CODE WHITE-VIOLENT PATIENT

Transcription

1 AUTHORIZATION: Operations Committee Page 1 of 5 POLICY STATEMENT North York General Hospital is committed to the prevention of injuries by providing a safe and healthy work environment for its employees, physicians, volunteers, patients and visitors. NYGH staff will activate a plan to manage violent or potentially violent patients who are unmanageable by any other means and present a danger to self or to others. AUTHORITY TO DECLARE Anyone who encounters a violent and unmanageable patient. DEFINITIONS Code White: the term used to alert staff when a violent or potentially violent patient who is unmanageable by any other means presents a danger to self or to others. This does not include a hostage situation or where a weapon is involved (Refer to Code Purple). Code White Response Team GENERAL SITE: the group of individuals that respond to a Code White at the General site: a) All staff on duty in the area of the Code b) One staff from each unit of the Mental Health Program c) Crisis Team when on site d) Security staff e) Admin Coordinator when available Code White Response Team BRANSON SITE: the group of individuals that respond to a Code White at the Branson site: a) One staff from each Mental Health unit during working hours b) Psychiatrist in-house, if available, if not, phone the most appropriate physician or on-call psychiatrist Code White Response Team SENIORS HEALTH CENTRE: the group of individuals that respond to a Code White at the Seniors Health Centre: a) Available department heads/charge nurses in the area

2 AUTHORIZATION: Operations Committee Page 2 of 5 Non-Patient: person who is not considered a patient/resident/or client ROLES AND RESPONSIBILITIES OF THE STAFF MEMBER ENCOUNTERING VIOLENT PERSON a) If patient, ensure that Code White is activated. Activate CODE WHITE: At the GENERAL site dial 5555 At the BRANSON site dial 2222 to notify Security, then 5555 to page Code White. At SENIORS HEALTH CENTRE call Security at or through Locating at , call Police State CODE WHITE, indicate exact location and request Police if needed. b) If non-patient: At General and Branson site: notify Telecommunications at 5555 to request STAT Security and indicate exact location At Seniors Health Centre: notify Telecommunications at to request STAT Security and call Police ROLES AND RESPONSIBILITIES OF THE CHARGE PERSON OF AFFECTED UNIT/DEPARTMENT OR APPROPRIATE STAFF MEMBER /INCIDENT COMMANDER 1. Assume the role of the Incident Commander and take responsibility for directing the team, including the police. 2. Ensure Code White has been called. 3. Control the situation as quickly as possible, involving as few persons and departments as possible. 4. Directs the team as necessary for verbal or physical intervention. 5. Consider 3 point protection (goggles, surgical mask, and gloves) where there is a potential for body fluid exposure (e.g. spitting) as per routine practice. 6. Ensures that all staff involved in the Code have the opportunity to debrief within the shift.

3 AUTHORIZATION: Operations Committee Page 3 of 5 7. Request notification of Clinical Team Manager-on-Call/Senior Administrator-on-Call, if required. 8. Ensure that a SLIP is completed within 24 hour period. 9. Offer support as needed to staff, patients, visitors. ROLES AND RESPONSIBILITIES OF TELECOMMUNICATIONS 1. A) If patient, page CODE WHITE and location three times. If patient has a weapon or someone is taken hostage, DO NOT page Code White. Refer to Code Purple Policy and Procedure. B) If non-patient, do not page overhead. 2. Contact directly the following staff: i. Crisis Team when on duty (only General site) ii. Security staff iii. Police if directed to do so iv. On-call psychiatrist if directed to do so v. Admin Coordinator when on Duty (only General site) 3. In the event that the overhead paging systems fails, Telecommunications will enact their internal system failure process. ROLES AND RESPONSIBILITIES OF UNIT STAFF AND MEMBERS OF THE CODE WHITE RESPONSE TEAM 1. Proceed to the designated location. 2. If STAT medical or surgical intervention is required, place a STAT page for the appropriate Physician (Medical, appropriate subspecialty for Surgery or Emergency Physician). 3. Direct visitors and patients away from the immediate danger area. 4. Assist the team in verbal or physical intervention at the direction of the team leader/incident Commander or appropriate staff member. ROLES AND RESPONSIBILITIES OF SECURITY

4 AUTHORIZATION: Operations Committee Page 4 of 5 1. Proceed to the designated Location. 2. Collaborate with the Team Leader/Incident Commander. 3. Assist the team in verbal or physical intervention at the direction of the Team Leader/Incident Commander. ROLES AND RESPONSIBILITIES OF MOST RESPONSIBLE PHYSICIAN/ON-CALL PSYCHIATRIST IF ATTENDING Direct the medical care of the patient. POST EVENT DEBRIEFING The team will have an informal debrief amongst themselves within the shift that the Code White occurred as organized by the Team Leader/Incident Commander. The Manager of the affected unit/department will discuss with the Corporate Risk Manager the need for a corporate debriefing, and will assemble the appropriate individuals within 10 days of the event to review and assess: The effectiveness of the response Requirement for additional documentation Opportunities for improvement POST EVENT DOCUMENTATION: Person who first identifies a Code White will complete a SLIP electronically within 48 hours. If a patient/visitor is injured, a SLIP will be completed within 48 hours. In the event that an employee is injured, the employee will be provided with aide or medical treatment, if needed, either in the Occupational Health and Safety Department or the Emergency Department. The manager or designate will be informed of the injury immediately and within 24 hours, the employee will complete an electronic Employee Incident Report. If the employee is sent to seek medical care for their

5 AUTHORIZATION: Operations Committee Page 5 of 5 injury, the manager or designate is to the Occupational Health and Safety Department and provide details of the injury/incident. If there is a critical injury or fatality, ensure that the Occupational Health and Safety Department is notified immediately.