Managing the Risk of Workplace Violence to Healthcare and Community Service Providers

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Appendix 1: Organisational Self-Assessment of the Prevention and Management of Violence in a Healthcare Setting

What: This self assessment is a ‘gap analysis’ across 12 factors, that can be used to identify the practicable steps that could be taken to prevent violence to employees in healthcare settings.

Who: It should be completed by the workplace health and safety committee and health and safety representatives.

When: It can be used to (a) identify gaps, thus leading to an action plan, and (b) compare situations before and after interventions.

How: Discussion between the workplace health and safety committee and management of the need for action and the practicable steps to be taken is seen as a sensible and inclusive way of reaching agreement.

Action plan: The selection of the actual steps that will be taken in the particular setting will be determined by the concept of ‘all practicable steps’ — the ones that are ‘reasonably practicable in the circumstances and are proportionate to known and avoidable risks’.

1. Name of organisation __________

2. Assessors __________

Date ___ / ___ / ______

Summary of Results

3. Important recommendations stemming from this assessment may be summarised here. __________

Client Information

4. For each patient, is there a care plan that includes:

State of mental and physical health – including the diagnosis - Yes / No
Known tendencies to challenging or violent behaviour - Yes / No
Effective calming techniques that work with the person - Yes / No
Early warning signs for the person — for both violence and return to calm - Yes / No
The strength and size of the person - Yes / No
The person’s mobility level - Yes / No
Any handling aids required - Yes / No
Presence of infectious diseases - Yes / No
The person’s social situation — contact with/ influence of family/ relatives/ friends - Yes / No
Healthcare needs — including, for example, medical conditions that predispose to confusion (and possible consequential violence) such as oxygen deficiency. - Yes / No

5. Have the patient’s/client’s relatives been asked about any triggers for violence (and its reverse) that are individual to the patient/client? - Yes / No

6. Is each patient/client care plan updated as circumstances/conditions change — e.g. after an incident investigation? - Yes / No

7a. Are caregivers given enough information on changes to care plans as they occur? - Yes / No

7b. Are changes to care plans communicated to staff on shift changeover? - Yes / No

8. Is there a system for identifying and documenting hazards that may be associated with violence in the patient’s/client’s place of residence, education and/or care? (For example, items that may be used as weapons.) - Yes / No

9. Are these hazards and the required controls notified to caregivers and /or support people before they start work with the patient/client? - Yes / No

9a. Are hazard controls put in place before the support person or caregiver begins work with the patient/ client? - Yes / No

9b. Is the effectiveness of the control assessed from time-to-time? - Yes / No

10. Does the employer have access to the patient’s/ client’s GP when necessary? - Yes / No

11. These questions are about steps the employer has taken to identify the risk to employees and must be answered before the support person or caregiver begins work in the patient’s/ client’s home.

Do referral agencies provide an accurate profile with the referral? - Yes / No
Does the employer refuse to accept new patients/clients until full information is supplied? - Yes / No
Does the employer accept only those patients/ clients whose needs are within the ability of the organisation to meet? - Yes / No
Has the employer decided on the conditions where services might be withdrawn? - Yes / No
After a decision is taken to withdraw services, are employees, supervisors and management clearly aware of their responsibilities to the patient/ client? - Yes / No
Have the referral agencies been told of the conditions when services might be withdrawn? - Yes / No
Is there a means to meet with the patient’s/ client’s family, friends or representatives to discuss and negotiate realistic levels of service? - Yes / No
Have caregivers been instructed on:
1. When they might reasonably refuse work they perceive as dangerous? - Yes / No
2. The sequence of events that should follow if they make the decision? - Yes / No

Job Design

12. Are the following elements of healthy work present?

Tasks are clearly defined - Yes / No
Tasks are assigned to people who have the skills to do them - Yes / No
There is a variety of tasks - Yes / No
There is good communication in the workplace - Yes / No
There are appropriate rewards - Yes / No
The workplace is supportive — for example through a team climate and buddying - Yes / No
Staff are rotated around unpleasant or dangerous tasks/jobs - Yes / No
Feedback on performance is provided - Yes / No

Comments __________

Facility Design

13. Are the following features of safe facility design present?

The lighting is adequate - Yes / No
There is enough space per person — to avoid crowding and possible interference with ‘personal space’ - Yes / No
Noise is reduced to a minimum - Yes / No

Security Arrangements

14. Are the following security arrangements in place, where appropriate:

Areas of special risk are labelled - Yes / No
Restricted areas are labelled - Yes / No
Areas where assaults may occur are visible through windows - Yes / No
Emergency exits are provided - Yes / No
Easy egress is available from areas where violence may occur - Yes / No
Cameras and good lighting in hallways where appropriate - Yes / No
Emergency signalling, alarm and/or monitoring systems are installed and tested regularly - Yes / No
Ability to summon help promptly — e.g. by using personal alarms - Yes / No
Weapons — and items that can be used as weapons — are removed where necessary - Yes / No
Prompt emergency response. - Yes / No

Best Practice Selection and Pre-employment

15. Best practice selection techniques are in use. - Yes / No

16. Is pre-employment screening for MRSA, hepatitis A and B and influenza offered? - Yes / No

Note: These measures are valid pre- employment, but cannot be required post-employment.

17. Is information from the employee’s pre- employment screening (including skill level) and the patient/client profile considered when assigning staff to clients?

Comments __________.

Enough Staff to Work Safely

18. Are the following aspects of work allocation present?

Adequate procedures to assess the number of staff required - Yes / No
Adequate staff numbers - Yes / No
Adequate cover available for staff who are suddenly not able to attend work - Yes / No
Adequate rest periods - Yes / No
Shift work arrangements are safe - Yes / No
Night workers can summon emergency assistance promptly - Yes / No
Hours worked are not excessive - Yes / No
Ability to request extra help when early warning signs of violence are evident. - Yes / No

Comments __________

Employee Monitoring

19. Does the employer have a system for monitoring the personal health of employees in relation to the hazards of:

Violent behaviour by patients/clients - Yes / No
Patient-handling injuries - Yes / No
Infectious diseases - Yes / No

Describe the monitoring methods used __________

Education, Training and Supervision

20. Is information and training given about the following topics?

The nature and use of patient/client profiles - Yes / No
Recognition of the precursors and triggers of both violence and calm and appropriate responses to same - Yes / No
Appropriate verbal and physical responses — given the different conditions patients and clients may have (for example, autism, schizophrenia) - Yes / No
Calming techniques to minimise the risk of violence from patients/clients - Yes / No
Dealing with pressure/bullying from relatives of clients/patients - Yes / No
Emergency response procedures (e.g. after an episode of violence) - Yes / No
Hazard identification — for identifying hazards in the client’s home and behaviour - Yes / No
Use of personal protective equipment - Yes / No
Infection control - Yes / No
First aid/reporting procedures after injury - Yes / No

21. Is expert training or advice for difficult or unusual cases available? - Yes / No

22. Is both induction training and refresher training given? - Yes / No

23. Are individual training records kept? - Yes / No

24. Is there adequate supervision* of employees on the job? - Yes / No

*Note: supervision ensures the ability of staff to put the intent of training into practice accurately and consistently. In the safety context this means:

(a) The use of the correct techniques to do the work and

(b) The ability to use the appropriate control measure for the hazards.

25. General comment on training: __________

Relationships

26. Referral agencies have a good knowledge of the ability of the organisation. - Yes / No

27. There are discussions and negotiations with stakeholders over the levels of service that can be expected/provided with the available resources. - Yes / No

28. Good relations exist with neighbours. - Yes / No

Employee Participation

Employees have the opportunity to participate in hazard management - Yes / No
The process for documenting hazards and raising issues is well communicated and accessible to employees - Yes / No

Employee Responsibilities

29. Staff recognise their responsibilities to other staff and management. - Yes / No

Staff co-operate with the employer and provide constructive feedback in matters of health and safety - Yes / No
Attend training and implement the health and safety objectives of the training as far as is possible - Yes / No
Report hazards and incidents (including stress and fatigue) - Yes / No
Take part in incident investigations - Yes / No

Injury Management

30. Does the hazard identification procedure provide comprehensive coverage of infectious hazards from violence, including specific infectious risks (e.g. dog bites, hepatitis B and C, tuberculosis?) - Yes / No

31. Are procedures for the following situations prepared and in use?

Prompt help from trained people is available in an emergency alarm response - Yes / No
Adequate provisions for first aid - Yes / No
Transport for injured employees to a suitable treatment facility - Yes / No

33. General comment on the emergency response preparedness of the organisation. __________

Injury Causation Investigation

34. Is there a functional accident and incident reporting and investigation system? - Yes / No

35. Are steps taken to modify:

patient/client violent behaviour? - Yes / No
staff behaviour if provocation was indicated? - Yes / No

Miscellaneous

36. General comments __________

Summary

37. Does this gap analysis indicate the need for action in any of the key topics below? Keep in mind that one ‘yes’ tick in each category does not necessarily indicate a ‘need for action’. You will have to use your judgement as to the significance of the gap identified for each section and the bearing it has on the need to take all practicable steps.

Client/Patient information - Yes / No

Job design - Yes / No

Facility design - Yes / No

Security arrangements - Yes / No

Selection and pre-employment - Yes / No

Enough staff to work safely - Yes / No

Employee monitoring - Yes / No

Education, training and supervision - Yes / No

Relationships - Yes / No

Employee responsibilities - Yes / No

Injury management - Yes / No

Injury causation investigation - Yes / No

Table 2 is a summary sheet for the Organisational Self-Assessment on the Prevention and Management of Violence. Use this sheet to note what is required for items that have been rated poorly in the assessment.

Table 2: Organisational Self-Assessment Summary Sheet

Factor	Practicable Steps	Likely Impact	Plan for Actioning Steps	Who will Action	Deadline
Client/patient information		H M L
Job design		H M L
Facility design		H M L
Security arrangements		H M L
Best practice selection and pre-employment procedures		H M L
Enough staff to work safely		H M L
Employee monitoring		H M L
Education, training and supervision		H M L
Relationships		H M L
Employee responsibilities		H M L
Injury management		H M L
Injury investigation		H M L