2020 131 Appendix 7 of 7 CCDHB Mgmt of Workplace Violence Aggression Procedure.pdf

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1.  Purpose
This procedure outlines the organisation and arrangements that Capital & Coast
District Health Board (CCDHB) will implement to ensure a safe and healthy working
environment free of violence for workers, consumers and visitors.

It builds upon the principles and responsibilities as defined in the Health and Safety
Policy ‘to ensure the minimisation of the risk of harm to workers and others within its
workplaces by providing a safe and healthy work environment for all’.

2.  Scope
This procedure applies to all CCDHB workers consumers and visitors.  Occurrences
classified as worker to worker bullying and/or harassment are managed as per the
Workplace Bullying, Harassment, Discrimination and Victimisation Prevention Policy.

3.  Definitions
  Consumer – A person who uses/receives a health or disability service
  Perpetrator - A person responsible for committing an offence or crime
  Violence – Any incident in which a worker has been abused, threatened or
assaulted in circumstances related to their work, involving explicit or implicit
challenge to their safety, wellbeing or health
  Physical Assault - The intentional use of force by one person against another
resulting in physical harm
  Aggressive/Threatening Behaviour - An act or gesture, verbal or physical,
towards a person, intended to cause them to believe that violence will be used
against them
  Verbal Abuse - The use of threatening or abusive words causing alarm,
harassment or distress. Examples include, but are not limited to:
-
Offensive language
-
Unwanted or abusive remarks
-
Racially aggravated remarks
-
Intimidation and any other non-physical words or actions which cause distress
or constitute harassment (or are likely or intended to do so)
  Intentional Violence – this definition of violence applies to a perpetrator who is
knowingly aware of the intent of their actions
  Violence due to a medical or clinical condition - this is where the perpetrator
does not knowingly choose to present with violent behaviour which is often the
result of them experiencing clinical instability.  This may be a result of
medication, anaesthesia, severe pain, dementia, illness, head injury etc.
  Capacity - A person is presumed to have capacity for the purpose of this
guidance unless he or she:
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  Is unable to take in and retain the information material to the circumstances
especially as to the likely consequences of their behaviour in the effect it
may have on them having or not having the treatment; or
  Is unable to weigh the information in the balance as part of a process
of arriving at the decision

Mental health problems/learning disability does not necessarily mean that a
consumer does not have capacity.  Capacity may be variable in people with
mental health problems.

4.  Responsibilities
In addition to their duties as stated in the CCDHB Health and Safety Policy:

4.1 Directorate Leads and Senior Managers
Are responsible for ensuring that:
  The requirements of this procedure are implemented within their directorates
  Formal risk assessments are undertaken in relation to the roles and tasks that
workers are required to perform which could lead to them being faced with a
situation of possible violence and/or aggression.  Assessments must also take
into consideration the risk of consumers and visitors being faced with potential
violent or aggressive situations.  The risk assessments may be undertaken at a
Directorate, service or department level
  A workplace violence and security departmental self-assessment audit is
performed in all areas on an annual basis and that ant corrective actions
identified are completed - Appendix 4
  Suitable and sufficient control measures are developed, implemented and
followed - Section 5
  Suitable and sufficient training is provided to all workers exposed to workplace
violence - Section 7

4.2 Managers
Are responsible for:
  Implementing the requirements of this procedure within their areas
  Undertaking and recording a risk assessment of the roles and tasks that workers
are required to perform which could lead to then being faced with a situation of
possible violence and/or aggression (the hazard).  This risk assessment may be
undertaken at a Directorate, service or department level.  Guidance on workplace
violence and aggression specific risk assessments is available in section 5 and
Appendix 1
  Applying appropriate control measures to ensure the safety of workers,
consumers and visitors - Section 6
  Ensuring that workers receive suitable and sufficient training in order to safely
undertake their role - Section 8
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  Providing post incident support (Section 9 and Appendix 3) to all workers
following any incident
  Performing an annual workplace violence and security departmental self-
assessment compliance audit and ensuring that any corrective actions identified
are completed - Appendix 4
  Ensuring that the requirements of section 7 are included in the planning stage,
when undertaking building refurbishments or planned builds
4.3 Workers
Are responsible for:
  Comply with all statutory legislation and associated policies/procedures
  Attend all training requested
  Communicate any identified risks to their manager immediately
  Report incidents in an accurate and timely manner, and complete an online
reportable events - SQUARE
  Assist in investigations by providing accurate information as requested.
  Consider self-referral to Occupational Health if support is needed to assist
recovery post incident

5.  Identification and Assessment of Risk
When the possibility of workplace violence and/or aggression to workers is identified,
managers are responsible for ensuring that documented risk assessments are
undertaken to assess risks faced by workers.  As part of this assessment they must
either eliminate the risk or implement suitable measures to control the risk (refer to
section 6).  It is a requirement that risk assessments are monitored to ensure
compliance and periodically reviewed.
Further details on workplace violence & aggression hazard identification and risk
assessment is detailed in Appendix 1.

6.  Control Measures
Where a risk cannot be eliminated, the law requires that suitable and sufficient
control measures are implemented to minimise the risks to health and safety.

6.1 Appropriate Worker Selection and Skills
  Use best practice selection methods and pre-employment procedures to identify
people who are suitable or unsuitable for the work
  Identify people who require training and their specific training needs before they
begin the work
  Assess employee skills in relation to dealing with consumers and assign
employees accordingly
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6.2 Communication of Risk
The normal care and precautions concerning the supply of consumer information
apply but information relevant to the safe and proper care of consumers, including
information concerning risks posed to worker wellbeing, is a necessary part of quality
consumer care and adequate worker health and safety management.

Where there is the possibility that a consumer presents a risk to the health or safety
of CCDHB workers or other caregivers, details of this risk must be communicated to
them (this includes security orderlies) in order for them to take appropriate
precautions.  Similarly, referring agencies need to provide adequate information to
permit comprehensive risk identification and on-going support plan development.
Where a group of providers are involved in the provision of support to a consumer,
ensure mechanisms are in place to enable exchange of relevant information.

Where appropriate:
  Consumer records should include a section which assesses the risk to
caregivers. In particular, the nature of the risk should be specified by asking the
following types of questions:
-  is there information in the consumer record that suggests violence has
occurred to workers in the past?
-  if you are aware of such incidents, from the information available, how
frequent are they?
-  do family members or support people report a history of violence or abuse in
the recent past?
  Ensure that workers have knowledge of the way the consumer may respond to
medication that they are receiving (i.e. the caregiver’s knowledge is matched to
the person’s needs and circumstances)

6.3 Safe Systems of Work
Safe Systems of Work (SSOW) (also known by various names e.g. working
procedures, standard operating procedures (SOPs), method statements etc.) are
formal, written documents, which accurately document and give detailed instructions
how workers must do a job/task.

A SSOW is needed when hazards cannot be physically eliminated and some
elements of risk remain. They are designed to define the safe methods to follow
when performing a task to ensure that hazards are eliminated or risks minimised.

They must be communicated to all relevant workers and the workers sign to state
that they have had the opportunity to read the safe system of work and will follow it.

SSOW documentation is available on the Health & Safety Service Intranet and
should be used for used by departments/areas for the work/tasks where the potential
for violence and/or aggression exist.

6.4 Local Protocols/Procedures
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Each area which has identified that there is a risk of violence should have a clearly
understood, written operational procedure (emergency response protocol/action
card) agreed with the staff which may include:
  Minimum levels of staffing
  Who should do what, when and how in the event of a potentially violent situation
  Traceability of workers (diary tracking, lone worker monitoring and alert systems)
  This plan should be based on the findings of the risk assessment.

6.5 Local Work Practices
  Consider rotating jobs/areas to reduce the period of exposure (with respect to
long-term mental fatigue)
  Define tasks and vary them if possible
  Assign tasks to workers who have the skill and ability to do them – consider
general abilities and things that may impact in the short term such as pregnancy,
fatigue and/or fitness
  Rotate workers who do dangerous and/or unpleasant tasks or who are new to the
job
  Introduce team care or buddying in situations where risk is unknown or high
  Consider the cultural factors (e.g. culturally inappropriate behaviour of employee)
that may escalate or de-escalate consumer aggression
  Provide clear messages to consumers and their visitors that violence is
unacceptable and has consequences
  Use behavioural techniques to promote non-violence

6.6 Means to Allowing Workers to Summon Assistance
Following risk assessments, where appropriate:
  Provide workers with personal communication devices
  Install emergency alarms and/or CCTV systems.  Any systems installed must be
tested periodically (minimum of monthly, weekly in higher risk areas).  All testing
must be documented.
  Consider a mixture of personal and wall-mounted alarms so that workers have a
variety of options to summon assistance
  Test these responses to alarm activation regularly and measure the response
time to ensure that intervention occurs before serious harm can be inflicted
  Ensure that all workers have received training in the use of any devices/systems
installed upon induction and periodically thereafter, as identified in the risk
assessment

6.7 Clothing and Jewellery
  Ensure that clothing is appropriate to the level of risk encountered
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  Instruct workers not to wear jewellery or carry tools or pens in at-risk situations
  In all areas the wearing of jewellery by all clinical workers, must be kept to a
minimum to avoid risk of injury to both the workers and consumers.  The CCDHB
Policy - Dress code – Nurses, Midwives and Health Care Assistants states:
Jewellery is limited to one pair of discreet stud earrings (not multiple), a single
wedding band or similar style of ring
  Ensure that emergency response devices cannot be used as a weapon (e.g. a
personal alarm used as a garrotte)
  In areas of higher risk, identification badges must be worn on ‘clothing clips’ as
opposed to lanyards worn around the neck.  This is to prevent the possibility of
them being grabbed and used as a potential means to strangling staff.  Lanyards
with one breakaway clip at the rear do not ‘give way’ if grabbed from the rear and
can be used to strangle a worker.  Workers must also be aware of the potential
risk associated with wearing ties and/or stethoscopes.

6.8 Other Measures
Where appropriate:
  Signpost areas for workers, consumers and visitors
  Use signage to identify areas of special risk or restricted areas
  Provide easy egress from areas where violence may occur
  Consider installing other security devices such as cameras and good lighting in
hallways
  Provide emergency exits
7.  Building Refurbishments and Planned Builds
Prior to the refurbishment or redesign of areas and/or premises owned or leased by
the DHB, as well as at the design stage of new builds, Directorates, managers and
Facilities and Development are required to consult with the Health and Safety
Service and any other relevant specialists at the earliest stage to encompass all
control measures to protect workers and others.

Appendix 2 – Designing for Safety, provides further advice and guidance for creating
a safer working environment.

8.  Training
8.1 General Training
As a basic level, all workers must receive training to introduce them to the subject of
violence and aggression in the workplace on induction.  As part of the Health &
Safety Service presentation at generic orientation day, workers will be provided with
a basic overview of workplace violence and aggression and the importance of
reporting all incidents.  Departmental inductions must include any specific
requirements for managing violence and/or aggression including any relevant
security precautions for the area, as well as how to summon help if required in an
emergency.  Every worker should be prepared on how to react appropriately in a
crisis.
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Depending upon the level of risk identified, further training may be appropriate.  The
identification of training needs is the responsibility of the Directorate Leads and
Senior Managers and departmental managers.  This must take into consideration the
past history of incidents of violence and/or aggression to workers and the risk
assessment of the possibility of such events occurring.

8.2 Personal Safety and De-escalation Training
Depending upon the level of risk identified by the directorate/service/manager, further
training in the form of personal safety & de-escalation may be appropriate.  Emphasis
must be placed upon the importance of de-escalation and the steps which can be
taken to prevent incidents of violence and aggression occurring in the first instance.

Training is intended to equip participants with the skills to recognise and de-escalate
potential violent incidents, and will include issues associated with customer care and
diversity.  Training must focus on prevention rather than just being reactive.

Mental Health and Intellectual Disabilities (MHAIDS) offer training, entitled ‘Te Roopu
Whakatau Challenging Incidents’, which is an interactive workshop focussing on
conflict resolution and communication strategies to effectively manage aggression
and threat of harm in the workplace.  This suite of courses can be accessed via
ConnectMe.

Having attended training, the frequency of re-attendance must be based upon the
assessed needs of the individual service and the workers role within the service.

8.3 Personal Restraint Training

All workers who may be required to restrain a consumer, or a visitor an emergency
situation, must receive additional training in personal restraint to ensure their own
and the restrained person’s safety.

All restraint techniques taught must be appropriate for use within a healthcare
environment, and backed up by appropriate risk assessments.  Pain compliance
techniques must never be taught or used.

Further information on the physical restraint can be found in the Restraint
Minimisation and Safe Practice Policy.

9.  Incident Reporting and Investigation
9.1 Reporting
All health and safety incidents and near misses, including verbal abuse, must be
reported on the SQUARE Reportable Event System.  Under-reporting of incidents is
a particular problem with aggression/violence.  Reporting is important to help identify
and manage such situations.  A positive culture to encourage reporting is therefore
required.

9.2 Investigation
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All reports must be investigated by the manager, to identify the root cause(s).  As
part of the investigation, the manager should review the triggers or circumstances
relating to the incident; and assess whether the situation is still a risk to workers.

As part of the investigation managers are required to state what actions are required
to prevent a recurrence and how they intend to implement them.  All investigations
and interventions must be recorded, by the manager, on the SQUARE Report.

The manager must keep the worker fully informed of the progress and outcome of
the investigation.
9.3  Learning from Incidents
When incidents occur they raise awareness and understanding of things that went
wrong, and perhaps could go wrong again.
The challenge is to learn as much as possible about the causes of accidents and
near misses that have already happened in order to prevent a reoccurrence.  The
focus should be to make sure that the lessons learned from incident investigations
are implemented and lead to an actual improvement in safety.
When experiences of previous incidents are translated into preventative measures,
an organisation can prevent incidents in the future.
It is also useful to learn from incidents that have occurred in other workplaces.
Knowledge from these incidents allows for the comparison of systems and processes
and enables managers to compare what they have in place to determine their
effectiveness and to identify any additional controls required.  Where necessary, the
findings should be communicated to other relevant departments to ensure that
CCDHB as a whole benefit from them.

9.4 Reviewing Risk Assessments
As part of the investigation process, managers should review their risk assessments
to determine if the existing control measures were adequate.  If necessary risk
assessments must be updated following the review.

Further information on H&S Incident investigation can be found on the H&S intranet
site.

10. Post Incident Support
Workers are entitled to expect that their actions will be supported with understanding
by their supervisors and managers and by CCDHB.  It must be reinforced that
workers are not to blame and that however insignificant others may consider the
abuse, threat or assault everyone is entitled to support.  The effect that one incident
has on a worker may differ greatly to that of another.

A worker who has been attacked may suffer psychological harm as well as physical
injury and confidential counseling services are available Occupational Health
(through the Health & Safety Service) or self-referral to the Employee Assistance
Programme.

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It may take some time for the individual to regain their previous level of confidence to
return to their work, and managers should carefully monitor the immediate period
after the return.

Following incidents all workers involved should be given the opportunity to discuss
the incidents in a supportive environment, usually with managers and peers.  CCDHB
will provide support and assistance for workers in the event of criminal/civil
proceedings.  All and any support/advice offered should be documented.

Further guidance is available in Appendix 3 - Guidance Checklist for Managers
Following an Assault on a Worker.

11. Sanctions

11.1  Consumers
Any action taken in response to violent or abusive behaviour by a consumer should
be carefully planned.  It should take into account the clinical needs of the consumer,
the right of all consumers to be treated in a safe and caring environment and the duty
towards workers.

Actions implemented should be relevant to the circumstances. These may include:
  Drawing the person’s attention to the fact that their behaviour is unacceptable  
  Treatment of consumer in the presence of increased security or Police and/or
alternative treatment facility/location/times/days, including suspension of routine
appointments following medical advice*  
  Reporting the behaviour to the Police

*As excluding consumers from clinical care has legal and ethical implications, it is
important that the consumer’s clinical team meet and come to an agreed
documented approach which will endeavour to continue to care/treat the consumer
and minimise the risk of further incidents of violence and aggression.  In certain
areas excluding a person is not a possible consideration.

11.2  Visitors
Visitors who display any unacceptable behaviour should be asked to stop and be
offered the opportunity to explain their actions.  Continued unacceptable behaviour
may result in the individual being asked to leave the premises by a manager or
person in charge of the area.

Visitors who appear to be under the influence of alcohol or drugs may be refused
entry to CCDHB premises.
Such action will need to be undertaken with minimal risk and should not be attempted
without appropriate support. Depending on the location and circumstances this can
involve security or the Police.  Incident reports must be completed for all incidents of
violence and aggression.  Any request to leave and the visitor’s response must be
documented within the reportable event report.

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11.3  Trespass Notice
Trespass arises from the right of an occupier to control property. The Trespass Act
1980 creates two offences:
  Warning to Leave – Every person commits an offence that trespasses on any
place and, after being warned to leave by an occupier of that place, neglects or
refuses to do so.
  Warning to Stay Off – Where a person has trespassed, or there is reasonable
cause to suspect they are likely to trespass, the occupier may warn that person to
stay off that place.  Having been warned that person commits an offence if they
trespass on the property.

A Trespass Notice is the means by which an individual is warned to leave and/or stay
off.  A warning to stay off applies for 2 years unless specified for a shorter period or
revoked.  Trespass Notices should be regarded as a last resort after all other means
of addressing the situation have been exhausted.  They should not be routinely used
to manage consumers or visitor behaviour, nor should they be used to penalise an
individual. For further details on Trespass Notices please refer to the CCDHB
Security Policy.

12. Lone Working
“Working alone means the normal contact with other staff is not available. This may
include working in isolated areas on-site or off-site, either during or outside normal
working hours”.

Specific advice and guidance on managing the risk to lone workers is detailed in the
Lone and Community Worker Safety Procedure.

13. Audits
Line managers are required to undertake annual (or sooner if identified in risk
assessments) self-assessment compliance audits into the management of violence
and aggression within their area and provide these to H&SS upon request. These
audits will be used as evidence of compliance with this procedure and relevant
legislation.

14. Reference
  Managing the Risk of Workplace Violence to Healthcare and Community Service
Providers: Good Practice Guide (Department of Labour)
  New Zealand Standard – Health and Disability Services (Restraint Minimisation
and Safe Practice) standards
  Private Security Personnel and Private Investigators Act 2010

15. Associated CCDHB Documents
  Health and Safety Policy
  Security Policy
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  Security Incidents Procedure
  Staff Support Following a Critical Incident Procedure
  Lone and Community Worker Procedure
  Restraint Minimisation and Safe Practice Policy
  Workplace Bullying, Harassment, Discrimination and Victimisation Prevention
Policy
  Managing and Preventing Workplace Bullying, Harassment, Discrimination and
Victimisation – Guidance for Employees and Managers
  Staff Support Following a Critical Incident Policy]
  Managing Healthcare Incidents (Reportable Events) Policy

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Appendix 1 - Workplace Violence & Aggression Hazard
Identification and Risk Assessment
The  Health  and  Safety  at  Work  (General  Risk  and  Workplace  Management)
Regulations 2016 state that the PCBU ‘must identify hazards that could give rise to
reasonably  foreseeable  risks  to  health  and  safety’.    Verbally  or  physically  abusive
behaviour towards workers is a reasonably foreseeable risk.

The purpose of a risk assessment is to:
  Identify the hazards - what can cause harm, how serious the harm could be and
who could be harmed
  Assess  the  risks  -  examining  existing  control  measures  to  determine  the
effectiveness  of  them  at  eliminating  or  controlling  the  potential  level  and
seriousness of harm
  Manage the risks - determining if there is anything else you can do to eliminate or
further reduce the level of risk
  Monitor control measures - checking that the control measures are being used
and are effective

1.1 Identification of Risk
Managers  are  responsible  for  ensuring  that  documented  risk  assessments  are
undertaken  to  identify  and  assess risks faced  by  workers.  Following  this, they  must
implements suitable and sufficient measures to eliminate or control the risks.  They are
also required to evaluate, monitor and periodically re-assess them.

The risk assessment must take into account the past, present and future:
  Past  -  any  previous  incidents  or  known  history  of  violence,  verbal  abuse  or
threatening behaviours towards workers
  Present - the environment and any existing arrangements in place to manage the
hazards  faced  by  workers,  such  as  the  equipment  available,  communication
systems in place and training
  Future - the risk inherent in the task to be carried out such as any threats that
have been made as to future behaviour and the process to be followed in the
event of an incident

The risk assessment must consider:
  Work Environment
-
Is work performed in unfamiliar environments?
-
Are workers working in isolated locations?
-
Is it easy for an aggressor to get physical access to a worker?
-
Is it difficult for a worker to retreat to a safe place?
-
Is the environment uncomfortable for consumers?
-
Does the physical layout fail to provide privacy for consumers?
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-
Would it be easy for an aggressor to break into the workplace after hours?
-
Is access to alarms difficult or too obvious?
-
Is there the potential for workers to be trapped by furniture/fixings?
-
What is the availability of weapons or furniture/fixings which could be used as
potential weapons?
-
Are there any issues around the observation of workers and others?
    Work Practices
-
Is there appropriate staffing and skills mix?
-
Are there likely to be service delays?
-
Are there workers working alone or in isolation?
-
Would it be difficult for a worker to get immediate assistance if threatened or
attacked?
-
Have  security  and  emergency  procedures  been recently  checked  and  is this
documented?
-
Are evaluations on the suitability of workers with medical conditions, such as
being pregnant carried out?

  Training
-
Are there inexperienced workers in front line positions?
-
Are  there  workers  who  have  not  received  training  in  how  to  deal  with
aggressive situations?
-
Are there workers who do not have the appropriate workplace knowledge and
skills to deal with clients?
  Consumer Behaviour
-
Are consumers likely to be distressed or aggressive?
-
Is the behaviour of the consumer 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?
-
Is the aggressor likely to be affected by delirium or other perception altering
medical conditions?

Advice on personal safety risk assessments can be obtained via the Health & Safety
Service (H&SS) or CCDHB Security Manager.
Higher risk areas such as triage or interview rooms should be examined in terms of
the need for appropriate alarm systems and/or ease of calling for assistance.
However,  it  is  essential  that  the  introduction  of  any  alarm  system  is  combined  with
appropriate training and guidance. On hearing the alarm, workers must be clear of how
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to respond, including their responsibilities, specifically in terms of calling for assistance
from security orderlies or the police.
In higher risk areas it is essential to designate safe areas where workers can quickly
retreat to, lock the door and raise the alarm.  For example the use of easily turned door
locks rather than keys will facilitate safely in an emergency situation.
The information provided in Appendix 2 – Designing for Safety, provides further advice
and guidance for creating a safer working environment.

Once  a  risk  is  identified  a  formal  risk  assessment  must  be  undertaken  and  all
reasonably  practicable  steps  taken  to  either  eliminate  the  hazard  or  if  this  is  not
possible, then appropriate control measures must be taken to minimise the risk to as
low a level as is reasonably practicable.

Information on the outcome of risk assessments should be communicated to workers
as part of the risk management process.  Arrangements also need to be put in place
to monitor and review the findings of the assessment.

1.2 Consumer Specific Risk Assessments
When  a  consumer  is  admitted  or  referred,  workers  should  try  to  obtain  as  much
information  as  possible  on  any  possible  risks  posed  by  the  consumer  in  relation  to
violence and aggression.  This may mean obtaining information from:
  A  current  medical  report  from  the  referral  agency,  a  general  practitioner,
psychologist or psychiatrist
  Those with recent responsibility for the consumer (e.g. caregivers, family)
  The Police

Workers must document if there is a risk or potential risk of harm to workers, or others,
that may result from contact with the consumer and communicate this to them.

Consumer specific risk assessments should be completed or reviewed if:
  the  consumer  has  a  history  of  unpredictable,  challenging,  violent  or  aggressive
behaviour
  the consumer user displays challenging, violent or aggressive behaviour
  an incident occurs or a consumer, relative or visitor becomes aggressive

Consumer specific risk assessments should take into account:
  What is the mental, emotional and physical condition of the person?
  Is their behaviour related to their medical conditions or ingestion of drugs, alcohol
or medicines?
  Are they facing high levels of stress?
  Do they have a history of challenging, violent or aggressive behaviour?
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  Do they consider workers a threat?

The prevention measures identified by the risk assessment must be recorded in the
consumers  care  plan  and  this  information  must  be  brought  to  the  attention  of  all
workers  who  are  likely  to  be  involved  with  the  care  of  the  consumer.    This  should
include all workers, not just medical staff, e.g. domestics.

There  must  be  procedures  in  place  for  the  ongoing  assessment  and  reporting  of
changes in consumer behaviour.

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Appendix 2 - Designing For Safety
This section (taken form: Managing the Risk of Workplace Violence to Healthcare and
Community Service Providers: Good Practice Guide (Department of Labour) applies
to  in-patient  care  services  and  is  not  necessarily  applicable  to  community-based
service providers.

The principles of such advice include:

Access
  Provide safe access and quick egress from the workplace
  Minimise multiple areas of public access to healthcare facilities
  Locate  security  services  at  the  main  entrance,  near  the  visitors’  transit  route  in
emergency departments
  Locate employee parking areas with close proximity to the workplace if possible
  Ensure the reception area is easily identifiable by patients and visitors, and easily
accessible to other workers
  Restrict access to employee areas (changing rooms, rest areas and toilet facilities)
to personnel of the facility

Space
  Provide enough space per person to reduce interference with personal space
  Design  waiting  areas  to  accommodate  all  visitors  and  patients  comfortably  -
provide adequate seating, especially if long waiting periods are a possibility
  Provide  employees  with  separate  rest  areas  and/or  meal  rooms  away  from
patients/clients, particularly when doing night work or dangerous work
  Install protective barriers for workers at special risk and to separate
  Dangerous  patients/clients  from  other  patients  and  the  public  consistent  with
assessment of therapeutic needs

Fixtures and Fittings
  Provide good lighting
  Provide an environment with an appropriate temperature, humidity and ventilation
  Where  high-risk  patients  are  cared  for,  ensure  that  the  wall  coverings  are
sufficiently robust to withstand assault
  Ensure fixtures and fittings cannot be used as weapons

Premises
When the opportunity presents itself for new premises or redesign:
  Design facilities with the potential for emergencies in mind
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  Address  the  issue  of  “black  spots”.    These  are  the  areas  that  either  promote
violence by tunnelling people into confined spaces, or by restricting egress from a
hostile situation
  Ensure interview rooms have two exits (to avoid a worker becoming trapped) and
viewing window(s) so that other workers can intervene if necessary
  Ensure treatment rooms in emergency service areas are apart from public areas
  Keep levels of noise to a minimum to reduce stress, irritation and tension
  Provide facilities for waste management i.e. soiled linen, clothing etc.
  Provide  extra  services  of  facilities  and  equipment  where  needed,  e.g.  where  a
patient/client is known to be hepatitis B positive
  In problematic areas, and where proven need exists, introduce facilities to ensure
that weapons or mood-altering substances are not smuggled to patients/clients
  Ensure weapons removed are stored off site by police or security
  Ensure that windows and doors are secure so that patients/clients can be cared
for in an environment safe for them, the staff and the public at large
  Isolate  potentially  dangerous equipment,  chemicals  or  medication  supplies (i.e.
locked cupboards where appropriate)
  Consider  the  use  of  closed-circuit  TV  where  oversight  may  be  required  in
geographically difficult or distant parts of the building
  Where  appropriate,  install  security  devices  such  as  metal  detectors  to  prevent
armed persons from entering the facility
  Test these security devices and personal/other alarm procedures regularly
  Where  appropriate,  provide  adequate  security  lighting  and  security  escorts  for
evening or night workers

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Appendix 3 - Checklist for Managers Following an Assault on a Worker

Health & Safety Service
Checklist for Managers Following an Assault on a Worker

The following points should to be considered & carried out by the Manager immediately
following an incident:

  Do you need to call Security?
  Do you need to call the Police?
  Does the assaulted worker require medical assessment or attention for physical or
psychological injuries?
  Do you need to contact Occupational Health for further assistance and support for
workers?
  Do you need to cordon off any areas to preserve evidence for the Police?
  Have you obtained the names and contact details of any witnesses, this will include
consumers and visitors as well as workers?
  Have you obtained photographic evidence of any injuries sustained by workers or
damage caused by the perpetrator?
  Does the worker feel fit to continue duties?
  Do they need assistance with transport to get home?
  Do they need recovery time after the incident?
  Has the worker had an opportunity to discuss the incident and talk about how occurred
and how it was managed?
  Does the worker require counselling from EAP Services?
  Do other workers within the team who were affected by the incident require support?
  Consider if it is appropriate for the worker to continue to provide care to the consumer
  Do any changes need to be implemented to prevent a reoccurrence, such as a change of
working practice or working environment?
  Has a SQUARE report been completed?
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Appendix 4 - Workplace Violence and Security Departmental Self-Assessment Audit
Please Note: This is a copy of the form which is available on the H&S intranet site

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