Guidelines from the International Association for Healthcare Security and Safety (IAHSS)

Program Management

Violence in Healthcare

STATEMENT: Healthcare Facilities (HCF's) will implement an interdisciplinary protocol addressing workplace violence prevention and response.

INTENT:

  1. The protocol should elaborate on the five main components of an effective safety and security program, whose components also apply to preventing workplace violence:
  2. 1) Management commitment and employee involvement
    2) Worksite analysis
    3) Hazard reduction and response
    4) Training
    5) Record keeping and program evaluation
  3. A multidisciplinary team should be appointed to develop and maintain the workplace violence program. The team should have express support of the facility's CEO along with authority for the program.
  4. Security should have a clearly defined role in the HCF's workplace violence program. Security often takes the lead role in coordinating the team. The team should receive orientation and training in evaluating and responding.
  5. Each HCF should establish a system such as patient record flags, electronic warnings, chart tags, log books, or verbal census reports that identify patients and clients who may present assaultive or threatening behavioral challenges.
  6. Each HCF should establish policies and procedures prohibiting the carrying of firearms and other weapons onto the facility with the exception of authorized law enforcement officers, weapons carried by the facility's security, and others specifically authorized, such as armored car personnel.
  7. Each HCF is encouraged to post 'No Weapons' type signage at entrances to the facility.
  8. Each HCF should incorporate Targeted Violence protocols (written in accordance with IAHSS Guideline 02.02.01-Targeted Violence) into its Violence in the Workplace policy or create a separate policy for preventing and responding to targeted violence (including domestic violence).

REFERENCES:

— Violence Occupational Hazards in Hospitals, DHHS (NIOSH) Publication No. 2002-101, April 2002

— Guidelines for Preventing Workplace Violence for Health Care & Social Service Workers, U.S. Department of Labor

Occupational Safety and Health Administration OSHA 3148-01 R 2004

— Workplace Violence Prevention and Response Guideline, ASIS International, ASIS GDL WPV 09 2005

Program Management

Violence in Healthcare

Targeted Violence

STATEMENT: Healthcare Facilities (HCF's) will provide responses to manage targeted violence.

INTENT:

  1. Definition: Targeted Violence — a situation where an individual, individuals or groups are identified at risk of violence, usually from another specific individual such as in cases involving domestic violence. Often the perpetrator and target are known prior to an incident.
  2. The three major functions of a threat assessment are: identification of a potential perpetrator, assessment of the risks of violence posed by a given perpetrator at a given time, and management of both the subject and the risks that he or she presents to a given target. The level of threat will determine the scope and timing of the response.
  3. The HCF policy should identify responsibility of staff to report a risk of targeted violence as quickly as possible so that the threat can be assessed and preventative measures can be initiated as required.
  4. Mechanisms should be in place to encourage reporting of threats where personal safety may be at risk.
  5. All identified threats of targeted violence should be treated seriously and assessed through a process that analyzes the threat and recommends the appropriate level or type of intervention to be initiated.
  6. Security should play a lead role in the threat assessment process and design of any safety plan.
  7. HCF staff involved in the process of assessing the threat to determine the appropriate level and type of intervention required should receive training for this role.
  8. Where warranted by risk in specific circumstances, HCF's should employ preventative measures to protect the potential target. Measures should include:
  9. 1) Placing a no information/privacy block on patient information system or, if a worker, protecting information related to work location
    2) Communicating with security to provide updated information
    3) Information to be shared with workers or other individuals in the area as appropriate
    4) Involvement of staff or family members for support as necessary
    5) Consideration of moving the person at risk to another care area or another site
    6) Restriction on visitors or access to the potential target, including lockdown of the area if required.
    7) In appropriate circumstances notify law enforcement
    8) Document risk and preventative measures initiated
  10. The safety of the potential victim should be of paramount concern at all times.

REFERENCES:

— Canada, Department of Justice, "Criminal Harassment: A Handbook for Police and Crown Prosecutors."

— US Department of Justice, National Institute of Justice, "Threat Assessment: An Approach To Prevent Targeted Violence."

Copyright © 2010 by International Association for Healthcare Security and Safety (IAHSS).
Reprinted with permission.