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Appendix 6: Sample Policies adapted from the Austin Hospital (NSW) Policies

Aggression Management Policy and Procedures

Overview

This Aggression Management Policy documents the process for the prevention and management of occupational violence and aggression (referred to as “aggression” throughout this document) at CMDHB Health.

Objectives

• to train staff to in recognising signs of aggression and preventive techniques
• to provide a procedure for the pro-active prevention and management of aggressive incidents
• to support staff following an aggressive incident.

Scope

Occupational aggression is defined as any incident where an employee is abused, threatened or assaulted in circumstances arising out of, or in the course of their employment.

Aggressive Behaviour may include:

• Verbal, physical or psychological abuse (including bullying)
• Threats or other intimidating behaviours (e.g. spitting, gesticulating)
• Intentional physical attack (e.g. hitting, pinching, biting or scratching)
• Threats or attacks with weapons or objects
• Any form of indecent physical contact, including sexual harassment or sexual assault.

At this hospital aggression includes aggressive behaviour that is demonstrated by patients, relatives, visitors, co-workers, supervisors or intruders into the workplace.

The policy applies to all employees (including labour hire/agency staff) and to independent contractors and their employees who carry out work under the control of this organization and all patients/residents and visitors to this hospital’s facilities.

The policy also applies to CMDHB employees who are required to provide Home Visit or similar services outside a facility.

References

Developed by the Occupational Health & Safety Unit in consultation with the Aggression Management Committee. Details of legislation, Codes of Practice and guidelines referred to are listed at the end of the document.

Policy

1. The employer is committed to preventing and managing risks associated with aggression to ensure a safe environment for staff, patients/residents and visitors.
2. No aggressive behaviour or behaviour provoking aggression will be tolerated.
3. All managers, staff, patients/residents and visitors must meet their responsibilities towards the prevention and management of aggression.

Procedure

Roles and Responsibilities

a. Senior Management – are responsible for ensuring that appropriate risk controls for the prevention and management of aggression are in place and followed.

b. Department/Unit Managers – are responsible for ensuring that employees are aware of the organisational approach to managing aggression and for encouraging a team approach towards aggression management. Departmental Managers are responsible for incorporating pro active measures in dealing with patients and visitors and developing patient care plans which will reduce the probability of aggressive incidents. Following an aggressive incident Department/Unit Managers are to identify contributing factors and implement preventative action in consultation with the OH&S Unit.

c. Employees – are required to take care of themselves and others in the workplace. They must report all aggression-related incidents on the Staff and Visitors Incident Report Form and actively participate in procedures and initiatives aimed at preventing and managing aggression.

d. Patients/residents/visitors – are required to behave in an acceptable manner and to actively participate in relevant procedures and initiatives aimed at preventing and managing aggression.

Hazard Identification and Risk Assessment

a. Patient/resident aggression – on admission, information will be sought on aggressive risk factors. During care, patients' behaviour will be monitored for aggressive tendencies. This information and any resultant risk control actions will be highlighted in the patient care plan.

b. Home visit Risk Identification – Services will not be provided in people’s homes or at other venues not on the hospital campus unless a risk assessment has been carried out which indicates that the service provision does not place any person in a position of unacceptable risk. (Home Visit Risk Assessment Policy April 03.)

c. Incident Reporting – all aggressive incidents (either actual or near miss) must be reported in line with the Incident Reporting Policy. (Section A 5.1 OH&S Manual).

d. Incident Investigation – all reports of aggression will be investigated by line managers, in consultation with the health and safety representative, to identify root causes and appropriate action taken to ensure the prevention of a recurrence.

e. Visitor aggression – repeat offenders are identified and flagged with Security and Department Managers. See Emergency Procedures Manual (Section B 6) for Pro-Active Management Strategies including Warning and Not-Welcome Notices.

Risk Control

a. Staged Process for Achieving Acceptable Behaviour

Except in unusual or emergency situations for example physical assaults, The employer will attempt to achieve acceptable behaviour through a staged process of behaviour management. Each step of the process should be recorded in the patient’s file and in the incident reports. This will ensure that all staff are aware of previous incidents and that later responses are based on evidence.

The process will include the following steps:

1. Verbal requests to the patient/visitor to modify their behaviour (recorded in the patient file/and /or incident reports).
2. Development of a patient care plan if appropriate.
3. Development of a patient/visitor contract.
4. Not Welcome Notice/Eviction from premises.

The Police may be contacted at any point during this process if it is determined that an emergency response is required or assistance is required in escorting a person from the premises.

The following two The employer references detail The employer processes for managing aggression and should be referred to for an expanded explanation of these processes where practicable.

• Emergency Procedures Manual Section B6 Pro-Active Management Strategies: Unacceptable Patient or Visitor Behaviour, pages 11- 23.
• Protocol for Early Intervention in Complex/Difficult Cases (Dec 02).

b. Training – Baseline De-escalation and Violence Management training will be available to managers and staff as appropriate for their potential to exposure and level of responsibilities. The Respond Grey Emergency Response Team members will be offered a second level of specialised Aggression Management Training.

c. Employee Relations – for aggressive incidents involving solely staff members, refer to the Employee Relations Unit and the Policies listed in the References to this document.

Post Incident Management

After the event interventions should be directed to minimise the impact of aggression and to prevent future occurrences. They should be targeted not only at the victim but also at the perpetrator, witnesses and any staff directly or indirectly concerned by an aggressive incident.

They may include, but are not limited to:

• Aggression Action plans including patient care plans
• Debriefing (Section C 5 OH&S Manual)
• Counselling or medical treatment
• Support to staff who wish to report assaults to the Police
• Grievance or disciplinary procedures
• Rehabilitation.

Monitoring and Evaluation

a. Key Performance Indicators – KPIs relating to aggression to be monitored by unit/ department heads and will include (but not be limited to):
i. Staff incidents and WorkCover claims relating to aggression
ii. Respond Grey Codes 1 and 2 statistics
iii Security Aggressive Incident Reports
iii. Debriefing Services provided by ITIM for aggressive incidents.

b. Aggression Management Policy evaluation – review of the Aggression Management Policy by the Aggression Management Committee will occur on a regular basis with appropriate action taken to correct or improve on non-compliance or poor outcomes.

c. Clinical Care Review – when patients repeatedly offend a comprehensive clinical care review should be undertaken.

References

Legislation

Occupational Health and Safety Act 2004^[3].

Information

• Guidelines for the Prevention of Workplace Bullying and Occupational Violence, WorkSafe Victoria 2003
• Zero Tolerance (Occupational Violence & Aggression): Policy and Interim Guidelines, Australian Nursing Federation (Victorian Branch), 2002
• Framework Guidelines for addressing Workplace Violence in the Health Sector, International Labour Office, World Health Organisation, 2002

Related Policies

• Occupational Health and Safety Policy and Procedures Manual
• Emergency Procedures Manual
• Protocol for Early Intervention in Complex Difficult Cases (Dec 02)
• Home Visit Risk Assessment Policy (April 02)
• Incident Report Form (reviewed Mar 02)
• Support for Staff Injured at Work (May 02)
• Support for Staff who wish to report assaults to Police after being assaulted at Work (August 02)
• Risk Assessment for Patient Admission (Nov 02)
• Terms of Reference, Aggression Management Committee
• Patient & Visitor Aggression Response Protocol (Nov 2002)
• Admission guidelines for the management of aggressive Patients (April 2006)

Employee Relations

• Bullying (Prevention of in the Workplace): Policy No: 75/02
• Discrimination and Harassment Prevention Policy: Policy No: 48/00
• Visitor Access (Employee Invited): Policy No: 45/02
• Equal Employee Opportunity, Policy No: 47/98
• E-mail and intranet Equal Opportunity Policy, Policy No: 71/02
  

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Footnotes:

[3] Health and Safety in Employment Act 1992 in New Zealand (return to text)

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