RESPECT PROTECT - Australian Nursing & Midwifery .../media/files/anmf/ohs/10pointplan-gui… · But...

RESPECT AND PROTECT OUR VICTORIAN HEALTHCARE WORKERS

anmfvic.asn.au/ovaguide

CONTENTS

Message from Victorian Health Minister Jill Hennessey page 1

Message from ANMF (Vic Branch) Secretary Lisa Fitzpatrick page 1

Introduction page 2

• Pre-conditions

• Scope

• Terminology

• Instructionsforuse

1. Improvesecurity page 4

2. Identifyrisktostaffandothers page 6

3. Includefamilyinthedevelopmentofpatientcareplans* page 9

4. Report,investigateandact page 10

5. Preventviolencethroughworkplacedesign page 11

6. Provideeducationandtrainingtohealthcarestaff page 12

7. Integratelegislation,policiesandprocedures page 14

8. Providepost-incidentsupport page 16

9. Applyanti-violenceapproachacrossallhealthdisciplines page 17

10. Empowerstafftoexpectasafeworkplace page 18

*ANMFNote:ReferraltoPatientCarePlanincludesallassociateddocumentse.g.BehaviouralManagementPlan.

First edition published in 2017. This edition was revised and printed in October 2018.

© This work is copyright. Apart from any use permitted under the Copyright Act 1968, no part may be reproduced by any process, nor may any other exclusive right be exercised, without the permission of The Secretary, Australian Nursing & Midwifery Federation (Victorian Branch), Melbourne, 2017. PAGE 1

MESSAGE FROM THE HON JILL HENNESSY MP Minister for Health, Minister for Ambulance Services

Nursesandmidwiveshavetherighttobesafe–andfeelsafe –atwork.Youcareforusatourmostvulnerableanddeservetheutmostrespectfortheworkyoudo.

You–andeverybodywhoworksinthehealthcaresystem–deservestogohomesafelytotheirfamilyaftereachshift.Violenceandaggressionjustshouldn’tbepartofthejob.

Yetitoftenis.

It’ssomethingourGovernmentisdeterminedtoaddress.

Wewon’ttolerateoccupationalviolenceandaggressionagainstnurses,midwivesandotherhealthcareworkersandwewillcontinuetowork withyoutomakeyourworkplacessafer.

IwanttothanktheANMFforitsleadershipindevelopingthis10 Point Plan to End Violence and Aggression: A Guide for Health Services.Thisisanimportanttool–whichalongsidearangeofresources–outlinestheactionshealthcareorganisationscantaketoendviolenceandaggressioninourworkplaces.

Saferworkplacesarevitalsothatnursesandmidwivescanconcentrate onwhatyoudobest–takingcareofthecommunity.

MESSAGE FROM LISA FITZPATRICKBranch Secretary, ANMF (Vic Branch)

Nursesandmidwives,andotherhealthworkers,areexperiencing frequentandfrighteningseriousphysicalandpsychologicalinjuriesatwork. Manyarerightlysayingenoughisenough.

Butweneedmorethanwordstoensurethepeoplewhoworkinourhealthcaresystemgohomesafelytotheirfamiliesandfriendsaftereachshift.

Tostoptheunacceptablenumberofassaults,theAustralianNursingandMidwiferyFederation(VictorianBranch)developedandreleasedthe10pointplantoendviolenceandaggressionin2014.We’vebeenworkingsincetotreatviolenceasanoccupationalhealthandsafetyrisk.

Theknowledge,informationandactionsnecessarytoendpreventableviolenceatworkareinthisguide.Thisiswhatasuccessfulorganisationalresponsetothepreventionofviolenceandaggressionshouldlooklike.

ThisguidewillonlyworkifchiefexecutiveofficersandhospitalboardsdrivethesechangessothatasaferwayofdoingthingsisabsorbedintotheDNAofeverylevel ofmanagement.

Nomorefragmentation.Toberunningahospitaloperatinginthegreensafezoneof thisguide,theworkofclinicalmanagersmustintersectwiththeoccupationalhealth andsafetyandthehumanresourcesmanagers.

Thedataismounting.Thespecificsofviolentincidentsandthehumancostareconfronting.Weknowthereisaproblem.Herearethesolutions.

Thiswilltakeleadershipandwholeofcommunityapproach–government,hospitalmanagementandthepublic.

Thisguideoutlinestheactionshospitalscancontrol.Let’sworktogethertooperateinthegreenzonesowecanstoptheunacceptablelevelsofviolenceinourhealthcarefacilities.


INTRODUCTION

HEALTH CARE WORKERS

PREVENTION OF OVA

DepartmentofHealth andHumanServices

OHSRegulatorWorkSafe

Hospital OHS SystemHospital Management Systems

Public Health Care System

Public Service

Public

Diagram: Ending violence and aggression requires changes to all levels of systems

Endingviolenceandaggressionrequireschangestoalllevelsofsystems,asdemonstratedintheadjacentdiagram.ThisGuideisatooltoenablehealthcareorganisationstoreviewtheirmanagementandoccupationalhealthandsafetysystems,andensurethatoccupationalviolenceandaggressionisappropriatelyrecognised,representedandincludedasarisk,andactionstakentopreventincidents.


Pre-conditionsCommitment: theGuidewillonlybesuccessfulifimplementedinanorganisation(andsystem)whichhasacommitmenttothepreventionofoccupationalviolencewhichisrealandirrefutable.Thiscommitmentneedstocomefromnotjust themiddlemanagementofafacility,butisrequiredfrom thosewiththeultimatepowerinthehealthsystem.

Thiscommitmenthasbeendemonstratedbythoseinchargeandincontrol,fromtheVictorianPremierandHealthMinister,throughtotheDepartmentofHealthandHumanServices.ThisGuideisintendedtoassistthoseatthehealthservicesindividually.Validationofthecommitmentcomesinmanyforms,nottheleastofwhichistherecognitionoftheproblemtobeginwith,andthededicationofresourcestoimplementstrategiestopreventandaddressthesystemicissues.

Thiscommitmentmustmanifestatthechiefexecutiveofficerandboardofdirectorlevel,withagain,theacknowledgment ofthefailingsofthesysteminitscurrentform,andapledge toaddresstheshortcomings.Suchademonstrationshouldalsoincludeareportingstructurewhichmeansthateachboardofdirectorsisprovidedwithanin-depthreportateachmeeting ofthenumberofassaultsthathaveoccurredwithintheirhospitalnetwork,thedetailsofeachassault,theinjuriessufferedbythestaff,andthecorrectiveactionswhichhave beenputinplacetoreducetheriskofrecurrence.

Communication,consultationandcollaboration:another pre-conditiontotheframeworkisacommitmentbythoserunningthehealthservicetoundertakethe‘ThreeCs’–communication,consultationandcollaboration,inrelation tooccupationalviolenceandaggression,butmorebroadly asamanagementimperative.

WhilsttheOccupational Health and Safety Act 2004mandateshealthservicestoundertakeconsultationinrelationtomatterswhichaffect(ormayaffect)thehealthandsafetyofstaff,experienceshowsthatthisisrarelyundertakeninthemanner inwhichitisdescribed.Again,thismustbedemonstratedfromdecisionmakers,inordertoaffectchangeatalocallevel. Suchcommunication,consultationandcollaborationmustinvolverepresentativesofallstakeholders,includinghealthservices,unions,workers,healthandsafetyrepresentatives andconsumers.

Moreover,thepresenceandinputatbothastrategicandlocallevelintosuchstrategieswillallowmorerobustsystemstobedevelopedandimplemented,whichwillleadtowideracceptance,andincreasedownership.

ScopeTheprinciplesandcontentoftheANMF(VicBranch) 10pointplanisapplicabletoallhealthserviceand hospitalfacilities,includingmentalhealth,acute, emergencydepartments,agedcare,communitycare andlocationsexternaltoapurposebuiltworkplace e.g.visitinghealthservices.

TerminologyClinicalstaff–includesnurses,midwives,doctors,allied healthandotherclinicalstaff

HSRs –healthandsafetyrepresentatives

OVA–occupationalviolenceandaggression,whichis definedbyWorkSafeVictoria(‘Preventionandmanagement ofviolenceandaggressioninhealthservices’,June2017) asanincident‘inwhichapersonisabused,threatened orassaultedincircumstancesrelatedtotheirwork… OVAincludesabroadrangeofactionsandbehaviours thatcancreaterisktohealthandsafetyofemployees. Itincludesbehaviouroftendescribedasactingout, challengingbehaviourandbehavioursofconcern.

OVAcanresultinanemployeesustainingphysicaland/orpsychologicalinjuries,andcansometimesbefatal.EmployeescanbeexposedtoOVAfromarangeofsourcesincludingclients,consumers,patients,residents,visitorsandmembers ofthepublic.ExamplesofOVAinclude,butarenotlimitedto:

• biting,spitting,scratching,hitting,kicking

• pushing,shoving,tripping,grabbing

• throwingobjects,damagingproperty

• verbalabuseandthreats

• usingorthreateningtouseaweapon

• sexualharassmentorassault.’

PatientCarePlan-documentse.g.BehaviouralManagementPlan,admissiondocumentation,riskassessmentsetc.

Patients–wherepatientsarereferredto,thismayalsobereadtoincludeclients,residentsandconsumersasappropriate.

NB:atallstepsoftheprocess,itiscriticalthatfrontlinestaffandHSRsareinvolvedinconsultation.

InstructionsforuseThetrafficlightapproachsupportshealthservicesintheirmovementfromasituationwithhighriskfactorstothelowerrisksolutions,steppingalongtheway.TheGuidecanalsobeusedasan‘audit-type’tool,wherebyhealthservicesareabletoself-assessagainstthecriteriaintheguide,andidentifytheirareasforimprovement.

TheGuideprovidesastartingpointforhealthservicestoworktowardsinrelationtoimplementationofanorganisationalapproachtothepreventionofoccupationalviolenceandaggression.Ithasidentifiedkeyfactorsthatcompriseeachofthe10Points,andthatdemonstrateorindicatecompliancewiththefactors,andprovidesexamplesofhigh,mediumandlowrisksolutionstoeachofthefactors.

Itisexpectedthatfacilitieswouldbeworkingtowardsthelowestrisksolutionsinordertoensurethattheirstaffareprovidedanenvironmentthatisassafeaspossible.Giventheongoingdevelopmentsoccurringwithinpreventionofoccupationalviolenceandaggression,thisguideprovidesastartingpoint,howeveracommitmenttocontinuousimprovement,andongoingreviewandrevisionofcontrols inthisareaisrequired.


1 IMPROVE SECURITY

CRITERIA HIGH RISK REDUCED RISK SOLUTION LOW RISK SOLUTION

1.1 The Department of Health and Human Services must develop adequate baseline standards for security and fund public health services to comply, whilst private organisationsmustdedicatefunding.

Thehealthservicedoesnotapplyforfundingopportunities,noristherefundingforsecurity.

Thehealthserviceappliesforallfundingopportunities, andrespondstosecurityfundingneeds.

Thehealthserviceappliesforallfundingopportunitiesandsubmissionsarebasedonpriorityareasevidencedfromriskassessmentfindings.Further,dedicatedongoingsecurityfundingisidentifiedinbudgets.

1.2 Specificallytrainedsecuritypersonnel(seealso6–Provideeducationandtrainingtohealthcarestaff).

Noareasorpartialareasandsiteshaveon-sitesecuritypersonnelavailable.

Someon-sitesecuritypersonnelareavailableforsomeareasandsiteswheneveroperational.

On-sitesecuritypersonnelareavailableinadequatesafenumbersforallareasandsitesduringalloperationalhours.

Thetrainingandexperienceofsecuritypersonnelisnotcheckedtoidentifywhethertheyhavehealthcarespecifictrainingandexperience.

Thetrainingandexperienceofsecuritypersonnelisinconsistentlyreviewed,againstanundocumentedsetofrequirements.

Allsecuritypersonnelhavehadhealthcareandorganisation-specifictrainingintheirrole,whichischeckedpriortoengagementagainstadocumentedsetofcriteria,andisregularlyreviewedandupdated.

1.3 Access to secure areas and safe zones.

Thefacilityhasnostaffsecureareas,safezonesand lock-downareaorprocedures.

Therearesomeestablishedstaffsecureareas,safezones,lockdownareasandproceduresbuttherearenosystemsinplace.

Asecurityauditofallestablishedstaffsecureareas, safezonesandlockdownareasandprocedureshas beenconductedandimprovementrecommendations havebeenimplemented.

Asecurityriskassessmentofallareasinthefacilityhas notbeenconducted.

Asecurityriskassessmentofallareasinthefacilityhasbeenconductedtoidentifyhighriskareas,secureareas,safezonesandlockdownareasincludingprocedures.

Asecurityriskassessmentofallareasinthefacilityhasbeenconductedtoidentifyhighriskareas,secureareas,safezonesandlockdownareasincludingprocedures andrecommendationshavebeenfullyimplemented andreviewed.

1.4 Security cameras. CCTVisnotinstalledon-site. CCTVisinstalledinspotsacrossareasandsitesincludingcarparkswithinconsistentmonitoringoffootage/feed.

Asecurityriskassessmenthasbeenconductedtoensure:• CCTVisinstalledinkeyareasacrossallareasand

sitesincludingcarparkswithaccompanyingCCTVwarningsignagealsodisplayedinkeyareasfor patientsandvisitors

• CCTVisusedforevidenceinhospitaland/orpoliceinvestigationswhereappropriate

• identificationofwaysinwhichCCTVcouldbeused inapreventativemanneroccurregularly e.g.trainingreviews

• proceduresareinplacetoensurefootageismonitoredaccordingtoidentifiedhighriskareas.

ThehealthservicedoesnothaveproceduresforaccessingCCTVfootage.

ThehealthservicehasproceduresforaccessingCCTVfootage.



1.5 Personal duress alarms. Ariskassessmentofallareasinthehealthservicehas notbeenconductedtoidentifyanyneedforpersonalduressalarms.

Ariskassessmentofallareasinthehealthservicehasbeenconductedtoidentifyhighriskareasforstaffneedingwallmountedandpersonalduressalarms,includinglocationidentification.

AriskassessmentofallareasinthehealthservicehasbeenconductedinconsultationwithHSRsandstafftoidentifyhighriskareasforstaffneedingwallmountedandpersonalduressalarmsincludinglocationidentification,andrecommendationshavebeenimplemented.

Personalandwallmountedduresssystemisnottested. Personalandwallmountedduresssystemisregularlytested.

Thefacilityhasaduressalarmsystemprocedureandtestingschedule.Personalandwallmountedduress systemisregularlytestedandresultsdocumented.

Thereisnotrainingofstaffintheuseofduressalarms. Inconsistentandunregulatedtrainingofstaffintheuse ofduressalarms.

Regular,consistenttrainingofstaffintheuseof duressalarms,governedbyprocedure,includingtrialingthealarms.

1.6 Searching or personal belongings.

Seealso2–Identifyrisktostaffandothersand6–Provideeducationandtrainingtohealthcarestaff.

Noproceduresinplaceregardingsearchingpatientandvisitorsuponadmissionandduringapatient’sstay.

Limitedproceduresareinplaceregardingsearchingpatientandvisitorsuponadmissionandduringapatient’sstay.

Thefacilityhasclearproceduresaroundperformingpatientandvisitorsearchestoensureaconsistentapproach.

1.7 Regular security audits of health services, including maintaining security equipment.

Thefacilitydoesnothaveadocumentedsecurityaudit andriskassessmentprocess.

Thefacilityhasadocumentedsecurityauditandriskassessmentprocess.

Thefacilityhasadocumentedsecurityauditandriskassessmentprocesswithregularschedulingandimplementationandreviewofidentifiedrisks.

Thefacilityhasnotreviewedthesecurityauditandriskassessmenttool.

Thefacilityhasreviewedthesecurityauditandriskassessmenttool.

ThefacilityhasreviewedthesecurityauditandriskassessmenttoolandhasadocumentedongoingreviewschedulewithresultsreportedtotheOHS/OVAgovernancecommitteeforoversight.

1.8 Monitoring systems for community clinics.

Asecurityriskassessmentofthecommunityclinicsincludingmonitoringsystemshasnotbeenconducted.

Asecurityriskassessmentofthecommunityclinicsincludingmonitoringsystemshasbeenconducted.

Asecurityriskassessmentofthecommunityclinicsincludingmonitoringsystemshavebeenconducted andrecommendationshavebeenimplemented.

1 IMPROVE SECURITY CONTINUED


2 IDENTIFY RISK TO STAFF AND OTHERS


2.1 Identifyingtheriskofapatientorothers (e.g. visitors or family) being aggressiveorviolenttowardsstaffmust be part of clinical pre-admission (prior to decision to admit).

Thefacilitydoesnotperformclinicalpre-admissionOVAriskassessmentsofpatients.

Thefacilityperformsclinicalpre-admissionriskassessmentsbutthecriteriatoassessandidentifythe riskofthepatient/othersbeingaggressiveorviolent islimited.

Thefacilityperformsclinicalpre-admissionriskassessmentsincludingappropriatecriteriatoassessandidentifytheriskofthepatient/othersbeingaggressive orviolent.Thisalsoconsidersthepatientmedicalrecordfrompreviousadmissionsandispartofthehandoverforambulanceandpolice.

Iftheclinicalpre-admissionriskassessmentidentifies riskofthepatient/othersbeingaggressiveorviolent,thereisnosystemtoensureimplementationofpreventativecontrols.

Iftheclinicalpre-admissionriskassessmentidentifies riskofthepatient/othersbeingaggressiveorviolent,thereisanadhocsystemofimplementationofpreventativecontrols.

Whentheclinicalpre-admissionriskassessmentidentifiesriskofthepatient/othersbeingaggressiveorviolent,thereisasystemtoensureappropriatepreventativemeasuresareimplementedandmonitoredthroughoutthepatientstay.

Thefacilityhasnotdevelopedaguidancelistofpreventivemeasuresavailableforuseatclinicalpre-admission.

Thefacilityhasdevelopedalimitedguidancelistofpreventativemeasuresavailableforuseattheclinical pre-admissionstage.

Thefacilityhasdevelopedarobustguidancelistofpreventativemeasuresavailableforuseattheclinicalpre-admissionstagee.g.speciallingpatients,nursinginpairs,placingthepatientinahighlyvisiblearea,sourcingmoreappropriatefacilityforadmission,ensuringappropriatelyqualifiedandexperiencedstaffareallocatedforcare,notificationofsecuritypersonnel.

Clinicalpre-admissiondoesnotincludereviewoftheappropriatesetting(environmentandmodelofcare) fortheindividualpatient.

Clinicalpre-admissionincludesreviewoftheappropriatesetting(environmentandmodelofcare)fortheindividualpatient.

Clinicalpre-admissionincludesreviewoftheappropriatesetting(environmentandmodelofcare)fortheindividualpatientandrecommendedpreventativemeasuresareimplementedpriortoadmission.

Thefacility/unithasnopatientadmission/exclusioncriteria.

Thefacilityorunithaspatientadmissioncriteriabuttheinclusionandexclusioncriteriarelatingtostaffandpatientsafetyarenotconsistentlycompliedwithorsupported, orarelimited.

Thefacilityorunithaspatientadmissioncriteriawithclearinclusionandexclusioncriteriarelatingtostaffandpatientsafetyanditisusedduringtheclinicalpre-admissionassessment.Complianceisconsistentanddecisionsmadeusingthecriteriaaresupportedbymanagement.

2.2 Identifyingtheriskofapatientorother being aggressive or violent towardsstaffmustbepartofadmission procedures (at admission).

ThefacilitydoesnotperformclinicaladmissionOVA riskassessmentsofpatients.

Thefacilityperformsclinicaladmissionriskassessmentsbutthecriteriatoassessandidentifytheriskofthepatient/othersbeingaggressiveorviolentislimited.

Thefacilityperformsclinicaladmissionriskassessmentsincludingappropriatecriteriatoassessandidentifythe riskofthepatient/othersbeingaggressiveorviolent. Thisalsoconsidersthepatientmedicalrecordfrompreviousadmissionsandispartofthehandoverforambulanceandpolice.

Iftheclinicaladmissionriskassessmentidentifiesriskofthepatient/othersbeingaggressiveorviolent,thereisnosystemtoensureimplementationofpreventativecontrols.

Iftheclinicalpre-admissionriskassessmentidentifies riskofthepatient/othersbeingaggressiveorviolent,thereisanadhocsystemofimplementationofpreventativecontrols.

Whentheclinicaladmissionriskassessmentidentifiesriskofthepatient/othersbeingaggressiveorviolent,thereisasystemtoensurepreventativemeasuresareimplementedandmonitoredthroughoutthepatientstay.



2.2 Continued. Thefacilityhasnotdevelopedaguidancelistofpreventivemeasuresavailableforuseatclinicaladmission.

Thefacilityhasdevelopedalimitedguidancelistofpreventativemeasuresavailableforuseattheclinicaladmissionstage.

Thefacilityhasdevelopedarobustguidancelistofpreventativemeasuresavailableforuseattheclinicaladmissionstagee.g.speciallingpatients,nursinginpairs,placingthepatientinahighlyvisiblearea,sourcingmoreappropriatefacilityforadmission,ensuringappropriatelyqualifiedandexperiencedstaffareallocatedforcareetc.

Thefacility/unithasnopatientadmission/exclusioncriteria.

Thefacilityorunithaspatientadmissioncriteriabutinclusionandexclusioncriteriarelatingtostaffandpatientsafetyarenotconsistentlycompliedwithorsupported, orarelimited.

Thefacilityorunithaspatientadmissioncriteriawithclearinclusionandexclusioncriteriarelatingtostaffandpatientsafetyanditisusedduringtheclinicaladmissionassessment.Complianceisconsistentanddecisionsmadeusingthecriteriaaresupportedbymanagement.

Clinicaladmissiondoesnotincludereviewoftheappropriatesetting(environmentandmodelofcare)fortheindividualpatient.

Clinicaladmissionincludesreviewoftheappropriatesetting(environmentandmodelofcare)forthe individualpatient.

Clinicaladmissionincludesreviewoftheappropriatesetting(environmentandmodelofcare)forthe individualpatientandrecommendedpreventativemeasuresareimplemented.

TransferofpatientOVAriskinformationdoesnotoccurfromdischargingunit/healthservicetotheadmittingunit/healthservice.

Transferofinformationisrequestedbyadmittingorganisation/ward/unitorprovidedbydischargingorganisation/ward/unitbuttheinformationislimitedormissingandtheprocessisadhoc.

Transferofinformationisactivelyrequestedbyadmittingorganisation/ward/unitandprovidedbydischargingorganisation/ward/unitsincludingand/orpolice. Followupsystemsareinplacetoensurethisinformation isavailableandactedupon.

2.3 Identifyingtheriskofapatientorother being aggressive or violent throughoutthepatient’sstay.

Clinicaldocumentationdoesnotincludeprovisiontoidentifyandassessapatient/othersbeingaggressive orviolent.

Clinicaldocumentation(includingclinicalhandoverandclinicalassessment)acrossallwards,areasandsiteshaveprovisionforidentifyingtheriskofapatient/othersbeingaggressiveorviolent.

Allclinicaldocumentation(includingclinicalhandoverandclinicalassessment)acrossallwards,areasandsiteshaveprovisiontoidentify,reviewandupdatetheriskof apatient/othersbeingaggressiveorviolentandthere areclearprocedurestoimplementcontrolswhererisk isidentified.Thisalsoconsidersthepatientmedicalrecordfrompreviousadmissionsandispartofthehandoverforambulanceandpolice.

2.4 Whenapatientisadmittedwithoutnoticetoahealthcarefacility–forexampletoanemergencydepartment – a violence risk assessmentmustbeinitiated assoonaspracticable.

OVAriskassessmentsarenotcompletedassoon aspracticableoratallwhenapatientisadmitted withoutnotice.

OVAriskassessmentsaresometimescompletedassoonaspracticablewhenapatientisadmittedwithoutnotice.

OVAriskassessmentsarecompletedassoonaspracticablewhenapatientisadmittedwithoutnoticeandappropriatepreventativeactionsareimplemented.

2 IDENTIFY RISK TO STAFF AND OTHERS CONTINUED



2.5 Staffarealertedassoonaspracticabletotheriskofapatient or other being violent or aggressive.

Currentbehaviouralcontractsarenotdisseminatedwithinandacrosssites.

Behaviouralcontractsaredevelopedbutarenotdistributed.Staffcaringforpatientsarenotawareofthem.

Currentbehaviouralcontractsaredisseminatedwithinandacrosssites,andflaggedoncomputersystems.

Therearenocommunicationprocessestoadvisestaffoftheriskofapatientorotherbeingviolentoraggressive.

Communicationprocessestoadvisestaffoftheriskofapatientorotherbeingviolentoraggressivearenotimmediate.

Communicationprocessestoadvisestaffoftheriskofapatientorotherbeingviolentoraggressiveareimmediateincludingdisseminationofbehaviouralmanagementplansandassociatedinformationwithinandacrosssites.

ClinicaldocumentationhasnoprovisiontoreviewandupdateOVAriskandrequirementswithinandacrosssites.

Clinicaldocumentationincludingassessmentand handoverhavelimitedprovisiontoreviewandupdate OVArequirementswithinandacrosssites.

Allclinicaldocumentationincludingassessment,careplansandhandoverdocumentationhaveprovisiontoreviewandupdateOVArequirementswithinandacrosssites.

2.6 Staffarealertedassoonaspossibletotheriskofarelative/visitor being violent or aggressive.

Currentbehaviouralcontractsregardingrelatives/visitorsarenotdisseminatedwithinandacrosssites.

Currentbehaviouralcontractsregardingrelatives/visitorsaredisseminatedamongstthehealthservice’sexecutivemanagementonly,orotherwiselimitedin theirdistribution.

Currentbehaviouralcontractsregardingrelatives/visitorsaredisseminatedwithinandacrosssites,andflaggedoncomputersystems.

Therearenocommunicationprocessestoadvisestaffoftheriskofarelative/visitorbeingviolentoraggressive.

Communicationprocessestoadvisestaffoftheriskofarelative/visitorbeingviolentoraggressivearenotimmediatewithinandacrosssites.

Communicationprocessestoadvisestaffofortheriskofarelative/visitorbeingviolentoraggressiveareimmediateincludingdisseminationofbehaviouralmanagementplansandassociatedinformationwithinandacrosssites.

Noviolentandaggressivevisitor/relativealertsystemisavailable.

Someareasandsiteshaveaviolentandaggressiverelative/visitoralertsystem.

Allareasandsiteshaveaviolentandaggressiverelative/visitoralertsystemwithclearprocessestoflagand manageidentifiedrelatives/visitors.

2.7 Healthservicesmustensurepatientalert systems, including violent or aggressive behaviour, are part ofadmissionandpatientstayprocedures.

Noviolentandaggressivepatientalertsystemisavailable. Someareasandsiteshaveaviolentandaggressivepatientalertsystem.

Allareasandsiteshaveaviolentandaggressivepatientalertsystemwithclearprocessestoflagandmanageidentifiedpatients.

Theviolentandaggressivepatientalertssystemisnotintegratedintotheadmissionandpatientstayprocess.

Theviolentandaggressivepatientalertssystemissomewhatintegratedintotheadmissionandpatient stayprocess.

Theviolentandaggressivepatientalertssystemis fullyintegratedintotheadmissionandpatientstay processtoensurehighriskpatientsareidentifiedandappropriatelymanaged.

Theviolentandaggressivepatientalertsystemisnotcompatibleacrossthenetworksystems.

Theviolentandaggressivepatientalertsystemhas limiteduniformityacrossthenetwork.

Theviolentandaggressivepatientalertsystemisuniformacrossthenetworkandiscompatiblewithallpatientinformationsystems.

ThepatientalertsystemdoesnotprovideinformationinrelationtopreviousOVAriskfactorsandincidentsspecifictothepatient.

ThepatientalertsystemprovideslimitedinformationinrelationtopreviousOVAriskfactorsandincidentsspecifictothepatient,butisusedinconsistentlyandonanadhocbasis,withtheinformationunreliable.

Thepatientalertsystemprovidesinformationinrelation toOVAriskfactorsandincidentsspecifictothepatient, isusedconsistentlyandtheinformationisreliable.

2 IDENTIFY RISK TO STAFF AND OTHERS CONTINUED


3 INCLUDE FAMILY IN THE DEVELOPMENT OF PATIENT CARE PLANS*


3.1 PatientCarePlansdonotonlytakeinto account the clinical component ofcaringforapatientbutalsohowcaringforthepatientmayimpactonthehealthandorsafetyofstafforothers.

TheprocessofdevelopingthePatientCarePlanonlyconsiderstheclinicalcomponentofcaringforapatient.

ThedocumentedprocessofdevelopingthePatientCarePlanconsiderssomefactorswhichmayimpactonthehealthand/orsafetyofstaffandothers,butdoesnotidentifypreventativemeasures.

ThedocumentedprocessofdevelopingthePatientCarePlannotonlyconsiderstheclinicalcomponentofcaring forapatientbutalsoconsidershowcaringforthepatientmayimpactonthehealthand/orsafetyofstafforothersandrequiresidentificationandimplementation ofpreventativeactions.

Theidentifiedpotentialimpactstothehealthand/orsafetyofstafforothersarenotformallydocumentedwithinthePatientCarePlanwhendevelopingaPatientCarePlan.

Theidentifiedpotentialimpactstothehealthand/orsafetyofstafforothersareformallydocumentedwithinthePatientCarePlanwhendevelopingaPatientCarePlan.

Theidentifiedpotentialimpactstothehealthand/orsafetyofstafforothersandpreventativemeasuresareformallydocumentedwithinthePatientCarePlanwhendevelopingaPatientCarePlan.

Clinicalstaff(doctors,nurses,midwives,alliedhealthandothers)involvedinthedevelopmentofaPatientCarePlandonotconsiderhowaPatientCarePlanmayimpacton thehealthand/orsafetyofstafforothers.

Someclinicalstaff(doctors,nurses,midwives,alliedhealthandothers)involvedinthedevelopmentofaPatientCarePlanconsiderhowaPatientCarePlanmayimpactonthehealthand/orsafetyofstafforothers.

Allclinicalstaff(doctors,nurses,midwives,alliedhealthandothers)involvedinthedevelopmentofaPatientCarePlanconsiderhowaPatientCarePlanmayimpactonthehealthand/orsafetyofstafforothers.

3.2 Thepatient’shistory,presentationand risk factors, and those of their visitorsandrelatives,aretakenintoaccount in the development ofPatientCarePlans.

Thepatient’shistory,presentationandriskfactors,andthoseoftheirvisitorsandrelatives,arenottakenintoaccountinthedevelopmentofPatientCarePlans.

Thepatient’spresentationonlyistakenintoaccountwhendevelopingPatientCarePlansandconsideringhowthecaremayaffectthehealthandsafetyofstafforothers.

Thepatient’shistory,presentationandriskfactors,andthoseoftheirvisitorsandrelatives,aretakenintoaccountwhendevelopingPatientCarePlansandconsideringhowthecaremayaffectthehealthandsafetyofstafforothers.

3.3 Wherepossible,PatientCarePlansshould involve family members to ensure clear standards of behavior are set and healthcare professionals can provide a consistent approach.

PatientCarePlansarenotdevelopedinconjunction withthepatientandfamily/carer.

PatientCarePlansaredevelopedinconjunctionwiththepatientandfamily/carer.

PatientCarePlansaredevelopedinconjunctionwiththepatientandfamily/carer,andclearstandardsofbehaviortowardsstaffaresetanddocumented.

PatientCarePlansarenotdevelopedinconjunction withthepatientandfamily/carer.

PatientCarePlansdevelopedinconjunctionwithpatientandfamily/carersdonotseekobservations,insights,informationandadviceonstrategiesthatmayincreaseand/orreducetheriskofaggressiveorviolentpatientbehaviourandproactiveearlyinterventionstrategiesthatmayreducetheriskthattheviolentoraggressivebehaviorwillescalatefurther.

PatientCarePlansdevelopedinconjunctionwiththepatientandfamily/carerseekobservations,insights,informationandadviceonstrategiesthatmayincreaseand/orreducetheriskofaggressiveorviolentpatientbehaviourandproactiveearlyinterventionstrategiesthatmayreducetheriskthattheviolentoraggressivebehaviorwillescalatefurther.ThisinformationisthenusedinthedevelopmentoftheCarePlan.

Thefacilityhasnobehavioralcontractpolicyandprocedure.

Thefacilityhasabehavioralcontractpolicybutitisinconsistentlyapplied.

Thefacilityhasabehaviouralcontractpolicyandprocedurewithsupportingtoolsthatareconsistentlyapplied,andsupportisprovidedbymanagementforthis.

*ANMFNote:ReferraltoPatientCarePlanincludesallassociateddocumentse.g.BehaviouralManagementPlan.


4 REPORT, INVESTIGATE AND ACT


4.1 Health services must build trust byinvestigatingincidentsinaconsultativeandcollaborativemanner.

Healthandsafetyincidentinvestigationsdonotcommenceorarenotcompletedinatimelymanner.

Healthandsafetyincidentinvestigationsarecommencedandcompletedinatimelymanner.

Healthandsafetyrootcauseincidentinvestigationsarecommencedandcompletedinacollaborative,timelymanner(includingwithANMFinvolvementasrequested),andthisisdocumentedintheincidentinvestigationprocedure.

Staff/HSRsarenotconsultedduringOVAincidentinvestigations.

Limitedconsultationwithstaff/HSRsoccursduring OVAincidentinvestigations.

Staff/HSRsareconsultedduringOVAincidentinvestigations.

FollowinganOVAincident,thecommencementofan OVAincidentinvestigationisnotcommunicatedtostaff.

FollowinganOVAincident,thecommencementofan OVAincidentinvestigationiscommunicatedtoinjured stafformanagementonly.

FollowinganOVAincident,thecommencementofan OVAincidentinvestigationiscommunicatedtoallstafflocatedwithintheworkareae.g.onaward,allshifts wouldbeadvised.

FollowinganOVAincidentInvestigation,systemlearningsarenotdisseminatedbacktostaff.

FollowinganOVAincidentinvestigation,systemlearningsaredisseminatedtoaffectedstaffonly.

FollowinganOVAincidentinvestigation,systemlearningsaredisseminatedtoallstafflocatedwithintheworkareaandorganisationallywhereappropriate.

OVAincidentinvestigationsarenotundertaken. OVAincidentinvestigationstakeintoaccountonlyclinicalorOHScontributingfactors,and/orfocusonidentifyingindividualcontributions,ratherthansystemfactors.

OVAincidentinvestigationstakeintoaccountallrelevantcontributingfactors,witha‘noblame’focus.

4.2 Health services must build trust bytakingclearandrelevantactionover incidents.

PreventativeactionsarenotidentifiednorimplementedafteranyOVAincidentsornearmisses.

PreventativeactionsareidentifiedandimplementedafteronlymultipleorhighriskOVAincidentsbutarenotidentifiedforlesscriticalOVAincidents.

PreventativeactionsareidentifiedandimplementedafterallOVAincidentsandnearmisses,andtrendsanalysedtoidentifyanypatterns.

Nomonitoringandreviewsystemisinplacetocollateandreviewtrends,incidentreportsandinvestigationstoestablishifclearandrelevantactionsaretakenandprocessesfollowed.

Aformalmonitoringandreviewsystemisinplacetocollateandreviewtrends,incidentreportsandinvestigationstoestablishifclearandrelevantactionsaretakenandprocessesfollowed,butisimplementedonanadhocbasis.

Formalcollating,monitoringandreviewofincidentinvestigationsandreportsareundertakentoestablishtrendsasperthemonitoringandreviewprocess.Thisissubjecttoformalreportingmeasuresinthehealthservice.

OVAincidentsarenotinvestigated. OVAincidentsareinvestigatedasasilo(i.e.thecurrentincidentonly).

OVAincidentinvestigationsaresystematicandincludeareviewofthepatientOVAhistoryacrossadmissions/timeandreviewofanypreviousimplementedpreventativemeasures,aswellasthecurrentincident.Investigationswillalsoconsiderthehistoryofincidentsintheunit/wardtoidentifysystemicfactorsand/orenvironmentalcontributingfactors.

- InvestigationofthecurrentOVAincidentdoesnotreviewtheleadupacrosstimetotheOVAincident(e.g.pre-admissionprocedure,admissionprocedure,preincidentstrategies,proactiveearlyinterventionstrategiesetc.)

InvestigationofthecurrentOVAincidentreviewstheleadupacrosstimetotheOVAincident(e.g.pre-admissionprocedure,admissionprocedure,preincidentstrategies,proactiveearlyinterventionstrategiesetc.)



4.3 Health services must build trust by communicatingactionstakenasaresult of incident reports.

Actionstakenasaresultofincidentreportsarenotcommunicatedtothepersonsreporting.

Actionstakenasaresultofincidentreportsarecommunicatedtothepersonsreportingviaawritten entryintotheincidentreportingsystemonly.

Actionstakenasaresultofanincidentreportareverballycommunicatedtothepersonsreporting,aswellasviawrittenentryintotheincidentreportingsystem.

- - Actionstakenasaresultofanincidentreportarecommunicatedtoallstafflocatedwithintheworkarea.

4.4 Health services must meet their governance and funding requirements by ensuring boards are provided with details of violent incidents,notjuststatistics,sotheyunderstandtheeffectsofviolence on healthcare workers.

Thefacility’sboardandCEOdonotreceiveOVA reportdata.

Thefacility’sboardandCEOreceiveOVAstatisticalinformationonly.

Thefacility’sboardandCEOreceivedetailsaboutviolentandaggressiveincidentsandeffectsonhealthcareworkers,aswellasOVAstatisticaldata,andinformationaroundpreventativeactionstaken.

4.5 Health services must build trust by working with police to enable prosecutionofoffenders.

Healthservicesdonothaveacollaborativerelationshipwithlocalpolice.

Thehealthservicehasasporadic,adhocrelationshipwithlocalpolice.

ThehealthservicehasacollaborativerelationshipwithlocalpolicethatassistsstafftopursuetheirrighttoprosecutionofoffendersofOVAinasupportivemanner.

4 REPORT, INVESTIGATE AND ACT CONTINUED

5 PREVENT VIOLENCE THROUGH WORKPLACE DESIGN


5.1 Theprinciplesofcrimepreventionthrough environmental design should be mandatory in designing, refurbishing,renovatingandretrofittingworkplacesto prevent and minimise violence.

Theprinciplesofcrimepreventionthroughenvironmentaldesign(CPTED)arenotconsideredduringthedesignprocess(design,briefpreparation,feasibility,contractdocumentation,construction,pre-occupancyandpost-occupancyevaluation).

Thehealthservicehasadesignpolicythatprovidesmandatorycommitmenttoconsidertheprinciplesof crimepreventionthroughenvironmentaldesign(CPTED)duringallstagesofthedesignprocess.

Thehealthservicehasadesignpolicythatprovidesamandatorycommitmenttoconsiderandimplementtheprinciplesofcrimepreventionthroughenvironmentaldesign(CPTED)duringallstagesofthedesignprocess.

Thehealthservicehasnotundertakenanenvironmentalandworkplacedesignriskassessment.

ThehealthservicehasundertakenanenvironmentalandworkplacedesignriskassessmentacrosssomeareasandsitesreviewingandidentifyinginfrastructureandprocessimprovementsinaccordancewithCPTEDprinciples.

Thehealthservicehasundertakenenvironmentalandworkplacedesignriskassessmentsacrossallareasandsites,reviewingandidentifyinginfrastructureandprocessimprovementsinaccordancewithCPTEDprinciples,andrecommendationshavebeenimplemented,orwherenotyetimplemented,budgetedforandprioritisedsuchimprovementsaccordingtolevelofrisk.



6.1 Educationabouthowtoprevent and respond to aggression and violence should begin at the undergraduate level.

Thehealthservicedoesnotmonitororreviewtheeducationprovidedtonewlyqualifiednursesand midwivesabouthowtopreventandrespondto aggressionandviolence.

Thehealthservicemonitorseducationprovidedonanadhocbasis,buthasnoorganisationalpoliciestoensureconsistentminimumeducationonhowtorespondandpreventOVAisprovided.

Thehealthservicemonitorsandreviewseducationprovidedtonewlyqualifiednursesandmidwives,andhasaprocessinplacetoensureconsistentminimumeducationisprovidedonhowtosystematicallypreventandrespondtoOVA.

Studentnursesdonotreceiveemployerspecifictraining onhowtopreventandrespondtoOVA.

Thehealthserviceprovidesemployer-specifictraining toallstudentnursesonhowtopreventandrespond toOVAfromanindividualperspectiveaspartoftheirclinicalplacements.

Thehealthserviceprovidesemployer-specifictrainingtoallstudentnursesontheirroleinhowtheorganisationwillsystematicallypreventandrespondtoOVAaspartoftheirclinicalplacements,atthestartoftheirplacement.

GraduatenursesdonotreceiveemployerspecifictrainingonhowtopreventandrespondtoOVA.

Thehealthserviceprovidesemployer-specifictraining toallgraduatenursesonhowtopreventandrespondtoOVAfromanindividualperspectiveaspartoftheirgraduateyear.

Thehealthserviceprovidesemployer-specifictrainingto allgraduatenursesontheirroleinhowtheorganisationwillsystematicallypreventandrespondtoOVAaspartoftheirgraduateyearasaninductionitemi.e.atthebeginningoftheyear.

6.2 Educationabouthowtoconductincidentinvestigations,preventandrespond to aggression and violence shouldcontinuethroughoutahealthworker’scareer.

Thehealthservice’snewstaffinduction/orientationprogramdoesnotincludeemployerspecifictraining abouthowtopreventandrespondtoOVA.

Allnewstaffreceiveemployer-specifictrainingonhowtopreventandrespondtoOVAfromanindividualperspectiveaspartofthehealthservice’sinduction/orientationprogram.

Allnewclinical(doctors,nurses,midwives,alliedhealthandothers)andnon-clinicalstaffreceiveemployer-specific,multi-disciplinarytrainingonhowtheorganisationwillsystematicallypreventandrespondtoOVAaspartofthehealthservice’sinduction/orientationprogram.Thisincludesvisiting(VMOs),consultantsandGPs.

Healthworkersdonotreceiveeducationabouthowtopreventandrespondtoaggressionandviolencethroughouttheircareerwhichisrelevanttotheirknowledge,roleandexperience.

Healthworkershavegenericrefreshertrainingabouthowtopreventandrespondtoaggressionandviolenceavailableonanelectivebasis.

Healthworkersreceivemandatory,regularrefreshertrainingandeducationabouthowtopreventandrespondtoaggressionandviolencethroughouttheircareerwhichisrelevanttotheirknowledge,roleandexperience,whichincludesafacetofacecomponent.Thiswouldincluderecognitionofearlywarningsignsforagitationandpre-coderesponses,developmentofskillstoreduceconflict,implementationofemployerprocessesthatconsistentlyidentifyandrecordrisksoforactualviolenceandsafetymanagementplans.

Staffreceivenoeducationandtrainingaboutthe functionsandpowersofsecuritystaffandVictoriaPolice.

StaffreceivelimitedgenericeducationaboutthefunctionsandpowersofsecuritystaffandVictoriaPoliceincludinghowandwhytolodgeapolicereport.

Allclinical(doctors,nurses,midwives,alliedhealthandothers)andnon-clinicalstaffreceivemandatory,multidisciplinarytrainingandeducationaboutthefunctionsandpowersofsecuritystaffandVictoriaPoliceincludingtheirroleinOVApreventionandmanagement,andhowandwhytolodgeapolicereport.Thisincludesvisiting(VMOs),consultantsandGPs.

6 PROVIDE EDUCATION AND TRAINING TO HEALTHCARE STAFF



6.2 Continued. OHSincidentinvestigationandpost-incidentsupporttrainingformiddlemanagement(i.e.NUMs,ANUMs,MUMs,AMUMsetc.)isnotprovided.

OHSincidentinvestigationandpost-incidentsupporttrainingisavailableonanelectivebasis.

AllmiddlemanagementreceivemandatoryOHSincidentinvestigationandpost-incidentsupporttraining.

6.3 Employer-specifictrainingandeducationforbothhealthworkersandsecuritystaffshouldbeprovided.

Emergencyproceduretrainingdrills(includingCodeGreyandBlack)arenotundertaken.

Emergencyproceduretrainingdrillsareinfrequentlyundertaken.

Emergencyproceduretrainingdrills(includingCodeGreyandBlack)arescheduledregularly,aremandatoryandattendedbyallmembersoftheemergencyteams,suchasCodeGreyandBlack.Debriefsareconductedaftereachtoidentifylearningsandimprovements.

Employeesarenottrainedinproceduresforsearchingpatientandvisitors.

Employeesreceivelimitedtraininginproceduresforsearchingpatientandvisitors.

Employeesreceiveregular,mandatorytraininginproceduresforsearchingpatientandvisitorsthatarecompliantwithlegislativeprovisionsandrelatedpolicies.Thisincludesvisiting(VMOs),consultantsandGPs.

Notrainingisprovidedinrelationtobehaviouralcontracts,nordutyofcareobligations/withdrawalofservicefollowingaggressiveincidents.

Trainingisavailabletostaffinrelationtobehaviouralcontractsonanelectivebasis.

Employeesincludingcorporaterepresentativesreceiveeducationtoassistallstafftounderstandandenactbehavioralcontracts.Clearguidelinesareprovidedinrelationtowithdrawalofservice.

OVA-relatedtraininghasnotbeendevelopedinconsultationwithstaff.

OVA-relatedtraininghasbeendevelopedinconsultationwithsomeclinicalstaff.

AllOVA-relatedtraininghasbeendevelopedinconsultationwithstafffromallclinicalandnon-clinicalareas,andisregularlyreviewedforappropriateness.

6.4 Standardised training for both health workersandsecuritystaffshouldoccur.

ThehealthservicehasnotbenchmarkedOVAtrainingprogramsagainstsimilarhealthservicesnorDepartment ofHealthandHumanServicesstandardsforconsistencyandquality.

ThehealthservicehasstartedtobenchmarkOVAtrainingprogramsagainstsimilarhealthservicesandDepartmentofHealthandHumanServicesstandardsforconsistencyandquality,buthasnotimplementedchangestoaddressgaps.

ThehealthservicehasbenchmarkedallOVAtrainingprogramsagainstsimilarhealthservicesandDepartmentofHealthandHumanServicesstandardsforconsistencyandquality,andhasaddressedidentifiedgaps.

6.5 Regular,multidisciplinaryrefreshertraining for health workers and securitystaff.

ThefacilitydoesnotofferOVArefreshertrainingtoallclinical(doctors,nurses,midwives,alliedhealthandothers)andnon-clinicalstaff.

Allclinical(doctors,nurses,midwives,alliedhealth andothers)andnon-clinicalstaffcanaccessOVA refreshertraining.

Allclinical(doctors,nurses,midwives,alliedhealthandother)andnon-clinicalstaffreceiveregular,mandatory OVArefreshertraining,includingafacetoface componentatleastannually.Trainingiscollectiveandmulti-disciplinary,involvingworkersfromclinicaland non-clinicaldepartments.Thisincludesvisiting(VMOs),consultantsandGPs.

6 PROVIDE EDUCATION AND TRAINING TO HEALTHCARE STAFF CONTINUED



7.1 Healthservices’responsestoaggression and violence such as Code Grey and Code Black must be consistent with state-wide guidance, and apply to all situationsofoccupational violence and aggression.

ThefacilitydoesnothaveaCodeGreyprocedure. ThefacilityhasaCodeGreyprocedurebutitisnotinlinewithDepartmentofHealthandHumanServicesguidelinesorisnotfullyimplemented.

ThefacilityhasaneffectiveCodeGreyprocedureinlinewithDepartmentofHealthandHumanServicesguidelinesthatisimplemented,regularlytrialedandusedbystaff.

NoclearprocessexistsforwhenmultipleconcurrentCodeGreys/Blacksarecalled.

- AclearprocessandresponseplanexistsforwhenmultipleconcurrentCodeGreys/Blacksareactivated,whichisimplementedandtrialled.

- Forhealthserviceswhodonothaveacapacitytoperform5personCodeGreyresponse,othermeansofaddressingthisissuemustbedevelopedandimplemented.

-

ThefacilitydoesnothaveaCodeBlackprocedure. ThefacilityhasaCodeBlackprocedureinlinewithAustralianStandards(AS4083).

ThefacilityhasaCodeBlackprocedureinlinewithAustralianStandards(AS4083),whichisimplemented,regularlytrialledandisusedbystaff.

- TheOVApreventionandresponsesystem,policyandproceduresdonotcoverallidentifiedsituationsatriskofoccupationalviolenceandaggression.

TheOVApreventionandresponsesystem,policyandprocedureshavebeenimplementedandreviewed,andcoverallidentifiedsituationsatriskofoccupationalviolenceandaggression,andstaffhavebeenprovided witheducationaboutanyupdates.

7.2 Workplaces should integrate their violencepreventionpolicieswithother policies such as clinical assessment,de-escalation,escalation,postincidentsupport,trainingandeducationand security policies.

OVApreventionandresponsesystem,policyandproceduresarenotintegrated.

OVApreventionandresponsesystem,policyandprocedureshavebeenreviewedandhavelimitedintegration.

OVApreventionandresponsesystem,policyandprocedures(inclusiveofeducationandtrainingforallstaff)areimplementedandregularlyreviewedforconsistency,andareintegratedintothehealthservice’sbroadersystems,suchas:• securitypolicies• equipmente.g.personalduressandfixedalarms,

CCTV,patientsearchesandstorageofbelongings(includingweapons),storageofdangerousgoods,mandatorytraining.

OVApreventionandresponsesystem,policyandprocedureshavenotbeenreviewedandintegratedwithsecuritypolicies.

OVApreventionandresponsesystem,policyandprocedureshavebeenreviewedwithsecuritypoliciesandinconsistencieshavebeenidentified.

OVApreventionandresponsesystem,policyandproceduresareimplementedandregularlyreviewedwithsecuritypoliciesforconsistency,andareintegrated.

OVApreventionandresponsesystem,policyandprocedureshavenotbeenreviewedandintegrated withclinicalandnon-clinicalOVA-relatedtrainingandeducationpolicies.

OVApreventionandresponsesystem,policyandprocedureshavebeenreviewedwithclinicalandnon-clinicalOVA-relatedtrainingandeducationpoliciesandinconsistencieshavebeenidentified.

OVApreventionandresponsesystem,policyandproceduresareregularlyreviewedwithclinicalandnon-clinicalOVA-relatedtrainingandeducationpoliciesforconsistencyandareintegrated.

7 INTEGRATE LEGISLATION, POLICIES AND PROCEDURES



7.2 Continued. Clinicalandnon-clinicalOVA-relatedtraininghasnotbeenupdatedtoensurebestpracticeandcurrentinformation.

Clinicalandnon-clinicalOVA-relatedtraininghasbeenpartiallyupdatedtoensurebestpracticeandcurrentinformation.

Allclinicalandnon-clinicalOVA-relatedtrainingisregularlyreviewedtoensureitcoversallaspectsofOVA,hascurrencywithOVAindustryknowledge,changesinthehealthservice’ssystemduetotheOVAactionplan, keyOHSculturalapproachesandconsistencyofOVA/ OHSmessaging.

Localareaprocessesforpreventingandrespondingtoviolencehavenotbeenreviewedandarenotconsistentwithorganisationalpolicies.

Localareaprocessesforpreventingandresponding toviolencehavebeenreviewedinlinewith organisationalpoliciesbutarenotfullyconsistent withorganisationalpolicies.

Localareaprocessesforpreventingandrespondingtoviolencehavebeenreviewedatregularintervalsand areconsistentwithorganisationalpolicies.

NoconsultationwithemployeesisundertakenregardingdevelopmentandreviewofOVA-relatedpoliciesandprocedures.

LimitedconsultationisundertakenwithemployeesregardingdevelopmentandreviewofOVA-relatedpoliciesandprocedures.

StaffareregularlyconsultedinthedevelopmentandreviewofallOVA-relatedpoliciesandprocedures.

7.3 Systemic policy changes and decisionsaboutapatient’scareshouldtakeintoconsideration anypotentialforthechangetoincrease the incidence of aggression and violence.

SystemicpolicychangesdonotconsiderthepotentialtoincreasetheprevalenceofOVAincidents.

SystemicpolicychangesconsiderthepotentialtoincreasetheprevalenceofOVAincidentsbutthisprocessisnotintegratedwithinthehealthservice’ssystemtopreventandminimiseimpacts.

Systemicpolicychangesconsiderthepotentialto increasetheprevalenceofOVAincidentsandthis processisformallyintegratedwithinthehealthservice’ssystemtopreventandminimisetheimpacts.

Decisionsaboutapatient’scaredonotconsiderthepotentialtoincreasetheprevalenceofOVAincidents.

Decisionsaboutapatient’scareconsiderthepotentialtoincreasetheprevalenceofOVAincidentsbutthisprocessisnotformallyintegratedwithinthehealthservice’ssystem,noristhereaprocesstopreventandminimisetheimpacts.

Decisionsaboutapatient’scareconsiderthepotential toincreasetheprevalenceofOVAincidentsandthisprocessisformallyintegratedwithinthehealthservice’ssystem,withactionsimplementedtopreventand minimisetheimpacts.

7 INTEGRATE LEGISLATION, POLICIES AND PROCEDURES CONTINUED



8.1 In the event of aggressive or violent incidents,staffmembersshouldreceiveextensiveandappropriatefollow up, support and care, including informationabout,andaccessto,theworkers’compensationsystemandthepolicereportingsystemprocess.

Nodocumentedpostincidentreportingprocedureexists. Apostincidentreportingprocedureexiststhatdoesnotincorporateallminimumstandards,orisimplementedonanadhocbasis.

Thehealthservicehasadocumented,implementedpostincidentreportingprocedurewhichcovers:• postincidentfollowuptimelinesandprocessesfor

contactinginvolvedworkers• protocolsthatensureevidenceisundisturbed(where

applicable)• supportandcareoptionsforallstaff/patientsinvolved• information,accesstoandprocessesforworkers’

compensationsystem• documentedreviewofthepatientcareplaninclusiveof

implementingmechanismstoprovideasafeworkplace• responsibilityforarrangingrepairsetcwithoutdelay• information,accesstoandprocessesforpolicereporting

systemwithoutlossofpay.

- Thehealthservice’spostincidentreportingprocedure,processesandtoolsareimplementedandreviewedforimprovement.

Thehealthservice’spostincidentreportingprocedure,processesandtoolsareimplementedandregularlyreviewedforimprovementandrecommendationsimplemented.

Thehealthservicedoesnotprovideinformation,supportoraccompanystaffduringthepolicereportingprocess.

Thehealthserviceprovideslimitedsupporttostafftopursuepolicereporting.

Thehealthserviceprovidesworkerswithinformationandsupportandoptionforaccompanyingstaffduringthepolicereportingandprosecutionprocessasrequested.

Thehealthservicedoesnothaveapoliceliaison. Thehealthservicehasanidentifiedpoliceliaison. Thehealthservicehasapoliceliaisonandappropriateemployerrepresentative(s)conductregularcontactmeetings.AregularreportonthesemeetingsisprovidedtotheOHScommittee,andinformation/updatesare alsodistributedtostaff.

Criticalincident,generalandoperationaldebriefsarenotconductedfollowingincidents.

Criticalincident,generaland/oroperationaldebriefsaresometimesconductedfollowingincidents.

Clearprocesses,requirementsandappropriatelytrainedstaffareavailabletoconductcriticalincident,generalandoperationaldebriefsfollowingincidents.

8.2 Incidentinvestigationand actionstakenasaresultmust also be reported.

Actionstakenasaresultofanincidentarenotcommunicatedtotheworkersinvolved.

Actionstakenasaresultofanincidentarerecordedandareavailabletothoseinvolved.

Actionstakenasaresultofanincidentarecommunicateddirectlytotheinvolvedworkers,andothersintheservicewhoarepotentiallyaffected,withoutemployeeprivacybeingbreached.

8 PROVIDE POST-INCIDENT SUPPORT


9 APPLY ANTI-VIOLENCE APPROACH ACROSS ALL HEALTH DISCIPLINES


9.1 All healthcare workers and other workers who come into contact withpatients(andtheirfamiliesandvisitors) have consistent knowledge aroundthepreventionandresponsestoviolence,andthehealthservice’sproceduresandexpectations.

Seealso6–Provideeducationandtrainingtohealthcarestaff

NoOVAtrainingisavailableorthereareonlylimitedplacesforstafftoattend.

Somecategoriesofclinicalstaffreceiveandattend OVAtraining.

Allclinical(doctors,nurses,midwives,alliedhealthandothers)andnon-clinicalstaffreceiveandattendmultidisciplinary,mandatoryOVAtrainingatorientationandthenatregularintervals.

Thereisnomessagingforpatients,familyandvisitors inrelationtoacceptablebehaviouralstandardsinthehealthservice.

Thereissomemessagingaroundbehaviouralexpectationswhichisnotproactivelyprovidedtoallpatients,family andvisitorspre-admission/onarrival/admissiontothehealthservice.

Clearmessagingisprovidedtoallpatients,familyandvisitorspre-admission/onarrival/admissiontothehealthservicesettingoutappropriatebehaviour,andthepossibleconsequencesoffailingtocomplywiththeseexpectations.

TheOVAworkingpartydoesnothaverepresentationofallworkgroups.

Thereislimitedrepresentationofclinicalandnon-clinicalworkersontheOVAworkingparty,withlittleopportunityforconsiderationoftheirviewsandexperiences.

Allclinicalandnon-clinicalworkersandANMF(asrequested)arerepresentedontheOVAworkingparty andtheirviewsandexperiencesconsideredinthedevelopmentandimplementationoftheOVAactionplan.

9.2 Allworkersinhealthcaresettingsshouldhavetheexpectationthatthey will not encounter violence or aggression at their workplace.

See10-Empowerstafftoexpectasafe workplace

Workersdonotreceivemessagingfrommanagement thattheyshouldnotacceptviolenceoraggressionin theirworkplace.

Allworkersreceiveinformalmessagingfrommanagementthattheyshouldnotacceptviolenceoraggressionin theirworkplace.

Allworkersinthehealthservicereceiveconsistentandsupportivemodellingfrommanagementthattheyshouldnotacceptviolenceoraggressionintheirworkplace e.g.formalcomponentoftraining,policies,messaging,policies,followupetcandputintoaction.

Noreviewofclinicaltraining,practices,policiesandproceduresaroundbehaviorsofconcernhasoccurred toensurealignmentwithOVAmessaging,policies andprocedures.

Limitedreviewofclinicaltraining,practices,policiesandproceduresaroundbehaviorsofconcernhasoccurredtoalignwithOVAmessaging,policiesandprocedures.

Allclinicaltraining,practices,policiesandproceduresaroundbehaviorsofconcernareregularlyreviewedto alignwithOVAmessaging,policiesandprocedures.

9.3 Allworkers’reportsaboutaggressiveorviolentbehaviorfromapatientor their visitors should be taken intoconsiderationwhenmakingdecisionsaboutthepatient’scareand management.

OVAincidentreports,includingCodeGreyandCodeBlackreports,andinclinicalnotes,aboutthepatientorvisitorarenotreflectedinthepatientcareplanortakenintoconsiderationwhenmakingdecisionsaboutthepatient’scareandmanagement.

OVAincidentreports,includingCodeGreyandCodeBlackreports,andinclinicalnotes,aboutthepatientorvisitoraretakenintoconsiderationwhenmakingdecisionsaboutthepatient’scareandmanagementbutthereisnoclearstandardiseddocumentedprocess.

AclearprocessexistsandisimplementedtoensureOVAincidentreports,includingCodeGreyandCodeBlackincidents,inclinicalnotes,andanyotherknownformsofviolenceoraggressioninrelationtothepatientorvisitor(s)arerecordedinthemedicalrecords,andthatthepatientcareplanreflectstheidentifiedhazard.

Noweightisgiventoreportsbynursesandmidwivesofaggressiveorviolentpatientbehaviourbythosemakingdecisionsaboutapatient’scareplan.

Littleweightisgiventoreportsbynursesandmidwivesofaggressiveorviolentpatientbehaviourbythosemakingdecisionsaboutapatient’scareplan.

ConsiderationisgiventothepotentialOVArisksasidentifiedbyalldisciplinesatalltimes,andactionsimplementedtoreflectconcernsandprevent/ minimiseimpacts.

9.4 In making decisions, it is important to communicate, consult and collaboratewithallstaffinvolvedinthepatient’smanagementandcare.

Collaborativemulti-disciplinarycaseconferencesforpatientswithchallengingbehaviordonotoccur.

Noclearmodelorprocessexistsforregularcollaborativemulti-disciplinarycaseconferencesforpatientswithchallengingbehavior.

Aclearmodelandprocessexistsandisimplementedforregularcollaborativemulti-disciplinarycaseconferencesforpatientswithchallengingbehavior,withOVAasaspecificconsideration.Whereappropriate,thisinvolvesfamilymembers,carersand/ornominatedpersons.


10 EMPOWER STAFF TO EXPECT A SAFE WORKPLACE


10.1 Management must demonstrate commitment to changing the culture ofhealthcareworkplacestoreflectno acceptance of aggression or violence in health services.

In workplaces where there is no acceptance of aggression orviolence,staffwillbecomeempowered to report incidents, andimplementpreventative actions,andbelieveintheir right to a safe workplace.

ThereisnoOVAworkingparty,norOVAoversightcommitteewithoversightofimplementationofactions inrelationtoOVA.

ThereisanOVAworkingpartydoingworkinrelationtopreventionofviolenceandaggression,butthereisnooverarchingstrategy,oritdoesnothavereportingresponsibilitytoahigherlevelOVAoversightcommittee.

Ahigh-levelOVAcommitteeisdesignatedtohaveoversightofallOVAwork,andafurtherOVAworkingpartyhasdevelopedanOVAstrategyandactionplantoimplementanorganisational,riskmanagementapproachtopreventionofviolenceandaggression.ANMFisrepresentedontheOVAoversightcommitteeandOVAworkingpartyuponrequest.

NoexecutivemanagementrepresentativesareactivemembersoftheOVAworkingparty.

SomeexecutivemanagementrepresentativesareactivemembersoftheOVAworkingparty

Thehealthservice’sCEOandexecutivemanagement areactivemembersoftheOVAworkingparty.

ExecutivemanagementdonotreceiveanysafetycultureandOVA-specifictraining.

ExecutivemanagementincludingtheCEOreceivelimitedsafetycultureandOVA-specifictraining.

Allmanagementroles(includingtheCEO,boardandexecutive)receivesafetycultureandOVA-specifictraining.

Thehealthservicedoesnothaveapreventionof OVApolicy.

ThehealthservicehasapreventionofOVApolicy. Thehealthservicehasacollaboratively-developedpreventionofOVApolicythatisfullyendorsed(signed) bytheCEOandchairoftheboard.

Thehealthservice’sincidentreportingandinvestigationpoliciesdonotpromoteanoblameculture.

Thehealthservice’spoliciesrefertoanoblameculture,butthisisnotactivelysupportedintoolsetc,orisnot fullyandactivelyimplemented.

Thehealthservice’sincidentreportingandinvestigationpoliciespromoteanoblameculturewithatleast90%ofstaffreportingthattheno-blamecultureisactivelyimplemented.Further,managersareprovidedwitheducationandtraining,andhaveaccesstoincidentreportingandinvestigationtools.

OVAtrainingdoesnotexistordoesnotpromoteanon-acceptanceofaggressionorviolenceintheworkplace.

OVAtrainingdoesnotactivelypromoteanon-acceptanceofaggressionorviolenceintheworkplace,orisnotbasedonappropriatepolicy.

OVAtrainingactivelypromotesnon-acceptanceofaggressionorviolenceintheworkplaceandincludesworkers’rightsforsafeworkplaceandprovisionsifthis isbreached.

Useoflanguagebyseniorandmiddlemanagementaroundnon-acceptanceofOVAdoesnotdemonstratepositivesafetyculturee.g.languageisusedwhichsuggeststhatviolenceisaninevitablepartofhealthcareworkplaces.

Useoflanguagebyseniorandmiddlemanagementaroundnon-acceptanceofOVAsporadicallyand/orinconsistentlydemonstratespositivesafetyculturee.g.languageissometimes/inconsistentlyusedwhichsuggeststhatviolenceisnotokay,butsometimesisusedsuggestingviolenceisaninevitablepartofhealthcareworkplaces.

Positivesafetycultureisdemonstratedthroughconsistentuseoflanguagewhichpromotesnon-acceptanceofOVA byallstaff,includingseniorandmiddlemanagement e.g.languageisalwaysusedwhichpromotesthemessagethatviolenceisneverokay,andstepswillbetakentoinvestigateandreducetheriskintothefuture.

TherearenoOVAstrategicprogramsnoractionplans inplace.

ThereareeitherOVAstrategicprogramsoractionplansinplace,whichhavenotbeendevelopedwithstakeholders,orarenotmonitoredbyanoversightcommittee.Theboarddoesnotreceiveprogressreports.

OVAstrategicprogramsandactionplanshavebeendevelopedinconsultationwithstakeholdersincludingANMF,andaremonitoredbyanOVAoversightcommittee,withregularreportsonprogresspresentedtotheboard.

NoextraresourcingisprovidedtoachievingOVAactionplanandOVAstrategicoutcomes.

LimitedresourcingisallocatedtoachievingOVAactionplanandOVAstrategicoutcomes.

ExtraresourcingisallocatedtoachievingOVAaction planandOVAstrategicoutcomes.



10.1 Continued. ThehealthservicedoesnotinvitenorrecogniseemployeeOVAachievements(e.g.OVAsafetysuggestionsbyemployees,actionstakenbyemployeestoidentify OVAhazardsandimprovesafety).

EmployeeOVAachievementsareinvitedandrecognisedinalimitedcapacityatanorganisationalwideandlocallevel(withintheunits).

EmployeeOVAachievementsandsuggestionsareactivelyinvitedandrecognisedbothatanorganisationalwideandlocallevel(withinunits).Improvementsaremadeasaresultwithappropriateacknowledgement.

Noclarityaroundemployee’scontrolordecisionmakingabilityisprovidedtopreventorminimiseOVA.

Thefacilityhasanescalationpolicybutitdoesnotprovideclearboundaries.

Thefacilityhasaclearescalationpolicythatcreates clarityaboutemployee,manager(NUM/ANUM)andexecutivemanagementescalationpointsanddecisionmakingability,andisimplementedwithdecisionsfor extraresourcessupported.

Organisationalvaluesplaceprimeandsolefocusonpatientsafetyandexperience,withoutregardforstaffsafety.

Organisationalvaluesrecognizestaffsafety,butitisconsideredsecondarytopatientsafety.

Safetycultureforbothpatientsandstaffareincludedandrepresentedasofequalimportanceinorganisationalvaluesandrepresentedinallbranding.

10.2 Allactionplansaroundpreventionand management of violent and aggressive incidents should be developedinconsultationwithstaff.

ThereisnoOVAworkingparty,norOVAoversightcommitteewithoversightofimplementationofactions inrelationtoOVA.

ThereisanOVAworkingpartydoingworkinrelationtopreventionofviolenceandaggression,butthereisnooverarchingstrategy,oritdoesnothavereportingresponsibilitytoahigher-levelOVAoversightcommittee.

AhighlevelOVAcommitteeisdesignatedtohaveoversightofallOVAwork,andafurtherOVAworkingpartyhasdevelopedanOVAstrategyandactionplantoimplementanorganisational,riskmanagementapproachtopreventionofviolenceandaggression.ANMFisrepresentedontheOVAoversightcommitteeandOVAworkingpartyuponrequest.

Norepresentativesfromclinical(doctors,nursing,midwives,alliedhealthandothers)andnon-clinicalareasontheOVAworkingparty.

ThefacilitydemonstratesalimitedcommitmenttoanintegratedapproachtoOVApreventionbyrepresentativesofsomeclinical(doctors,nursing,midwives,alliedhealthandothers)andnon-clinicalareasbeingactivemembers oftheOVAworkingparty.

ThefacilityhasanintegratedapproachtoOVApreventionandmanagementbyactivelyincludingrepresentativesofallclinical(doctors,nursing,midwives,alliedhealthandothers)andnon-clinicalareas/departmentsandANMF (asrequested)asbeingactivemembersoftheOVAworkingparty,withmeetingsscheduledattimesthatenablestafftoattend.

NoHSRsaremembersoftheOVAworkingparty. HSRsareinvited(butnotactivelyencouraged)tobemembersoftheOVAworkingpartyand/ormeetingsarenotscheduledtofacilitateattendance.

AppropriatenumberofHSRsareactivemembersoftheOVAworkingparty,andareencouragedandfacilitatedtoattendinpaidtime.

HSRsandemployeesarenotconsultedintheformulationofthehealthservice’sOVAstrategyandactionplan.

LimitedconsultationwithHSRsandemployeeshasoccurredinregardtothedevelopmentandproject workofthehealthservice’sOVAstrategyandaction planwithlessthan85%awarenessoftheOVAaction planamongststaff.

HSRs,employeesandANMFhavebeenandareregularly consultedinthedevelopmentandprojectworkofthehealthservice’sOVAstrategyandactionplan,andthereisgreaterthan85%awarenessoftheOVAactionplanamongststaff.

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