Management of Violence and Aggression Policy Approved by: Trust Health and Safety Committee Date First Issued: August 2000 Reviewed July 2006
TABLE OF CONTENTS Section Page No 1 STATEMENT OF POLICY 2 SCOPE OF POLICY 3 DEFINITION 4 BACKGROUND 5 AIM OF POLICY 6 OBJECTIVES 7 RESPONSIBILITIES 8 TRAINING 9 RESPONDING TO VIOLENCE OR AGGRESSION 10 COMMUNICATIONS SYSTEMS 11 REPORTING AND POST INCIDENT ACTION 12 RISK ASSESSMENT 13 CO-OPERATION AND THE SHARING OF INFORMATION 14 REFERENCES
1. STATEMENT OF POLICY Management of Violence and Aggression Policy The trust has a duty to provide a safe and secure environment for staff, patients and visitors. Violent or abusive behaviour will not be tolerated and decisive action will be taken to protect individuals. It is the Policy of Swansea NHS Trust to ensure that the likelihood of employees being exposed to violence and aggression whilst at work is reduced to a minimum. The Trust supports fully the Welsh Assembly Government All Wales Violence and Aggression Training Passport and Information Scheme and the Government Zero Tolerance Campaign, and will endeavour to protect staff and those visiting its premises from the risk of violence and aggression. Violence to Trust staff is a crime, and the Trust will seek every opportunity to work with the police to prevent such occurrences. The Trust, with the consent of the employee, will report to the police any assault, threat of assault or incident of a violent nature in order that the matter can be investigated. The Trust will ensure that any member of staff is supported in pursuing a prosecution against individuals. This policy supports the Trust Health and Safety Policy and reference should be made to that document to identify responsibilities in ensuring the implementation of this policy and procedure. 2 SCOPE This policy applies to any person who is likely to be exposed to a violent or aggressive situation whilst on Trust premises or any person carrying out duties elsewhere on behalf of the Trust. 3 DEFINITION Work related violence and aggression is defined as - Any incident, in which an employee is abused, threatened or assaulted in circumstances relating to their work, involving an explicit or implicit challenge to their safety, well-being or health. This definition is extended to include verbal abuse against staff that includes threatening, insulting, obscene, racist or sexist language sufficient to cause fear, intimidation or serious offence.
4 BACKGROUND It is recognised that nurses and other healthcare workers face an increased risk of violence and aggression during the course of their normal duties over and above those experienced by most other professions. Problems of substance misuse and the use of weapons compound the general increase of violence in society. Under the Health and Safety at Work etc Act 1974 and the Management of Health and Safety at Work Regulations 1999, employers have a duty to ensure the health, safety and welfare of their staff. Where they may be at risk this must be assessed and documented and staff provided with adequate information, instruction and training. 5 AIM OF THE POLICY To reduce the risk of violence and aggression wherever possible and create a safe environment for staff, patients and others who use the service. 6 OBJECTIVES To introduce a comprehensive risk assessment process. To clearly define responsibilities for the management of violence and aggression within the Trust. To ensure there is a training programme appropriate to the needs of staff. To introduce measures to protect staff by the application of a range of sanctions against violent or aggressive individuals. To provide guidelines for managing confused patients in an acute setting. To promote and develop co-operation with other organisations. To provide guidelines for implement measures to safeguard lone workers. To define the role of the security personnel within the Trust. 7 RESPONSIBILITIES The Trust recognises its responsibilities as an employer for ensuring the safety of its employees and for providing a safe environment for others whilst on its premises. The responsibilities for the successful management of violence and aggression is described as follows - 7.1 The Chief Executive has overall responsibility for the management of violence and aggression, and has the ultimate authority to authorise the withdrawal of treatment to a patient who represents an unacceptable risk of violence or aggression to staff and/or others.
7.2 The Management Executive Team will ensure that the prevention of injury and ill health to staff, patients and visitors is given a high priority in the overall management strategy of the Trust, and that adequate resources are made available to ensure compliance with statutory regulations and NHS guidelines. 7.3 The Executive Director with responsibility for health and safety reports to the Chief Executive and will ensure that - The performance of the Trust in dealing with violence and aggression is monitored and communicated to the Chief Executive, Trust Health and Safety Committee and Executive Board. The risk management process and control measures are co-ordinated across the Trust. The Trust has an effective incident reporting system for recording violent and aggressive incidents. Violence and aggression related training is planned, implemented and recorded effectively. 7.4 Divisional General Managers and Directors of non clinical services are responsible for - Prioritising, where necessary, the actions required for addressing issues identified by risk assessment. Supporting service/line managers in implementing measures necessary for the effective management of violence and aggression, and reviewing and monitoring their effectiveness. Monitoring that systems set in place are effective. 7.5 Service/Line Managers will - Ensure risk assessments are carried out to identify the potential for violence and aggression. Implement measures to minimise any risks identified. Assess the training needs of their staff and ensure the training provided is appropriate to their needs. Facilitate the attendance of their staff on training courses and maintain local training records. Ensure incidents and are reported, investigated and accurately recorded. Ensure there is support for staff following an adverse incident. Ensure clear and accurate guidance relating to dealing with issues of violence and aggression is provided to staff. Ensure local procedures and safe systems of work are developed, implemented and followed. Make this policy and associated procedures available to staff. 7.6 All employees are required to -
Comply with the organisation's policies and procedures at all times. Take all reasonable steps to protect themselves and others from harm. Attend training 7.7 The Health, Safety and Fire Department will - Develop and deliver training that is appropriate to the needs of the organisation. Record and monitor attendance at training. Review the effectiveness of training. Provide advice to managers and other staff Manage the Trust incident reporting system. Inform managers and committees regarding performance of the Trust in managing violence and aggression. 8 Training The level and type of risk identified by risk assessments will determine the training required, and managers must ensure that the training addresses these issues. Training plans will be developed in line with the training need analysis, and monitored via the normal performance management arrangements within divisions. The basic training programme is broken down into modular sections for flexibility in its delivery, and modules 1 and 2 include elements from the All Wales Violence and Aggression Training Passport and Information Scheme as a minimum standard. The modules cover the following topics: Module 1 - Induction and Awareness Raising This forms part of the Trust Induction Programme and will provide participants with a general introduction to the subject of violence and aggression. It will provide a basic overview of the importance of managing violence and aggression in the workplace and will also reflect upon the prevalence of violence and aggression within society and its relevance to the workplace. This will be supported through the provision of clear definitions for violence and aggression. Local policies and procedures will also be introduced. Module 2 Theory of Personal Safety, De-escalation and Breakaway Techniques This offers generic training to all staff and will provide participants with greater awareness of the issues associated with the theory of personal safety and de-escalation. It builds upon the introductory module and emphasis is placed upon the importance of de-escalation and the steps that can be taken to prevent incidents of violence and aggression occurring in the first place. The module 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. It will also provide the participant with the practical skills to enable them to breakaway from a situation of violence and aggression. Emphasis will be placed upon the importance of communication skills and management of personal safety throughout all breakaway techniques. Module 3 - Physical Intervention Training This training is limited to nursing staff dealing with mental health patients at Cefn Coed Hospital and other staff identified by risk assessment. It includes all the elements of module 2 and in addition provides the participants with the skills and techniques to undertake physical intervention and restraint using the Trust approved methods. 9 RESPONDING TO VIOLENCE OR AGGRESSION When faced with violent or aggressive individuals, staff will be supported fully if they have responded in a way that is deemed to be appropriate at the time. If an aggressor does not respond to reasonable requests from staff, the Trust would not expect those staff to remain exposed or vulnerable in an escalating situation. The right of staff to call for police assistance to deal with an aggressor will always be supported by the Trust, and staff should not feel reluctant to do so if they feel this is necessary. Also, withdrawing to a place of safety may be deemed appropriate in some circumstances. In some situations, however, the involvement of the police may not be an immediate course of action chosen by staff, as other options to deal with the individual may be considered more appropriate or more effective. In whatever course of action is pursued against an individual, the Trust needs to demonstrate that due consideration was given to the circumstances as they were perceived to be at the time, and correct procedures were followed. Staff, also, need to be assured that they are acting with the support of the Trust so long as their actions are appropriate and within agreed parameters. The Trust will provide guidance to staff in the following circumstances - 9.1 General guidance in responding to violence and aggression, the police and the role of the Trust security personnel. 9.2 Referring individuals to the Community Safety Partnership 9.3 Placing warning markers on patient notes. 9.4 Implementing patient undertakings and the withdrawal of treatment in line with the recommendations contained within the All Wales NHS Violence and Aggression Training Passport and Information Scheme.
9.4 Restraining confused patients in an acute setting. 10 COMMUNICATION SYSTEMS The traditional perception of lone working, such as community visiting, is dealt with under separate guidance, but many staff, although they may work as part of a busy ward or department, can find themselves at times working remotely from others. Also, many staff work in environments that are considered high risk in violence and aggression terms, such as A&E or assessment/admission facilities, or working with or interviewing clients with psychiatric problems. In these situations there may arise a need to summon assistance if under threat. Managers need to recognise these situations and consider whether the use of personal attack alarms, fixed panic alarms or radio call systems etc, would be of benefit to staff. Where any systems are introduced, managers will need to ensure that local procedures are developed so that all staff understand fully how to respond safely to a call for assistance. 11 REPORTING AND POST INCIDENT ACTION 11.1 All incidents of violence, including verbal abuse, must be reported using the Trust Incident Report Form and the relevant investigation instigated. 11.2 A full de-brief of the circumstances should be undertaken by a senior member of staff as soon as possible after the incident. 11.3 Line managers are required to support a member of staff following an incident. The considerations that may be necessary could include - Is the member of staff too distressed to continue their duties? Do they need assistance to get home? Do they need recovery time after the incident? Does the individual need medical attention? Has any of the other staff been affected by the incident? Does the member of staff require counselling? 11.4 It is recognised that it is the choice of the victim as to when de-briefing takes place and whether counselling is desired. 11.5 Following any adverse incident and the resulting investigation, risk assessments must be amended accordingly.
12 RISK ASSESSMENT The Management of Health and Safety at Work Regulations 1999 requires employers to assess the risks their staff face through the work they carry out. This includes the risk of violence and aggression. The assessment should identify the measures needed to either eliminate the risks or, if this is not reasonably practicable, to adequately control them. The Regulations do not specify which measures should be introduced to control the risk and it is for the employer to demonstrate that the measures taken are adequate. A violence and aggression risk assessment should be documented for any task/activity that presents a significant risk. The form and its guidance was developed by the All Wales NHS Steering Group for the Management of Violence and Aggression for use by trusts in Wales, and is intended for the assessment of generic activities and tasks. It is not intended to be used to assess risks relating to a specific patient as a separate patient risk assessment should be undertaken if this is deemed necessary. A risk assessment should be conducted in consultation with employees and reviewed at least annually or after an incident has occurred. If a major change is required as part of the review a new form must be completed. Although it is recognised that there are circumstances where it is reasonable to anticipate problems arising, there are certain situations and clinical conditions where violence or aggressive tendencies are much more likely to be displayed. These include - Persons under the influence of alcohol and/or drugs, especially in the accident and emergency or casualty setting. In-patients who are confused. Patients suffering from head injuries. Patients suffering from alcohol or drug withdrawal. Patients suffering from a paranoid illness where their perception of reality is distorted. Patients with poor communication skills. Patients with a history of violent behaviour.
13 CO-OPERATION AND THE SHARING OF INFORMATION Violent and aggressive acts can take place anywhere within society. Events occurring in other settings and locations can impact on our ability to provide a service and sometimes the safety of our staff, as well as our experiences affecting others. Actions that take place outside of our immediate sphere of work cannot be ignored and events affecting us need to be shared with others if they have the potential to present risks to others. The Trust will endeavour to promote co-operation and agreement with other organisations that share the same concerns as us, such as the ambulance service, police and social services etc in dealing with disruptive individuals. The Trust, also, will promote the sharing of information where it is deemed appropriate to do so for the safety of Trust staff or others, within the legal framework. 14 REFERENCES 13.1 Health and Safety at Work etc Act 1974 13.2 Management of Health and Safety at Work Regulations 1999 13.3 Working Together: Securing a quality workforce for the NHS (1998) 13.4 Staff Health, Safety and Welfare (1998) 13.5 Effective Management of Security in A&E (1997) 13.6 Safer Working in the Community 13.7 Review on Violence to NHS Staff Working in the Community 13.8 Dealing with Violence Against Nursing Staff 13.9 Violent Times 13.10 Violence and Aggression to Staff in the Health Service 13.11 Preventing Violence to Staff 13.12 Violence at Work: A guide to risk prevention for UNISON branches, stewards and safety representatives 13.13 Management of Imminent Violence 13.14 Personal Safety at Work: Guidance for All Employees 13.15 We Don't Have to Take This - NHS Zero Tolerance Zone (1999)
13.16 All Wales NHS Violence and Aggression Training Passport and Information Scheme