VIOLENCE PREVENTION POLICY

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1 HEALTH AND SAFETY GUIDANCE DOCUMENT VIOLENCE PREVENTION POLICY ROYAL FREE HAMPSTEAD NHS TRUST & ROYAL FREE & UNIVERSITY COLLEGE MEDICAL SCHOOL UNIVERSITY COLLEGE LONDON (ROYAL FREE HOSPITAL CAMPUS) February 1999

2 VIOLENCE PREVENTION POLICY GENERAL STATEMENT The purpose of this policy is to outline the Royal Free Hampstead NHS Trust and Medical Schools responsibility in the prevention and management of violence and the support of those staff involved in violent or potentially violent situations. The policy outlines the general principles that should be followed in the management of violence and is intended as a guide for those responsible for developing local policies within their operational areas if applicable. 1. INTRODUCTION The Royal Free Hampstead NHS Trust and Medical School recognise and accept their responsibility, in accordance with the Health and Safety at Work Act 1974 and good employment practice, to provide, as far as is reasonably practicable, conditions of working that are conducive to the prevention of and safe management of violence. The Management of Health & Safety at Work Regulations 1992 state that it is the duty of employers to identify the nature and extent of the risk and to devise, wherever possible, measures that provide a safe system of work and a safe workplace for employees. 2. DEFINITION OF VIOLENCE For the purpose of this policy violence can be defined as any incident in which an employee, contracted staff, patient,volunteer, student or visitor is verbally abused, threatened or assaulted by a patient or member of the public in circumstances arising out of the business of the Trust or School. Examples of violence covered by the policy are severe verbal abuse, which makes the recipient feel threatened or severely distressed, physical assault and/or threatening behaviour. N.B. In instances of harassment the Trust s current policy, Staff Guidance for dealing with Harassment from Patients and the Public should be followed. 3. RESPONSIBILITIES 3.1 TRUST AND MEDICAL SCHOOL The Trust and Medical School commit themselves to providing the following conditions relating to the prevention and management of violence; the primary 2

3 responsibility of which rests with Directors, General Managers and Head of Administration at the Royal Free Campus through the provision of: An appropriate working environment which is conducive to the safe management of potential or actual violence. information and training for staff involved in handling potential and actual violence. positive and practical support to staff involved in violent incidents. effective and comprehensive systems of work: - A system for monitoring and reviewing violent incidents. - A system of risk assessment including the monitoring of risk to enable the assessment and management of potential and actual risk within each given work setting. - The implementation of any changes in the workplace deemed necessary following the risk assessment process. - A system for recording details of incidents to be forwarded to the Occupational Health and Safety Unit. - Written local policies and procedures on dealing with violence where appropriate. 3.2 GENERAL MANAGER OPERATIONS The General Manager, Operations, manages security services within Trust and School premises. 3.3 MANAGERS/HEADS OF DEPARTMENT Managers and Heads of Departments are responsible for ensuring the following where applicable: That a risk assessment in relation to violence has been carried out in their area(s) of control. The development and dissemination of agreed local policies and procedures for managing violence within their areas of responsibility which reflect the needs of the department/area. Responsibility for the implementation of an agreed system for the prevention and management of violence as a result of risk assessment, ensuring compliance with local policies and procedures. Regular review of the effectiveness of control measures for the prevention of violence. 3

4 Regular review of staff training requirements, ensuring that staff receive adequate and appropriate training in dealing with violence within their individual areas, and keeping a record of those who have attended. The accurate and adequate recording of all incidents of violence and the rapid reporting of violent incidents resulting in injury. Any such incidents must be documented using the Trust and Schools Incident Form and sent urgently to the Occupational Health and Safety Unit along with any witness statements. Responsibility for informing staff who have been subject to assault of the options available to them following the incident including the reporting of the incident to police. 3.4 STAFF RESPONSIBILITIES Every member of staff is encouraged, commensurate with their individual level of training; skills and experience to respond to a call for assistance in an incident which might result in injury. The level of support is dependent on the staff members individual capability, confidence and training and may include physical or moral support. When giving assistance it is important that staff do not put themselves at risk and any staff member should feel free to call on more experienced members of staff, designated security staff and the police for assistance. It is expected that all staff members of both the Trust and Medical School will: a) Be made familiar with and comply with this and other local policies and systems regarding workplace violence. This is a joint management and staff member s responsibility. b) Report all incidents of violence including verbal abuse or threats. c) Attend training as directed by their Manager/Head of Department, including refresher courses. d) If involved in a violent situation (either as a victim or responding to a call for assistance) to use the minimum force required to control the violent individual(s), bearing in mind legal and medical constraints and their personal responsibility to act within the law. 4. PREVENTION OF VIOLENCE 4.1 RISK ASSESSMENT/RISK CONTROL The process of Risk Assessment is intended to assess the potential for violence to occur. Only a Manager who has been appropriately trained in risk assessment should take on the responsibility for risk assessment. Managers must also ensure that risks once identified are minimised. Advice on risk assessment and other Health and Safety 4

5 issues and/or legislation can be accessed directly from the Safety Adviser at the Occupational Health & Safety Unit (extension 8034 or 3148) A useful starting point in assessing risk is a review of violent incidents which have occurred within the last six or twelve months to see whether a pattern is discernible and try to identify the areas/occasions when a violent situation is likely to occur. It is also useful to look at the staff members job, the clients they work with and the context in which they work to identify areas for potential violence. In areas where there is a known risk it is expected that a full risk assessment be carried out using the Violence/Aggression Risk Assessment Form (appended). Once risk factors have been identified, measures can be taken to reduce the risk of violence. Health and Safety Executive guidelines advise the involvement of all staff in this process including the input from the local health and safety representative or shop steward. 5. MANAGING VIOLENCE Physical intervention in the management of physical violence is a particularly difficult and complex problem involving moral, legal and ethical issues. However it is recognised that at times physical intervention may be required. The following points should be borne in mind. 1. Staff must follow whatever guidelines are in place for physical restraint within their area. 2. Only staff who have been trained in applying physical restraint should be involved. Other staff may help by clearing the area or calling for assistance. In areas identified as High Risk e.g. Accident & Emergency Departments, Out Patients and Community Mental Health Units all staff are expected to undertake relevant training and act in accordance with this training when required. 3. Where there are no trained staff available consideration should be given to the following: a) If a violent incident occurs within the Royal Free Hospital site then the initial call for assistance should be to Security, followed by a call for Police assistance if the situation merits this. b) In community facilities where there are no security staff in place then the initial contact should be the Police. 4. Irrespective of the above staff may take all reasonable steps to defend themselves. (See point 3.4 (d)). 5

6 6. TRAINING AND INFORMATION Appropriate training is an essential component in enabling staff to confidently manage violent or potentially violent situations. Managers must ensure that all staff within their areas of control have the level of violence awareness training that Managers perceive as relevant to their area. All staff within the Trust and Medical School should as a minimum. Attend a lecture on maintaining personal safety in the workplace which will include advice on maintaining a safe environment, circumstances that could predispose a violent incident to occur, training available to staff within the Trust and an introduction to the Trusts Violence Prevention Policy. Receive information on local policies and procedures for managing violence in the workplace. For staff working in environments where there is an increased risk of violence the following training must also be considered: - De-escalation and breakaway techniques. The Lawn Road Staff Education and Development Centre currently runs a two day course on these aspects of violence awareness. The Team Approach to Managing Violence (High-Risk areas only). 7. FOLLOW UP PROCEDURE AND SUPPORT 7.1 RECORDING OF INCIDENTS All departments have a duty to monitor the level and nature of violent incidents and take appropriate preventive action. Staff who have been involved in a violent incident should notify their respective manager of the full circumstances. The manager should discuss the circumstances, provide support and reassurance and where necessary assist the staff member in the completion of the Trust and School Incident Report Form, which must be completed. If applicable, witness statements must also be completed. It is important that this procedure is completed as quickly as possible, preferably within 24 hours of the incident. It is important to note that staff injured as a result of a violent incident may be able to claim compensation under the Criminal Injuries Compensation Act 1968 so long as the incident is reported to the police within 24 hours. In the event of injury an incident form must be sent to the Occupational Health and Safety Unit as soon as possible. Certain serious injuries (staff, patients, students, visitors) or one where an employee has been off sick for more than three days (or cannot resume their normal duties) must also be reported to the Health and Safety Executive (HSE) on a RIDDOR report form. If the incident involves a patient in the hospital or in the community, full details should be recorded in the casenotes. 6

7 7.2 SUPPORT AFTER INCIDENTS Any assault on staff can be extremely distressing even if it does not result in serious injury. Managers should react sensitively to staff who have been assaulted and provide as much support as required. A medical assessment should be sought as soon as possible with the staff member being escorted to the Accident & Emergency Department or referred to their G.P if this seems appropriate. Staff who are the victims of threatened or actual violence may access confidential support from the occupational health nursing and medical team. Managers should ensure that all their staff are aware of this service, and encourage them to attend if they are involved in an incident. 7.3 POST INCIDENT DEBRIEFING A debriefing meeting should be held as soon as possible after a serious violent incident to help identify the possible causes and to allow staff to discuss their concerns. Sufficient time should be made available and staff should feel safe to identify factors that may have contributed to the incident and voice any concerns about the management of the incident. Debriefing meetings can help to improve management of violent incidents and develop measures to prevent recurrence. 7.4 SICKNESS ABSENCE Most staff who are off sick as a result of a violent incident will be entitled to sick pay. Where as a result of such an incident, a member of staff s pay is reduced, they can apply for a Temporary Injury Allowance. The amount of the allowance is the sum which when added to any pay received during the absence together with certain Social Security Benefits brings their income up to 85% of their pre-loss pay. The pre-loss pay is based on the previous twelve months pensionable pay (notionable pensionable pay for a non pensionable member of staff) and is taken up to the last day before they first suffer a reduction of earnings. The staff members Line Manager should keep both the Human Resource Department and Payroll Department informed. 7.5 LEGAL CONSIDERATIONS The Trust and Medical School view all violence to staff as unacceptable and will fully support any member of staff who wishes to pursue a prosecution so long as the member of staff acted in "good faith" in the situation and themselves used only the minimum force required to deal with it. Whilst a public prosecution is preferable, the Trust and Medical School will give necessary time off with pay to a member of staff seeking legal advice in connection with a private prosecution, and, in appropriate cases, will give positive consideration to contributing to the legal and other costs such as a prosecution. Full support and encouragement will also be given to patients who have been assaulted by another patient to pursue the matter with the police. The decision to be made after a full investigation is made to determine the circumstances leading to the assault. 7

8 RISK ASSESSMENT FORM FORM Please copy the form and use as required. Alternatively you may use the headings from the form and complete a more detailed assessment in free text. IMPLEMENTATION The most important aspect of a risk assessment procedure is the implementation of suitable controls. Completing a written assessment alone is insufficient. REVIEW The assessment needs to be reviewed if the situation changes or at least once a year anyway. 8

9 VIOLENCE/AGGRESSION RISK ASSESSMENT DEPARTMENT/WARD/SECTION LOCATION(S) SITE PERSONS INVOLVED Trust/School (Delete as applicable). DIR/DIV Tick as appropriate HAZARD PERSONAL ASSAULT VERBAL ABUSE Specify who is at risk? Tick as appropriate RISK FACTORS PSYCHOLOGICAL PROBLEMS ALCOHOL/SUBSTANCE ABUSE WAITING TIMES DEALING WITH CASH LONE WORKING WORK PLACE OTHER Give details: 9

10 MANAGEMENT CONTROLS SEPARATE STAFF FROM SOURCE OF VIOLENCE HAVE ADDITIONAL STAFF AVAILABLE CHANGE METHOD OF WORKING REDUCE WAITING TIMES IMPROVE LINKS WITH EXTERNAL SECURITY/POLICE DISPLAY WARNING NOTICES PROVIDE VIDEO/SECURITY OBSERVATION IMPROVE LIGHTING IMPROVE ENVIRONMENT PROVIDE ALARM(S) AND RESPONSE PROVIDE MOBILE COMMUNICATION TRAIN STAFF (AS APPROPRIATE) SUPERVISE STAFF PROVIDE INFORMATION TO STAFF Specify: CO-OPERATION AND CO-ORDINATION Who else needs to be involved or informed. Is method of recording incidents adequate? If patient/client is the cause, how is information recorded to warn others? ASSESSMENT CARRIED OUT BY Name. Position Date Name of responsible Manager Position REVIEW date and sign 10

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