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Appendix 4: Workplace Violence - Risk Assessment Form and Samples

Example 6: Independent Medical Examination in Private Rooms

Section 1: Context Appendix 4: — setting the scene

Location: Specialist medical rooms

Division: Physician working both in private and within the hospital environment

Area/Activity/Person: Mr MJ is a 33 year old labourer. He was referred for an assessment of his work capacity following an injury. He presented with a variety of symptoms after having apparently fallen on stairs at a work-skills training course. Later the same day he was involved in a fight. Following this fight he reported experiencing pain of his head, left anterior chest, neck, buttocks, left elbow and wrist, bilateral anterior ankle and sole of foot pain. During this assessment he demonstrated those activities he was unable to perform (which included a one-handed push-up and a headstand). He reported that he was unable to work as a traffic controller (road repairs) due to his level of symptoms, but stated that appropriate vocational goals for him included: him working as an actor, a male model, a professional boxer, a bobcat operator or go to university to become a Mechanical Engineer. The physician considered Mr MJ to be physically fit for employment, but had concerns regarding his psychological fitness for employment recommending that he be referred for a psychiatric assessment. His rehabilitation provider provided Mr MJ with a copy of my report. He has a record of previous assaults on medical professionals, this history was unknown to the assessing physician at the time of the assessment.

 

Section 2: Identifying Hazards — what can go wrong and who will be affected

Hazard	Something with the potential to cause harm	Persons at risk [√]
A	Physical injury to attending persons; targeting professionals who disagree with his perceptions	S[√]  V[√]  P[ ]  O[ ]
B	Mental injury from intimidation to independent physician or their staff	S[√]  V[ ]  P[ ] O[√]
C	Soft tissue injury to self resulting from falls and acts of physical aggression directed at inanimate objects	S[ ]  V[ ]   P[√]   O[ ]

S = staff; V = Visitor, P = Patient; O = Other

Section 3: Existing Control Measures —what practical steps are already in place

Hazard	Existing Control Measures
A	Preventing the decision to commit violence: The doctor and their staff can reduce the risk by being courteous and professional (particularly in the face of provocation). Create a physical and emotional environment, which is calming and relaxing. This can be achieved through a variety of mediums, including the use of light, colour, music, pot plants and space. Not allowing clients free access to offices and consultation rooms. Maintain an attitude of not being intimidated by threats of violence. With a difficult client, give clear reasons why their demands cannot be met based on sound principles and logic. Make use of a chaperone or witnesses to conversations. Always retain the right to terminate the interview, or offer the client an “out” of the situation. It may be appropriate to re-schedule the assessment for a later time or alternatively advise the client as to the reasons for terminating and explaining the possible implications. Design for safety in private rooms, have a (potential barrier between you and the patient, have an escape route and a mechanism for summoning help. Require referrers to identify individuals with history of assault of intimidation towards professional staff.
B	Induct staff into appropriate responses and actions when confronted with potential violence. Have yourself and staff undertake calming and de-escalating training. Develop a protocol for staff to follow post incident based on the UK NICE recommendations[1]. Have access to appropriate treatment services for yourself or staff as per protocol.
C	Be able to offer independent treatment options to individual, warn provider of potential problems.

[1] http://www.nice.org.uk/ [external link, pdf file]

 

Section 4: Evaluating risk — not ‘worse case scenario’; takes into account existing controls

Hazard	Consequence ( 1 – 5 )	X	Likelihood (1 – 5 )	=	Risk Rating (1 – 25 )
A	4	X	3	=	12
B	4	X	3	=	12
C	2	X	2	=	4

 

Section 5: Risk prioritised action plan - applying the hierarchy of controls:

E=eliminate I=isolate M=minimise

Hazard	E /I/ M	Practicable Steps required to further control risk	Responsibility
All	M	Identify individuals at risk Ensure environment is equipped  to minimise risk and to provide options in the unlikely advent of behaviour deterioration	Specialist or practice manager
B	M	Consider such situations when employing staff and if such incidents are a significant hazard avoid  employing staff with pre-existing anxiety or depressive disorders. Post incident provide a safe working environment while the staff member adjusts	Specialist or practice manager

 

Section 6: Further Information: cross-sector safety responsibilities

Who is responsible for local monitoring?: Practice Manager, booking staff (when accepting individual from referrer)

Is further competent (clinical risk, manual handling) advice required? Yes / No Comments: Psychiatric review

Do third parties (agencies) require a copy of this risk assessment for their safety? Yes / No Comments: All parties at risk

 

Section 7: Assessment Sign-Off – assessment monitoring responsibilities

Assessor’s name: Physician

Date of assessment: 17 July 2005

Assessor’s signature:

Review: (tick one) daily weekly monthly yearly

Reassessment date: 18 August 2005

Manager’s signature:

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