the ACT Health employer representative, is responsible for the WPO application or may provide written authorisation to others to make the application. This written authority may need to be provided to the ACT Magistrate’s court. It is important to act in a timely manner. All details of the event that occurred must be documented.Document Number Version

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Application to obtain a WPO against a patient or consumer is made through the ACT Health Insurance and Legal Liaison Unit (ILLU) who should be contacted for further advice. Specific instructions are to be given if the person is to continue treatment with ACT Health.

3.7 Behaviour Management Plan (Visitors only)A Behaviour Management plans will be used to manage the violent and aggressive behaviour of a visitor against a specific staff member, after a verbal warning and written warning have already been issued. See attachment 5.

EvaluationThis SOP will be considered as part of the evaluation of the Violence and Aggression by Consumers and Visitors: Prevention and Management Policy.

Related Legislation, Policies and StandardsRefer to Violence and Aggression by Consumers and Visitors: Prevention and Management Policy.

ReferencesRefer to Violence and Aggression by Consumers and Visitors: Prevention and Management Policy.

DefinitionsBullying The repeated unwelcome behaviour of a person which has the potential to cause harm to a person/s wellbeing (e.g. verbal abuse, putting someone down, spreading rumours or innuendo, exclusion, interfering with personal property or work equipment). Bullying can:

Be characterised by continued aggressive behaviour that intimidates, humiliates or undermines

Involve the deliberate misuse of power and can come from people at level, above or below the recipient in the hierarchy, and

Occur outside of work location or hours and still affect a staff member’s work performance or well-being.

Code Black/Emergency Procedure is an emergency response used within the Canberra Hospital (TCH) campus when there is assault, violence or high risk of violence displayed by a consumer or visitor who is deemed to be unmanageable and dangerous.

Discrimination Unfair treatment of an individual or group of people because they belong to, or are associated with a particular individual or group, or because they are have a particular characteristic or attribute.

Employee Assistance Program (EAP) The EAP is an independent and confidential counselling service provided for staff free of charge. Details of the EAP are available on the ACT Health Intranet site or from Workplace Health Advisory Unit.


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DGD15-019Harassment Any form of behaviour that is unwelcome, offensive, humiliating, or threatening. This can include creating an atmosphere that is offensive, humiliating or threatening. Harassment may have occurred even when there was no intention to cause offence.

Violence and Aggression In this document occupational violence and aggression refers to any incident where staff member(s) are abused, threatened or assaulted in the course of their work. Observation of violence and aggression can also adversely affect staff.

Weapon A weapon is a tool used to injure, incapacitate, or kill. Any object used to cause damage, even psychologically, is referred to as a weapon.

Workplace Protection Order (WPO) The ACT Magistrates Court may, on application, make a Workplace order if satisfied that a consumer: Has engaged in personal violence in relation to the Workplace, and May engage in personal violence in relation to the Workplace during the time the order

is proposed to operate if the order is not made.

A WPO can state the conditions on which the consumer may enter or approach the Workplace or contact the employee. It is also able to prohibit the consumer from entering the Workplace; being within a particular distance of the Workplace; contacting, harassing, threatening or intimidating an employee at the Workplace or causing someone else to do so and damaging property in the Workplace.

Atachments

Attachment 1- Common signs of impending violent or aggressive behaviourAttachment 2 - Attachment 2 – Flowchart - Reporting Workplace Violence and Aggression Perpetrated by Patients, Consumers or VisitorsAttachment 3 – Written Warning Letter TemplateAttachment 4 - Letter & Conditional Treatment Agreement TemplateAttachment 5 – Behaviour Management Plan

Disclaimer: This document has been developed by ACT Health, specifically for the use of ACT Health. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and ACT Health assumes no responsibility whatsoever.


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DGD15-019Attachment 1

Common signs of impending violent or aggressive behaviour

Common Precursors A variety of behaviours referred to as ‘escalation’ may indicate actual or impending aggression and the presence of a calming support person can often de-escalate the client or situation.

The four emotive/behavioural states commonly displayed on presentation of aggression are: Fear Frustration Manipulation Intimidation

A variety of behaviours may indicate impending or actual aggression/violence. These can present as, but are not limited to, the following forms:

loud clipped or angry speech pacing angry facial expressions refusal to communicate threats or gestures physical or mental agitation restlessness persecutory ideation delusions or hallucinations with

violent content

person themselves reporting violent feelings

intoxication or disinhibiting medications

psychosis or paranoia e.g. a delusional or perceived belief that the person is being persecuted or threatened

anxiety/panic attacks

Inhibition can be decreased due to: confusion, e.g. delirium or dementia neurological disorders e.g. epilepsy intoxication of alcohol or substances disinhibiting medication, including

diazepam

poor impulse control e.g. in some people with a developmental disability

alcohol/nicotine withdrawal or other substance withdrawal

Anger can be due to: humiliation rejection interpersonal deregulation

feelings of being ignored concerns or request dismissed

Stress can be due to: grief e.g. to potential or perceived loss frustration/helplessness pain both acute and chronic agitation secondary to depression inadequate finances side effects from medications which cause neurological agitation dependency and withdrawal

Diminished capacity to self regulate emotional wellbeing can be due to: disrupted sensory process


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Attachment 2 FLOWCHART

REPORTING Workplace Violence and AggressionPerpetrated by Patients, Consumers or Visitors


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Incident of workplace violence and aggression (V&A) incident against staff

Staff member reports the workplace violence and aggression incident either electronically (preferred)

or paper based

PAPER BASED ACT Government Accident Incident Report (AIR)

ELECTRONIC ACT Health Staff Accident Incident Report (SAIR)

Staff member completes a paper AIR form and sends it to Workplace Safety

Incident involves V&A from a consumer, client, consumer, carer, relative, visitor

Workplace Safety administrator enters the incident into SAIR Riskman

Staff member documents the incident in the SAIR electronic reporting system

WorkPlace Safety Reviewer forwards report to appropriate areas/managers – e.g. Staff Member’s Manager(s), Security, V&A Project Manager

DefinitionsSAIR = Staff Accident Incident Report on Riskman

AIR = ACT Government Accident Incident Report

WPS = Workplace Safety, ACT Health

Manager is responsible for: Reviewing the incident Documenting the investigation Ensuring appropriate controls are

implemented.

*SAIR Support Phone No: 6174 8060WorkPlace Safety: Reviews management follow-up Follows-up if appropriate Aggregates the incident into

Executive and Manager Reports

Attachment 3 – Written Warning - Letter template

<<NAME>><<ADDRESS>>

Dear <<NAME>>This letter is to let you know that the recent incident that occurred at <<ORGANISATION>> on <<DATE>> between you and a member of <<THE PUBLIC/ACT HEALTH>>, where you <<INSERT BRIEF DESCRIPTION THAT MATCHES the CLINICAL RECORD OF THE INCIDENT e.g. threatened a staff member >> is behaviour that will not be tolerated by ACT Health.

Violent or aggressive behaviour is unacceptable. It affects other consumers, their visitors and staff and causes distress.

You are being given this letter because you have continued to be aggressive or violent after being asked to stop by ACT Health staff.

You are now being asked again to stop this behaviour for the safety of yourself and others.

In future, if you feel that ACT Health can help you with something you are upset about you are asked to talk about this calmly and as soon as possible with a senior staff member of your treating team who will try to help you. It is important to keep in mind that staff need to feel safe so that they can help you.

This letter is also to let you know that if you keep on being aggressive or violent, ACT Health may have to take extra steps to protect other consumers, visitors and staff. For example, your may have to receive your treatment in a different ACT Health setting and/or only at certain times and/or under certain conditions that will stop you from harming others. Assault of other consumers, visitors or staff or damage to property may result in police involvement and/or legal action against you.

If you would like to talk about this letter with a representative from <<ORGANISATION>>, please phone <<PHONE NUMBER>>. A copy of the Australian Charter of Health Care Rights and our consumer complaints procedure is enclosed for your information.

Yours sincerely,

<<SIGNATURE BLOCK OF DIVISIONAL DIRECTOR>><<DATE>>4 Original (signed) to the Patient, Consumer. 5 Copies are to be provided for:

6 Clinical record of the Patient or Consumer 7 The treating consultant of the Patient or Consumer 8 The GP of the Patient or Consumer 9 Director-General10 Senior Executive of the area, and 11 Director Workplace Safety


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Attachment 4 – Letter & Conditional Treatment Agreement Template

<<NAME>><<ADDRESS>>

Dear <<NAME>>This letter is to let you know that the recent incident that occurred at <<ORGANISATION>> on <<DATE>> between you and a member of <<THE PUBLIC/ACT HEALTH>>, where you <<INSERT BRIEF DESCRIPTION THAT MATCHES the CLINICAL RECORD OF THE INCIDENT e.g. threatened a staff member>> is behaviour that will not be tolerated by ACT Health.

Violent or aggressive behaviour is unacceptable. It affects other consumers, their visitors and staff and causes distress.

During your treatment at settings there have been repeated occasions where your behaviour was aggressive or violent. Previously, ACT Health has given you a letter to let you know that your behaviour is unacceptable and asking you to stop this behaviour for the safety of yourself and others.

ACT Health must take steps to make sure that other consumers, visitors and staff are kept safe. For that reason any further health care treatment that you will need may only be given if you agree to the arrangements described in the attached Conditional Treatment Agreement (CTA).

You will need to sign the agreement to show that you have understood and agree to these arrangements and return it to us.

Please be aware that if you keep on being aggressive or violent or do not follow the CTA arrangements, ACT Health may have to take extra steps to protect other consumers, visitors and staff. For example, your treatment may be withheld. Assault of other consumers, visitors or staff may result in police involvement and/or legal action against you.

If you wish to discuss the contents of this letter with a representative from <<ORGANISATION>> please phone <<PHONE NUMBER>>. A copy of the Australian Charter of Health Care Rights and our consumer complaints procedure is enclosed for your information.

Yours sincerely<<SIGNATURE BLOCK OF DIVISIONAL DIRECTOR>><<DATE>>12 Original (signed) to the Patient, Consumer. 13 Copies are to be provided for:

14 Clinical record of the Patient or Consumer 15 The treating consultant of the Patient or Consumer 16 The GP of the Patient, Consumer17 Director-General ACT Health18 Senior Executive of the area, and19 Director Workplace Safety


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CONDITIONAL TREATMENT AGREEMENT

ONGOING ACCESS TO AND USE OF << ORGANISATION>> FACILITIES AND SEVICES

Staff, consumers and visitors of ACT Health are entitled to a safe environment free of violence, threats and intimidation.

THE CONDITIONSI, _____<<NAME>>_______ agree to treat all staff, consumers and visitors politely and with respect at all times.

I understand that threats, intimidating behaviour, verbal abuse, physical violence and other anti-social behaviour are unacceptable.

I accept that I will be restricted to the treatment area or ward where I am a consumer or visiting.

I agree to visit the hospital on <<DAYS>> only and between the hours of <<TIME>> and <<TIME>> and on every occasion I will report to [the head of security at the reception desk] before proceeding to the treatment area or ward.

I understand that in certain circumstances, a security guard will be based on the ward during my treatment or visit.

I am aware that a request for information about a relative (if I am next of kin) from a member of staff may be made through the [consumer liaison] officer or after hours administrator.

I understand that if I breach any of these conditions security staff may evict me from the hospital and/or contact the police to enforce the eviction. A Workplace Protection Order (WPO) may be taken out by ACT Health against my returning to this hospital or returning under strict conditions.

<<ADD ADDITIONAL CONDITIONS IF WARRANTED>>

I agree to the conditions above and am aware that failure to comply with these conditions will result in my eviction from this hospital. I have been given a copy of this agreement.

Consumer Signature: __________________________ Date: _______________________Print Name: _________________________Witness’s signature: ___________________ Date: _______________________Witness print Name: __________________________Original (signed) to ACT Health, Director-GeneralCopy to Patient, Consumer20 Additional copies are to be provided for:21 Clinical record of the Patient or Consumer 22 The treating consultant of the Patient or Consumer

2324 The GP of the Patient, Consumer25 Director-General ACT Health26 Senior Executive of the area, and Director Workplace SafetyAttachment 5Attachment 5 Behaviour Management Plan Template (visitors only)


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Behaviour Management PlanName: ------ (relationship to patient) Date: X January 2015

Duration: 2 months and then for review on 2 February 2015

Reason for this behaviour management plan: (Name) has exhibited behaviours that are unacceptable and despite many warnings has not been able to control his/her outbursts. He/She has had great difficulty conducting reasonable and professional conversations with health professionals involved in the care of (name of patient). Senior Managers need to ensure a safe environment is provided for staff, patients and visitors.

Behaviour Expectations:

Displaying behaviour that is threatening, intimidating, violent or abusive towards staff, other patients or visitors will not be tolerated. Unacceptable behaviour includes:

1. Raised voice – yelling, swearing, verbal abuse2. Aggressive / bullying or verbally threatening behaviour towards staff or others

These behaviours are a breach of the work, health and safety legislation and cannot be allowed to continue.Future expectations:

(Name) to approach staff with common courtesy (Name) to allow all health professionals to do their job without interference (Name) to control self behaviour – leave the ward if feeling frustrated or stressed (Name) to make an appointment with Consumer Engagement during in business hours (ph

6207 7627, email [email protected]) to discuss any concerns or put concerns in writing

(Name) to limit time spent at visits to allow (patient name) to rest and recuperate and staff to undertake essential care requirements.

Suggesting visiting regime – (x) minutes a day

(name) is to phone the ward each day to advise the time he/she plans to visit (not between 11am and 12 midday at the request of Security) – Ward phone number 6244XXXX

Ward will advise security who will then send two guards to supervise the visit.

Consequence:A breach of the behavouir expectations will result in security staff immediately removing (name) from the hospital campus. The AFP will be engaged immediately if (name) refuses to leave.

Furthermore ACT Health will seek an order against (name) to prevent staff, patients and visitors being exposed to this unacceptable behavouir. Agreement is sought from (name) to comply with this behavouir management plan. Any further breach of behaviour will result in the ACT Health taking decisive action.

I have read and acknowledge the behaviour management plan outlined above

(name) ___________________________________ Date: / 01 /2015


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Violence and Aggression by Patients Consumers or …health.act.gov.au/sites/default/files/new_policy_and_plan... · Web viewBeing accompanied by people who have a history of violent