Prevention and management of aggression in ... - WorkSafe Victoria

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5.Policy, procedures and practiceA risk assessment should be conducted if conditions change or if there areany other indicators the behaviour might be a problem.An example of a high-risk screening tool for the point of entry (triage) canbe found in Tool P2, and a tool for combined violence risk identification andassessment is included in Tool P3.Risk factors should be noted and highlighted in a care management or treatmentplan, after completing a behaviour assessment worksheet (Tool P4).5.5 Client alert systemsInformation known about any risks of violence or potential violence that may posea threat to health and safety should be provided to staff who may come intocontact with the client or to another health service to which the client is referred.Where a health service is aware of a risk of aggressive or violent behaviour, thereis an obligation to inform other parties of the risk if the client is referred to anotherservice, department or facility.Alert systems, or ‘file flagging’, are used for a variety of clinical risk managementand client safety reasons (e.g. to identify clients with life threatening allergies) andcan also be used to identify client behaviours that could create a risk to health andsafety. Criteria for flagging should be carefully developed and linked to safetyissues that arise from a client’s behaviour, rather than personal characteristics.An example of a client alert can be found at Tool P5. Alternatively, a chart tag orlog book may be used. The information needs to be objective, reviewed regularlyand kept up-to-date.A client alert procedure should cover the following issues:• Clearly defined purpose for the flag, such as focus on behaviour and risk.• Person to whom the flag refers (e.g. client only, family, regular visitors).• Behaviour management planning.• Delegated responsibility for initiating, reviewing, removing flags, andreviewing and updating associated management plans.5.6 Care planningCare planning requires a clinical understanding of aggressive behaviour.Some common causes include:• pain• medication-related issues• drug withdrawal• fatigue, or• change of environment, routine or care giver.Clinical reasons can include:• delirium• perception of loss• response to overwhelming stimuli, or• some psychological states.24 Handbook / Prevention and management of aggression in health services WorkSafe Victoria
5.Policy, procedures and practiceIf a client file has an alert flag it should be supported by an up-to-datemanagement plan. Care plans can be developed through a multi-disciplinary teamapproach. Case conferences can be an opportunity to prepare a multi-disciplinarycare plan that could include health and safety representatives (HSRs)or OHS staff.5.7 Incident managementIf an incident occurs or escalates, it is important staff have immediate responseoptions, which may include calling more senior staff for assistance, a duressresponse team, security or the police.The response approach selected needs to be appropriate to the situation andskills of staff and may include:• review by a clinician• calm verbal and non-verbal communication• verbal de-escalation and distraction techniques• support from other staff• request that the aggressor leave• withdrawal to a safer location• internal emergency response• external emergency response• evasive self-defence, or• initiating a duress response.It should be possible for any member of staff to initiate a duress responseat any time.Where facilities have more than one high-risk area (e.g. emergencydepartments and mental health facilities), consider a secondary duressresponse protocol, in case two incidents occur at the same time.Evasive self-defenceEvasive self-defence assists staff to safely remove themselves from a violentsituation and minimise the risk of injury to themselves and others. The degree offorce used must be proportionate to the degree of potential harm faced and mustnot be applied for longer than is reasonably required to control the risk.Evasive self-defence strategies may provide staff with a controlled physicalresponse when retreat is blocked; all other non-physical strategies have failed;the staff member is under threat of attack; or is being attacked.RestraintRestraints can be physical, mechanical or chemical and are designed to safelyrestrict a person’s freedom of movement. Organisations need clearly writtenpolicies and procedures related to client restraint, which should include:• a method for evaluating situations where restraint might be needed• safe and proper application of safety devices• client monitoring and review, and• documentation.WorkSafe Victoria Handbook / Prevention and management of aggression in health services 25
Page 1: A handbookfor workplacesPrevention
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Page 8 and 9: 3.Review, prepareand implement3.1 C
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Page 35 and 36: 7.References7.1 Related DocumentsTh
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Page 39 and 40: ToolsOrganisationTool 01 Organisati
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Page 61 and 62: ToolD2Violence and the design proce
Page 67 and 68: ToolP1Violence prevention policyNam
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Page 71 and 72: ToolP2High risk screening (cont)No
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ToolP4Behaviour assessmentHandbook
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ToolP5Client alertHandbook keyTempl
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ToolP7Conditions and agreementDear
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ToolT1Exposure to aggression risk c
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ToolT2Aggression risk calculatorThi
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ToolT3Post-training evaluation tool
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Tool T5 - Competency-based assessme
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Tool T5 - Competency-based assessme
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