Occupational violence and aggression case study

As part of the introduction of their framework for preventing and managing occupational violence and aggression (OVA), this metropolitan health service reviewed its security arrangements to prevent and manage OVA. The health service considered physical security controls, workplace design improvements, electronic security mechanisms and security-trained staffing requirements.

What they did

Risk assessments

The health service conducted risk assessments at each site. This included assessment of the practices of staff working in community and home-based settings.

Factors considered included the local context in which the health service resides, organisational factors particular to each site, seasonal factors that may impact on risk at certain times during the year, current physical and electronic security mechanisms in place, and a review of OVA data at each site.

Refer to the Security risk assessment tool: preventing and managing occupational violence and aggression for more guidance on how to conduct a security risk assessment.

Security-trained personnel as an effective control

The results of the risk assessments were used to design appropriate security arrangements. In relation to security-trained staffing requirements at the acute site, the following specific considerations were taken into account:

Local factors

• The memorandum of understanding with a neighbouring health service was reviewed to make sure it was still current and appropriate to access additional security resources in emergency situations.
• Local crime statistics were reviewed and showed an increase over the last two years.
• The distance between higher-risk departments, including the emergency department and the mental health unit, was factored into determining security staffing requirements and where to base security staff during their shifts.
• It was also noted that security staff sometimes undertake other tasks when codes are called, such as escorting staff to vehicles. This is more likely to occur after 8 pm.

Data

• A full review of the past three years of data was undertaken.
• Some key statistics reviewed included duress alarm activation (on site and off site), incidents by clinical stream, incidents by location and incidents by severity and what action was required.
• Some key findings included that most incidents occurred between 7 am and 3 pm each day when most staff are rostered on, and that most incidents occurred in the emergency department, the mental health unit and the maternity unit.
• A review of the circumstances where restraint was required revealed that for physical restraint to be undertaken safely, four security-trained personnel were required to routinely attend, however this was infrequent and there had never been two at the same time.
• The data revealed that concurrent codes occurred in multiple locations regularly, so this needed to be factored into the staffing requirements.
• A review of Code Grey and Code Black revealed that Planned Code Grey accounted for 60 per cent and Code Grey 40 per cent, and that the time spent on codes had increased over the last year.
• Calls to police so far this year were tracking at the same rate as the previous year.

Outcome

Determining a minimum number of security-trained personnel

Taking into account the results of the site-specific risk assessment and considering the appropriate controls required, the health service determined it needed to roster on a minimum of four security guards per shift at the acute site to effectively control risk and undertake safe restraint practices in conjunction with the senior clinician attending each code.

Flexing up to effectively control risk

The health service recognised that it needed to have the ability to increase its security-trained personnel on particular shifts to reduce risk. Particular circumstances known to lead to this requirement included treating a patient:

• with family members who visit who are known to be violent or aggressive
• for a period of time who may become violent or aggressive while waiting for transfer to a more appropriate clinical setting.

Reviewing for effectiveness

The health service also put in place processes to regularly review its security-trained staffing requirements to determine if changes need to be made:

• in response to changes in risk
• if the four staff rostered on each shift are not adequately controlling risks as intended.