Previous Section | Table of Contents | Next Section

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

Protocol for Early Intervention in Complex/Difficult Cases

Overview

Provides guidance for identifying the need for early intervention, the first actions to be taken, and staff roles.

Objectives

To ensure early recognition of complex/difficult patient cases and prompt effective reducing action.

Scope

Protocol covers all patient situations on all campuses.

Reference

Developed by the Aggression Management Committee in consultation with OHS Unit.

Identification of Serious Cases

These cases can be identified by any member of the Support Team in consultation with clinical staff. Triggers for identification of these patients include:

• Repeated incidents of aggressive behaviour eg assaults, threats, abuse
• Numbers of staff incident reports relating to the one patient /visitor/family member
• Lack of cooperation with treatment plans
• Issues with medical power of attorney/guardianship
• Refusal to participate in residential care planning
• A pattern of complaints and/or extensive liaison with Patient Representative
• Threats of medico-legal action

Education and Aggression Management Committee

Education of staff about early intervention and prevention of further escalation is an important step in preventing cases progressing or escalating to Serious Case status.

The Aggression Management Committee is responsible for actioning a medical centre wide approach including involvement of the Psychiatric Liaison Nurse.

First Steps After Identification of Complex/Difficult Patient Case

• Patients and/or their families who present with complex or difficult management issues should be identified as early as possible.
• The Nursing staff should undertake a Risk Assessment and then develop and implement an action plan in consultation with patient and family. This action plan should be discussed with the CSU Manager or their delegate in the first instance.
• If staff or other patients or visitors or families are threatened, OH&S or Security should be contacted immediately.
• The Support Team which is available to assist in the management of difficult and complex cases includes the CSU Manager, Psychiatric Liaison nurse, Social Worker, OH&S Unit, Site Nursing Manager, Patient Representative and Security.
• Staff support can be provided to check that protocols are in place and are working on a regular basis.

Protocol for Managing Serious Cases

• The CSU Manager or delegate identifies a Serious Case and convenes a meeting of representatives as appropriate from OH&S, Patient Representative, Nursing Services, Social Work, Acute Services/Medicolegal, Corporate Counsel, Psychiatric Liaison Nurse, Registrar/Resident/Consultant and NUM from the area.
• The Support Team can provide assistance with reviewing the plan, identifying additional protocols and processes that may be required to obtain adherence to the plan and provision of support to staff. A Case Manager is nominated by this group.
• The Case Manager (usually the CSU Manager/ delegate) is responsible for
• ensuring the plan is in place and proceeding as agreed.
• liaising with the Care Team and Support Team, including Corporate counsel.
• allocating roles /responsibilities to Team members
• identifying any barriers or additional resources or staff support required to implement the plan
• ensuring that a communication plan is in place to inform security staff, after hours supervisors and other relevant staff.
• escalating issues to Director of CSU or Executive Director as appropriate.
• The Case Manager and Registrar involved will liaise with the consultant and convene family meetings as required. This may involve members of the Support Team

Risk Assessment

Area:

Process:

Risk Assessment Conducted With Staff and NUM (Name):

Date:

Risk assessment undertaken using Worksafe Victoria, Prevention of Bullying and Violence at Work, February 2003, Risk Assessment
Checklist, page 23, Part 2: Preventing Occupational Violence.

Describe task/s or area being assessed

Risk Areas to Assess		No √	Yes √	If Yes Adequate Controls Y/N	Recommendation
Incident/ Injury records	Have there been any incidents of occupational violence in the past 12 months?
	Have employees been threatened in the past?
	Have the recorded incidents of occupational violence resulted in serious injury or impact?
Work environment	Is work performed in unfamiliar environments?
	Are employees working in isolated locations?
	Is it easy for an aggressor to get physical access to an employee?
	Is it difficult for an employee to retreat to a safe place?
	Is it difficult for employees to communicate when threatened?
	Is the environment uncomfortable for clients?
	Does the physical layout fail to provide privacy for clients?
	Would it be easy for an aggressor to break into the work place after hours?
	Is access to alarms difficult or too obvious?
	Does the building have multiple access points?
	Is visibility impaired for awareness of potential threats to safety?
	Is external lighting inadequate?
Work Practices	Are there likely to be service delays?
	Are there likely to be circumstances that would frustrate clients?
	Are staffing numbers insufficient at demand times?
	Do employees have the responsibility for cash or other valuable items?
	Are employees providing community outreach services?
	Do employees ever work alone?
	Would it be difficult for an employee to seek assistance if threatened or attacked?
	Does the workplace lack security and emergency procedures?
	Does the work place fail to regularly check and test emergency procedures?
Employee training	Are there inexperienced employees in front line positions?
	Are there employees who have not received training in how to deal with aggressive clients?
	Are there employees who do not have the appropriate knowledge and skills to deal with clients?
	Are any employees unaware of the policy on occupational violence?
Client behaviour	Are clients likely to be distressed or aggressive?
	Is the behaviour of clients unpredictable?
	Is the aggressor likely to have a weapon?
	Is there likely to be more than one aggressor?
	Is the aggressor likely to be under the influence of alcohol or drugs?
	There is no method to review patient aggression or violence?

 

---

Previous Section | Table of Contents | Next Section