Zoran Bukarica - Australian Nursing & Midwifery Federation
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Transcript of Zoran Bukarica - Australian Nursing & Midwifery Federation
Z O R A N B U K A R I C A
O H S O F F I C E R , A N M F ( V I C B R A N C H )
SESSION OUTLINE
1. Objectives
2. Causes and Consequences of Violence in Nursing & Midwifery
3. OVA working parties – what are they?
4. ANMF involvement – how, why, when?
5. Impact of working parties on the employer
6. Impact of working parties on the members and the general nursing workforce
7. Example of a successful case
8. Conclusion & Questions
OBJECTIVES
To explain the involvement of the ANMF in OVA
To identify positives from ANMF involvement in OVA at the workplace level
Showcase an example of a positive experience with working parties
CONTEXT
88% of Australian nurses and midwives consider occupational violence a risk (Driscoll, T, 2008)
36% - high risk
Reporting of violence incidents - approx. 50% (Farrell, Shafei and Gaynor, 2010)
Main types of occupational violence -Verbal abuse (90%)Physical (44%)Threat of harm (27%)
CONTEXT (CONT)
Main perpetrators
Patients (75%)
Visitors (19%)
Over half of perpetrators are aged
50+, and 61% are male
55% rate organisation’s management
of situations as only “fair” or “poor”
CAUSES OF VIOLENCE IN NURSING
No single factor – multifactorial
Some contributing factors include:Mental health of clients (53%)Patient’s personality (63%)Drug and alcohol-affected patients / clientsInexperience of nurse / midwife
CAUSES OF VIOLENCE IN NURSING (CONT)
Organisational contributing factors include:Management commitment to elimination of violence
Situational and/or Environmental factors
e.g. Physical layout, design
Policies and Procedures
Training
Security
Support
CONSEQUENCES OF VIOLENCE IN NURSING
Workers Compensation Claims Injuries
Physical Psychological Friends and Family
Absenteeism Loss of trust in the organisation High staff turnover Lost to profession Economic loss
WHAT ISSUES DOES ANMF FIND?
Lack of true consultation
Lack of collaboration
Short sighted
Single factorial approach
No systemic view
Too much concentration on ‘mopping up after’ (and even then poorly…)
Lack of consistency in approach across health services
MONEY
WORKING PARTIES – WHAT ARE THEY
Employee and employer organised
committees to look at system of managing
OVA (the WHOLE system)
ANMF present at meetings to represent
members
Review the system, find gaps and improve
ANMF INVOLVEMENT
Member initiated contact
Members feeling their place of work is not
safe
Generally after a number of incidents
which hasn’t resulted in improvements or
one serious incident
IMPACT ON EMPLOYERS
Negative about Union involvement at the start
External party review of management system
Provide benchmark and ideas from other
hospitals
After a few meetings, employer comes around
ANMF encourage employees to report and
follow procedures
ANMF aim to assist employers
IMPACT ON MEMBERS AND WORKFORCE
Their Union is there representing them
Regain trust in the employer
Have a voice and ensure they are heard
Working party success story
St. Vincent's Hospital
BACKGROUND
1. St Vincent’s highlighted as leading the pack in relation to violence and aggression prevention and management
2. Feb 2011 - Report re incidents of client assaults
3. 4 Feb – Urgent meeting convened to discuss, with detailed follow up letter
4. Initially some hesitation regarding ANF direct involvement -> constructively addressed
5. SVMH committed and willing to undertake collaborative approach with ANF to genuinely resolve issues – very quickly initiating actions to address many issues
BACKGROUND6. Post-incident psychological support arrangements appropriate,
but did not resolve systemic contributing factors
7. 1st working party meeting utilised Action Plan based on issues articulated by ANF, with desired actions
8. Within a week, further 4 assaults / aggression incidents on staff -> posed risk regarding nurses confidence in the collaborative approach
9. Action Plan determined generally appropriate, but no associated timeframes -> SVMH agreed to amend
10. Urgency of actions stepped up to prevent further incidents whilst longer term actions were being implemented
CONTRIBUTING FACTORS IDENTIFIED
INCLUDED:1. Delayed alert of duress alarms
2. New Medical staff not aware of policies and procedures to follow
3. Communication concerns and issues relating to risk assessment of clients
4. SVMH policies not clear / communicated to all staff
5. Resources not in place to fully implement
CONTRIBUTING FACTORS IDENTIFIED
INCLUDED:6. Inadequate refresher training of insufficient regularity
7. Security not part of training undertaken, but part of Code
Grey response
8. Delays in security attendance at Codes
9. Variable levels of tolerance of aggression
10. Poor co-ordination and inconsistent approach for breaks
to seclusion
11. Inadequate medication for clients
SOLUTIONSWorking party – ANF attending initially via HSR request for assistance
Training
Training calendar developed and distributed
Additional TRAM training scheduled across calendar year, with inclusion of medical staff
‘Blitz’ on staff who had not recently undergone training as many had recently started rotation
Local Practice drills initiated on Monthly basis, including all AIS staff, security and Code Grey Response Team
Local orientation and checklist reviewed and varied
Security to attend TRAM training to ensure consistency of message and response
MORE SOLUTIONS
Duress Alarms
Review of duress alarm system – significant software upgrade required and being implemented
Testing of all handsets part of handover
Review of policy
Development of annual competency
Purchase additional 30 handsets to account for shift overlap times
Installation of wall mounted duress alarms
MORE SOLUTIONSPolicy & Procedure Awareness, Training & Compliance
Review of all relevant policies and roll out of campaign & training to all staff, including:
Code Grey Prevention of Aggression and Violence Policy Seclusion Policy OH&S MS Critical Incident Stress Management Policy ASCOM Policy Transfer of Acutely Disturbed Patients form the ED and AIS Policy AIS Admission Guidelines Emergency Response Team (ERT)
MORE SOLUTIONSCommunication of Risk Assessment and Outcomes
Risk Assessment currently under review
Alerts to be placed onto CMI (RAPID) – centralised mental health electronic system with patient histories and use code grey stickers
Training in use of system
Inconsistency of Knowledge / Awareness amongst staff
Direction that all medical staff attend TRAM and ASCOM training prior to commencing work
Medical staff to participate in scheduled TRAM training, followed up by Inpatient Educator & Director of Clinical Services Mental Health
MORE SOLUTIONS
Practice Issues
Review of use of sedation and other medication
Acute Arousal guidelines developed
Management support to staff when activating Code Grey and Pre-Code Grey
Consistent approaches via equipment, policies, education, training, drills implemented
Increased Client Awareness Campaign regarding no tolerance of aggression
Seclusion breaks policy to be reviewed and tightened
AND MORE SOLUTIONSSecurity location
All response times to be monitored
Early Code Greys to be called
Collaborative training to assist co-ordinated response
Professional Development – ANUMs / Shift Leaders
ANUM Development Training Day scheduled to focus on supporting their leadership skills and professional development
Two days allocated for training of ANUMs / Shift Leaders including training on policies, responses, equipment, etc.
Ergonomic assessment of nurses work area
CURRENT STATUS
ANMF no longer involved
Fantastic progress and support from SVMH towards their staff
Ongoing Acute Inpatient Service Consultative Working Party
Significant improvements in collaborative working environment
Overall improvement in management of OVA
LEARNINGS
Collaborative approach is most effective
means of addressing hazards
An entire systems approach is essential –
one component alone is not going to have
the required affect
OVA PREVENTION STRATEGY FRAMEWORK
Physical environment /
workplace design
(CPTED)
Post-incident support
Pre-admission/ admission risk assessment
Security –access,
personnel, CCTV, alarms
Incident reporting,
investigation, review and feedback
Training and education
Organisationalpolicies and procedures,
including Code Grey and Black
Cross disciplinary understanding, communication and consistent
approach
Empowered staff
Management plans /
Care plans
Executive commitment to OVA
prevention
OHS Management
System
QUESTIONS???
Contact details: Zoran BukaricaOHS OfficerANMF (Vic Branch)[email protected]
Ph: 9275 9333 or 0487 277 339