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OHS Management System: Risk Management |
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> Introduction to Risk Management |
> Pets |
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Aggression and Violence
> Introduction
> Hazard Identification
> Risk Assessment
> Risk Controls
> Evaluation
> Resident Aggression Incident Reports
> The Guide: Implementing Occupational Health and Safety in Residential Aged Care
> Templates & References
Introduction
Workers Compensation claims in 1995/96 showed that violence is most prevalent in:
1. Health, and
2. Welfare and community services.
In 1997/98 there were 952 injuries across all sectors involving violence. They cost $13.1 million and 19,860 weeks in lost time
Under OHS legislation, you are required to provide a safe working environment. This includes making sure your staff are safe from aggression.
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Case Study A client is intellectually impaired. He has a history of violence including sexual assault and suffers from a psychiatric disorder. He receives assistance in his home. He assaults a home worker. In 1999, the Department of Community Services is fined $95,000 for failing to ensure the safety of their worker. They had not provided the employee with a mobile phone or duress alarm. NSW Health, Managing OHS&R. October 1999 |
Case Study It is April 1997. In Rozelle Hospital a psychiatric patient becomes violent. Four nurses rush to the ward. The patient is unrestrained. Joe (not the patient’s real name) lashes out. He punches and kicks the nurses. In the confusion, one nurse becomes locked in the ward with him. Joe spots some broken glass. He picks it up and threatens the nurse. In this case, the nurses suffered only minor physical injuries. But the result could have been very different. In the NSW Industrial Relations Commission in |
2002, Justice Schmidt finds the Central Sydney Area Health Service (CSAHS) failed to provide a safe workplace for staff. Justice Schmidt points out the breakable glass is a known risk. He notes that there should have been a designated controlled entry point for staff in such an emergency. He said, if the choice is restraining a violent patient or risking the safety of employees, the employees must come first. He fined CSAHS $180,000. WorkCover NSW, Media Release, 10 April 2002 |
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Have you identified the risks associated with violent behaviour?
Have you taken steps to ensure your employees will be safe in such a situation?
Hazard Identification
As with any workplace hazard, our starting point needs to be hazard identification.
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• Conduct an inspection of the client’s residence. This should be done by more than one person. • In the absence of formal reports, consult with carers on previous instances. • Consult with previous field workers. |
• Conduct workplace inspections – are there environmental factors contributing to resident aggression? • Undertake security assessments |
• Review incident and accident reports • Consult with employees – they may have valuable information on resident behaviours. |
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Risk Assessment
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• Screen new clients – is there a history of aggression? • Does the client have a history of drug or alcohol abuse? • What is the physical and psychological condition of the client – could this lead to aggression? • Are there any cultural considerations that could cause misunderstandings and trigger an abusive reaction? |
• What is the frequency, duration and severity of resident aggression? • Can triggers of aggression be identified? • Is there a history of drug or alcohol abuse? • What is the physical and psychological condition of residents? • Are there issues with resident size or strength in comparison to staff? |
• Are there any cultural or language considerations? • Review history of new residents prior to admission. |
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Risk Controls
- Are potentially aggressive people identified and staff numbers altered accordingly, such as working in pairs?
- Are staff trained in aggression management? Is training ongoing?
- Are communication procedures in place for communicating aggressive behaviours particularly at change of shift or staff?
- Have staff been given mobile phones, pagers or other communication devices?
- Are incident reports completed?
- Are there procedures for post-incident management?
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• Make sure somebody knows your schedule. • Stay alert. • Don’t go where you don’t feel safe. • Put your own safety first. • If you don’t feel safe – leave! • Work in pairs. |
• Consider your organisation design particularly lighting, access and barriers. • Can the resident be isolated? Consider fences, visibility barriers, seclusion rooms. • Can a safer piece of equipment be used such as perspex instead of glass? |
• Are policies and procedures for violent situations in place, such as minimum number of responding staff? • Is protective equipment used, such as video surveillance? |
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Evaluation
It is vital to continually review your aggression procedures. In particular:
- Have behaviours changed?
- Could a degenerative condition such as dementia cause worsening behaviour?
- What can be learned from incident reports?
Resident Aggression Incident Reports
Incident Reports can help you to find triggers for aggressive behaviour. They should include:
- Are there patterns of aggressive behaviour?
- What was happening at the time?
- What happened as a result of the aggressive behaviour? Did they want something to change and did they get what they wanted through the aggressive behaviour?
- How was the person’s health?
- Were any behaviour management strategies used?
- Does the care plan need to change in response to this incident?
- Does this incident have implications for the organisation?
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If an incident occurs: • Take time to recover and call your employer if you are working offsite. • Report the incident. • You may suffer post-trauma reactions. That’s normal and OK. • If reactions persist or are severe ask for help. |
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The Guide: Implementing Occupational Health and Safety in Residential Aged Care
The Guide is an excellent resource for aged care organisations. Module 5 deals with resident aggression. It includes an extensive checklist for identifying hazards and a sample Resident Aggression Incident Report. The Guide is a good starting point for dealing with resident aggression.
Templates & References
The Guide: Implementing Occupational Health and Safety in Residential Aged Care - Module 5: Resident Aggression
The Community Services Safety Pack (PDF) - Section 3.2 deals with workplace violence in the community services sector.
Restraint in the Care of Older People - recommendations on the use of restraints.