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Occupational Violence Incident Response Kit –Queensland ... · 1. Medical conditions (e.g. fear,...
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Occupational Violence
Incident Response Kit
Queensland Occupational Violence Strategy Unit
Children's Health Queensland
Queensland Children's Hospital
WelcomePurpose of toolkit:
There are a significant number of cases of Occupational Violence (OV) occurring in hospitals and healthcare
settings every day across the state. This toolkit has been designed specifically to support managers (e.g.,
Nurse Unit Managers, After Hours Nurse Managers, Team Leaders and/or Shift Co-ordinators) navigate the
processes following the occurrence of an OV incident and support their employees. This toolkit includes:
what is OV, what to look for, ensuring employee and patient safety, reporting incidents, and supporting
employee’s post incident.
How to use this toolkit:
The post incident process has been conceptualised into five steps. Each step is presented as a section with
the relevant pages colour referenced to the process page (outlined on the following page). Each section
includes:
• A front-page
• Highlights of what’s included in each step
• A checklist of what needs to be actioned in each step
• Supportive information relevant to each step
Initiate immediate safety response:
• Security –
• Activate Duress Alarm
• Code Black –
• Police – DIAL (0) 000
Address safety:
• Patient and staff (engage medical treatment
as required)
• Environmental hazards
OV can look like:
• Physical assault
• Verbal abuse/harassment
• Threatening behaviour
• Sexual assault/harassment
• Abuse through technology
Occupational Violence Incident Response
Process
01Occupational Violence Incident Occurs
02 Immediate Response
DIAL 555
DIAL 555
Queensland Children's HospitalV1 Effective: October 2018 Review: October 2020
• Check-in within 1-week post incident
• Consider WorkCover return to work
procedures
• Report incident via RiskMan
• Consider need for WorkCover
• Engage Police (with staff consent) and provide
support throughout the process
• Provide employee support
• Look (common response)
• Listen (understand immediate needs)
• Link (offer break/patient
reallocation/leave/support)
• Offer Employee Assistance Program (EAP)
• Provide OV Toolkit for Employees
03Psychological First Aid and OV Toolkit for Employees
04 Escalating the Incident
05 Follow-up Support
Occupational Violence Incident Occurs01
What’s Here?
Checklist:
What is Occupational
Violence?
Why does OV Occur?
What does OV look
like?
Normal Responses to abnormal
events
� An OV incident has occurred as defined
What is occupational violence?
Occupational violence (OV) is not just “part of the job”. OV is
defined as any incident where an employee is abused, harassed,
threatened or assaulted by patients, consumers, their relatives or
members of the public, in circumstances arising out of their
employment, irrespective of the intent for harm.
Occupational violence is not limited to incidents which occur within
health facilities. It can also include violence that occurs away
from work but is a result of work. For example, a nurse who
receives a threatening telephone call from a patient at his or her
home has experienced occupational violence.
Why does occupational violence occur?
Common contributory factors linked with OV include:
1. Medical conditions (e.g. fear, pain, dementia, mental
illness)
2. Individuals (e.g. patients with history of substance
abuse and violence, and cognitive impairment, patient
journey, restricted smoking routines)
3. Relationships (e.g. relationships with all hospital
employees, rules and limit setting, patient and visitor
movements)
4. Organisational and environmental factors (e.g. wait
times, availability of community health services, ease of
access to facilities)
5. Societal factors (e.g. community attitudes towards
violence and service expectations)
What does occupational violence look like?
Unfortunately, statistics indicate that OV is common within the
healthcare setting due to the multiple contributing factors which
may be present. OV can present in a range of different forms and
by no means is it just “part of the job”.
95% of healthcare workers have experienced some form of
occupational violence at least once during their career. OV can
take many forms, and may include one or more of the following:
Physical Assault
Verbal Abuse/Harassment
Personal Intimidation
Threatening Behaviour
Sexual Assault/Harassment
Abuse Through Technology
Normal responses to abnormal events
Responses to OV incidents can vary person to person.
People respond to stressful events in different ways, the best thing
you can do to help is offer your support. Listed are some examples
of the range of responses employees may experience in response
to incidents of OV.
Behaviour changeSleep disturbances
Withdrawal
Avoidance of reminders Alcohol/drug use
Apathy
Easily irritable
Confusion
Anger
Feelings of dreadAnxiety
Sadness
GuiltHelplessness
Numbness/Shock
Aches and pains
Nausea
ShakingSweating
Heart Palpitations Headaches
Intrusive thoughts
Memory blanks
FlashbacksThoughts of self-blame
Ruminating thoughtsDifficulty concentrating
EMOTIONSBEHAVIOUR
PHYSICAL COGNITIVE
Immediate Response
02
Is it my Responsibility
to Call for Help?
What’s here?
Which Safety Option
Should I Choose?
Immediate Safety
Response to OV
Injury & Patient
Management
Environmental Safety
Concerns
Process for Delayed Care
Checklist:
� The appropriate safety response was engaged
� Injuries sustained as a result of OV incident have been
attended to
� If the injury was sustained by the aggressive
patient/consumer/visitor, the treating team have been notified
of the incident
� Environmental concerns have been addressed
Is it my responsibility to call for help?
Check with the person/s involved to ensure an immediate safety
response occurred. Typically, this would have occurred
immediately, in the event that it has not, ensure that the
appropriate response is engaged (refer to next page).
Engaging security, even in low risk situations, can ensure
proactive interventions are implemented.
The below safety options are available to you if an OV incident
has occurred.
Which safety option should I choose?
The most appropriate safety option will depend on the
circumstances and the severity of the incident.
For further information, the following page provides a detailed
outline of each of the safety responses, how to engage, and who
is engaged at each step.
Security
Police
Duress Alarm
Code Black
Immediate Safety Responses to OV
The boxes below illustrate the safety options available to respond to an OV incident. The appropriate pathway will entirely depend on the
circumstances and the severity of the incident. Engaging security early can allow measures to be taken to prevent the aggression/abuse from
escalating.
Security
Trained in de-escalation and
minimum force techniques to help
prevent potential injury/harm. If the
situation cannot be contained security
will call the police.
The earlier security is engaged,
the better the outcome for all
involved. Provide security with as
much relevant information as
possible.
ACTIVATE
Duress Alarm
Typically located under desks or
near work stations. When
activated, a duress alarm alerts
Security Officers.
If unable to dial code black or
security, locate a duress alarm near
you or direct a colleague to activate
the alarm if the situation requires.
Code Black
Dial the number and state “CODE
BLACK”. Security will respond
immediately.
A code black alarm is raised where an
employee, patient, or visitor is
behaving in a manner perceived by
employees to pose an immediate
threat to the safety of others, or to
hospital property.
DIAL (0) 000
The incident requires immediate police
intervention when the
patient/consumer/family member is
engaging in aggressive/abusive
behaviour, causing harm and/or
the situation is unable to be
contained.
Further information on making a
complaint to the police in step 05
Escalating the Incident.
Police
DIAL 555 DIAL 555
South Bank Police Station DIAL (0) 3020 8377
Injury Management Process
OV incident resulted in an injury
EmployeePatient/Consumer/Family
Member
Engage appropriate medical care
Notify treating team of incident and any safety
precautions they may be able to engage
Engage appropriate medical care
Who was injured?
Environmental Safety Concerns
Biohazardous material: Ensure any biohazardous material
(blood, urine, saliva) is cleaned up appropriately as per hospital
policy.
Furniture/ Objects: Ensure any misplaced or damaged assets
(e.g., furniture, objects) have been removed from the area. If
damage has occurred, consider reporting to Police.
Spills: Ensure any spills or food materials have been
addressed as per hospital policy.
Managing Patient Post-Incident
The following considerations should be made to reduce the risk of
further incidents occurring:
Patient Handover: Ensure all employees assigned/in contact
with the patient are informed of the patient’s behaviour and any
triggers which might have been identified.
Consultation Between Managers: If the incident occurred
after hours, then the After Hours Nurse Manager / Hospital Co-
ordinator should contact the NUM and ensure they are aware
of the incident, who was involved, and if any injuries were
sustained.
Psychological First Aid & OV Exposure Kit
03
What’s here?
Psychological First Aid
Employee Assistance
Program (EAP)
OV Toolkit for
Employees
Support Hotlines
Checklist: � Look out for signs of distress
� Listen and normalise responses
� Encourage, support and provide information
� Provide the Occupational Violence Toolkit for Employees
What is Psychological First Aid?
Psychological First Aid (PFA) refers to a simple and practical skill set
aiming to support employees in times of stress. The Psychological First
Aid model presented here follows the Australian Red Cross and the
World Health Organisation’s approach which focusses on Look,
Listen and Link.
The key aims of the Look, Listen and Link approach include:
The next few sections will help give you a brief understanding of what
Look, Listen and Link involves and how you can use these steps to
help others feel safe, calm, connected, empowered and hopeful.
LOOK
It’s normal to experience strong reactions after exposure to violence and aggression in the workplace. Some common responses include:
COGNITIVE
Intrusive thoughts, memory blanks, flashbacks, thought's of self-blame, ruminating thoughts and difficulty concentrating
EMOTIONS
Confusion, anger, feelings of dread, anxiety, sadness, guilt, helplessness
and numbness/shock
BEHAVIOUR
Behaviour change, sleep disturbances, withdrawal, avoidance of
reminders, alcohol/drug use, finding it hard to empathise and easily irritable
PHYSICAL
Aches and pains, nausea, shaking, sweating, heart palpitations and headaches
Some factors to keep an eye out for:
• Limited social supports at home
• Experience with similar events in the past
• Perceived threat to life
• Poor physical health (e.g., feeling run down)
• Other stressful life events
LISTEN
Listen focusses on understanding the immediate needs:
Introduce yourself, your role, and what kind of support you can offer to
them right now
Don’t underestimate how important having someone physically with you
can be
Find out what is most important to them in the moment and ask them about
their needs/concerns right now
Avoid the compulsion to jump to task or to find the quick fix. Make the
decision to be present and listen
LINK
Linking in practical information and support:
COPE WITH IMMEDIATE PROBLEMS
Provide guidance regarding information in this pack: Police, leave/break,
patient allocation, travel allowance and escalation
GIVE INFORMATION ABOUT SUPPORT SERVICES
Provide information about support services as well as what to expect next
CONNECT WITH SOCIAL SUPPORTS
Encourage connection with partner, family members, friends, peers, or
religious/spiritual connections. Let the employee know that you will contact
them in the days following
Avenues of Support
Employee Assistance Program (EAP) OV Toolkit for Employees
Manager to provide OV Toolkit to Employee:
The OV Toolkit for Employees includes:
EAP is a confidential, short term counselling and support service
for employees. EAP provide up to 6 counselling sessions per
year. These sessions are free to QLD Health employees and their
family members.
Manager EAP Support:
EAP also offer a telephone based ‘helpline’ called Manager
Hotline, specifically tailored to support Managers. The service
provides confidential support to managers in navigating critical
incidents and more. This hotline can be reached by calling the
EAP number and asking for the Manager Hotline.
1800 604 640
https://www.livewell.optum.com/public/welcome.asp
auchhs
Support HotlinesThe following services provide counselling and support over the phone. These services may be of assistance to you and/or your employees.
Support Hotline Contact 24/7 In Person Online Additional Information
Beyond Blue 1300 224 636 www.beyondblue.org.au � �Online chat offered between the hours of 3pm and 12am. You may remain anonymous.
DV Connect 1800 811 811 www.dvconnect.org � Crisis hotline for anyone affected by domestic/family violence.
Griefline 1300 845 745 www.griefline.org.au � � �
Confidential counselling services to anyone who may need support through bereavement. Contactable midday- 3.00am, 7 days a week. Offers online 24/7 counselling.
Mensline 1300 789 978 www.mensline.org.au � � Support for men with family and relationship concerns.
Mindspot 1800 614 434 www.mindspot.org.au �
Service for Australian adults experiencing symptoms of anxiety or depression. Contactable 8am-8pm Monday to Friday and 8am-6pm Saturday.
QH Victim Support Service 1800 208 005 www.health.qld.gov.au/qhvssStatewide service that provides specialised counselling, support and information to victims of crime when the person charged has been assessed as having a mental illness or intellectual disability.
Queensland Doctors Health Program
(07) 3833 4352 www.dhasq.org.au �
Helpline staffed by Senior General Practitioners, supporting Doctors/Medical Students suffering from a wide range of health or stress related problems.
National Sexual Assault, Domestic & Family Violence Counselling
1800 737 732 www.1800respect.org.au � �
Provides information, support and counselling to assist people experiencing the effects of sexual assault, domestic or family violence.
Nurses and Mid-wife support
1800 667 877 www.nmsupport.org.au �National support service providing access to confidential advice and referral.
Suicide Call Back Service 1300 659 467 www.suicidecallbackservice.org.au � �Nationwide service for anyone who may be suicidal, caring for
someone who is suicidal, or anyone bereaved by suicide.
Lifeline 13 11 14 www.lifeline.org.au � � � Access to crisis support and suicide prevention services.
Victims Counselling and Support Services
1300 139 703 http://www.vcss.org.au � � �
Face to face, telephone, and online counselling for Queenslanders, 24/7, who have been affected directly or indirectly by any criminal act.
Escalating the Incident
04
What’s here?
Checklist: � Incident reported via RiskMan
� Consider WorkCover process and explain to employee
� A complaint has been made to the Police with the
consent of the employee
� Support has been provided to the employee throughout
the complaint process
Reporting an OV Incident via RiskMan
WorkCover Process
Police Complaint Process
Relatable Offences
RiskManRiskMan is an integrated, web-based system utilised for the collection
and management of incidents. It is a safety information system that is in
place across Queensland Health facilities. Employees are required to
report all incidents, including near misses.
How to enter an OV incident into RiskMan
My Workspace > New > Incident
(Your screen should resemble the image below)
General tips when entering an incident
• All fields highlighted yellow need to be completed
• When selecting a classification, be sure to click Occupational
Violence, however, you may select more than one classification
• Ensure there is sufficient detail provided in the details section
How do I report an OV incident if the RiskMan
system is down?
In the event that RiskMan is down, the relevant RiskMan
downtime form should be completed. This form can be
accessed by searching Staff/Worker Incident – Reporter
Form on QHEPS.
When the RiskMan system is available again:
1. Enter the data into RiskMan system
2. Date and sign the downtime form
3. Scan and upload the form into the record
4. Submit the record
WorkCover Process
If an employee is injured as a result of an OV incident, they may
be eligible to claim compensation benefits from WorkCover
Queensland.
Benefits of early and safe return to work
Earlier Recovery
Reduction in Long Term Impairment
Minimal Interruption to
Weekly Earnings
Early Re-engagement
with Team
Reduced Impact to
Family
Increased Physical and
Emotional Wellbeing
(Franche, Baril, Shaw, Nicholas & Loisel, 2005)
Manager’s role in WorkCover claims Ensure that the employee receives appropriate and timely
medical assistance. Attend to the Incident Management Process
as outlined below.
Employee and manager to complete the relevant sections of the
Worker’s Compensation claim form. Forms can be accessed through:
• WCQ online: www.workcoverqld.com.au• Health and Safety Unit
• Employees Medical Practitioner
Completed WorkCover claim kit to be sent to:
Email to:
Employee’s will be assigned to an Injury Management Advisor (IMA). IMA will contact the employee
Work with the employee’s IMA to identify suitable duties to assist
with the employee’s early and safe return to work (RTW)
Provide the Payroll Injury and Rehabilitation Claims Team
(PIARCT) with accurate information pertaining to the employee’s hours of work during the RTW process to ensure the correct
payment of wages
Maintain contact with the employee while they are off work
Ensure provisions of suitable duties in accordance with medically
certified restrictions are provided, and Workplace Rehabilitation and RTW processes are followed
Engaging the Queensland Police Service
The investigation process begins with a complaint to the Police
specifying that an assault/harassment incident occurred.
Offer the employee the option to contact the Police if they have not
already been contacted. You or a colleague may contact the local
Police Station on behalf of the employee, with their full consent.
However, you or a colleague may not make a statement on
behalf of the employee involved in the OV incident. The Police can
be contacted to make a complaint in the following way:
PoliceLink will guide you through the process and will connect you
with the local Police.
What does the investigation process look like?
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t • The Police will take a detailed statement from the employee, and
any witnesses including specific details of what occurred and what was said during the incident
• The Police will document any injuries acquired as a result of the incident
• The Police will examine forensic evidence and body worn camera or CCTV footage if it is available
• The offender may be charged with assault, but this will depend on
the specific incident (refer to relatable offences for more
information)
• The perpetrator (defendant) has a right to legal representation
• You can withdraw your complaint at any point, however after the
offender has been charged, the decision to discontinue
prosecution will rest with the prosecuting authority
Where to for legal supportYour local Legal Services can provide support to employees. They are available to assist employees in preparing their statement, liaise
with Police, and at times, escort employees to Court. Legal Services can be contacted via:
What to wear in court• If the employee attends Court they will be provided with advice
on what to wear. Often employees attend in their work uniform
PoliceLink
131 444
PoliceLink via Smartphone or App
https://www.police.qld.gov.au/programs/policelink/
Where do statements get taken?
The Police will work with the employee and you as their manager, to
obtain the statement at an appropriate time during work hours. The
Police can take a statement at:
� the Hospital
� the Police Station
Is the employee required to disclose their home address?
All personal particulars are treated by the Police as strictly
confidential. The personal details of the impacted employee and
witnesses such as their residential address or personal contact
number are not divulged to suspects or persons of interest. A
statement commonly begins with, “I am [name of employee], and I
reside at an address known to Police.”
As the prosecutor has access to the employee’s statement, this helps
to maintain the employee’s privacy and prevents exposure of personal
details.
What if the patient was of impaired capacity?
Assaults by patients who have impaired capacity will be investigated
as per any assault that occurs within Queensland. Impaired capacity
does not prevent an offender from being charged with a criminal
offence.
Patient’s with a mental illness may be eligible to have their case heard
at the Mental Health Tribunal, as opposed to traditional Court. Police
will advise if this is the case.
FAQs Regarding the Queensland Police Service
Reporting and recording of Injuries
If the employee suffered injuries they will be required to promptly attend
a doctor who will document their injuries. Police may ask the employee
to sign a medical consent form so they can access the employee’s
medical records of the assault and provide to the Court. The Doctor may
be called to attend Court to give evidence regarding the extent of the
employee’s injuries.
If the employee suffered visible injuries, Scenes of Crime (SOC) Unit will
contact you and arrange to have the employee’s injuries photographed
to present to the Court at a later date. This is required to be done within
24 hours to 48 hours of the assault. Additionally, damage to property will
be photographed by a SOC Officer. Where the property is likely to be
repaired prior to a SOC Officer’s attendance, you should photograph the
damage and advise Police that you have done so.
Who can access body worn camera and CCTV footage?
If security attended the incident, there may be body worn camera or
CCTV footage of the event. If the employee makes a complaint to the
police, the police will contact security directly to obtain this footage.
Due to the large amount of footage captured across the hospital 24
hours a day, security footage is managed on a time loop and is deleted
approximately every 28 days.
If the employee is unsure if they wish to make a complaint to QPS at the
time of the incident, security can be contacted and asked to save the
footage for use at a later date.
Relatable OffencesSome offences where a proceeding may be commenced against a person who commits an offence on a hospital employee are listed
below. This list is for your reference and the Police will assist in ensuring the correct charge is laid for the specific incident.
Relatable Offences Description
s.6 Public Nuisance
If a person behaves in:i) a disorderly way; or
ii) an offensive way; oriii) a threatening way; oriv) a violent way and
the person's behaviour interferes, or is likely to interfere with passage of a public place.
s.335 Common Assault
Any person who unlawfully assaults another. This includes the threat to carry out an assault, however it must include the gesture or bodily act associated with the
words, indicating the intention of assault.
s.340 Serious Assault
Same as Common Assault, however includes assault on:* Any person over 60 years; or anyone who relies on a guide dog, wheelchair or other remedial device;
* A Police Officer;* A public officer employed under the "Ambulance Service Act 1991" or “Hospital and Health Boards Act 2011"Therefore all assaults on health employees should be classed as Serious Assault.
s.339 Assaults Occasioning Bodily Harm The same as s.335 Common Assault, including "any bodily injury which interferes with health and comfort".
s.320 Grievous Bodily HarmGrievous bodily harm is defined as "the loss of distinct part or an organ of the body; serious disfigurement; or any injury that could cause, or be likely to cause permanent injury to health".
s.395E Unlawful Stalking
Acts that constitute stalking include:* Following, loitering, or watching a person (including approaching or entering the home or workplace of a person)
* Giving offensive material to a person (directly or indirectly)* An intimidating, harassing or threatening act against a person.
s.474 Menacing Harassing threatening phone calls
This includes a person who engages in menacing, harassing or offensive verbal behaviour via the means of a mobile or landline service.
Follow-up Support
05
Wellbeing Check-in
Follow-Up Processes
Self-Care Check
How to Engage in Self-Care
What’s here?
� The employee has been contacted within one-week post
incident
� Check-in with employee using Look, Listen and Link
approach
� Employee has been offered the opportunity to engage the
Police
� Return to work procedure has been engaged if applicable
� Manager has completed the self-care check
Checklist:
Follow-up Processes (if applicable)
• Engaging the Police: If the employee has not reported the
incident to Police, offer to engage with employee’s consent
• WorkCover: Continually review the WorkCover return to work
procedures and adapt as necessary
Wellbeing Check-In
1. Contact the Employee: Within one week of the incident
2. Wellbeing Check: Check in following Psychological First
Aid principles
Look: It is normal to experience strong reactions after
exposure to violence and aggression in the workplace
Listen: Listen to understand the immediate needs of the
person. These may be different compared to their needs
immediately post incident
Link: Linking in with the employee within one week of the
incident promotes a sense of connectedness and support.
This can be over the phone or face to face. Reiterate
support options and the helpful information available in the
OV Toolkit for Employees. Ongoing support and review of
the employee’s welfare is likely to be required
Refer to Section 03 PFA & OV Toolkit for Employees for further information.
Self-Care Check
Your wellbeing is also important, so don’t forget to
check-in on yourself. Supporting employees after OV
incidents can be emotionally draining. Hearing about the
specifics of an OV incident may negatively impact you.
Witnessing/being involved and/or supporting an employee
after an OV incident may put you at higher risk of:
What to look for:
BurnoutCompassion
Fatigue
Secondary Traumatic
Stress
Feelings of Tiredness/Exhaustion
Feelings of Hopelessness
Finding it Difficult to Empathise
Feelings of Anxiety
Illness/Susceptibility to Illness
How to engage in self-care:
Engaging in self-care has proven effective in reducing risk of the above.
Self-care practices look different for everyone and are about finding
what works for you.
Engage in regular supervision or consult with a colleague
How to: Identify a colleague you feel comfortable discussing your experience
with. This can be a great opportunity for self and professional development
Contact EAP or other support hotlines
How to: A list of support hotlines and your EAP can be found in section 03
Psychological First Aid and OV Toolkit for Employees
Take regular breaks when possible
How to: Take time to pause, try and find a space where you won’t be
interrupted with work duties
Participate in regular exercise
How to: This doesn’t need to be vigorous exercise, but can be a walk outside
Participate in mindfulness exercises
How to: The Headspace and Smiling Minds app offer useful mindfulness
exercises
Notes
Notes
Notes
This resource kit has been developed by the Queensland Occupational
Violence Strategy Unit (QOVSU). QOVSU is a statewide team focussed
on the design and delivery of initiatives targeting occupational violence within healthcare. This toolkit has been intended as a post incident tool to assist managers in supporting affected employees.
If you have any questions contact QOVSU via: [email protected] V1 Effective: October 2018 Review: October 2020