It took a shooting incident to spark action, but serious work to reduce hospital violence is finally underway.
Sixteen months after a dramatic Code Black incident at Nepean Hospital put the issue high on the agenda, the Ministry of Health and health unions have met to review progress on measures to reduce violence at health facilities.
NSWNMA General Secretary Brett Holmes and Assistant General Secretary Judith Kiejda attended the meeting to review progress in implementing a 12-point action plan.
The Ministry and unions adopted the plan in February 2016 following the shooting of a policeman and security guard inside Nepean Hospital’s emergency department a month earlier.
Judith Kiejda told a recent NSWNMA committee of delegates’ meeting that while there was no “quick fix” the union was “confident that the Ministry understands its responsibilities for workplace safety and security” and was committed to making hospitals safer.
ED AUDIT
The 12-point plan included a security audit of 20 hospital emergency departments and self-assessments of all others.
Judith said all 57 audit recommendations are being implemented and some have been completed.
She said the Ministry was “not pleased” with the results of the audit, which showed failure to comply with security requirements across the local health districts.
“The Ministry will play a tighter monitoring role, which will include random spot checks to ensure future compliance,” she added.
Also, future construction and renovation projects will have to be supported by documented safety assessments. This will apply to all departments, not only EDs.
DURESS ALARMS
Judith said the audit showed employees at many facilities did not wear duress alarms, left potentially dangerous implements lying around and failed to lock plaster rooms and other areas containing implements that could be used as weapons.
Workplace visits by the NSWNMA and the Ministry showed “many staff do not take the wearing of duress alarms seriously.”
“Some systems are less than perfect and there are even cases where they do not work, however an employee must use whatever has been supplied.
“If the duress alarm is ineffectual, does not work, or is faulty, the employee has a responsibility to document and report it and the employer has a responsibility to fix it.
“If the unit is faulty but works occasionally, the employee must wear the duress alarm in line with workplace policy.”
Judith said this approach would prevent management from blaming nurses for the outcome of any incident.
“The Ministry now acknowledges that systems must work and these are being upgraded where necessary.”
POLICE HANDOVERS
The Ministry and police are working on a new agreement that goes beyond the current mental health scope and improves handover procedures.
Judith said the new “memorandum of understanding” would require both health services and police to change current practices. Breaches will be dealt with by the local health district chief executive and the police local area commander.
TRAINING
Judith reported that the Ministry is rolling out a comprehensive package to train ED nursing, security and medical staff in the management of disturbed and aggressive behaviour.
She told the delegates that so far, 89 staff had gone through a one-day “train the trainer” course supported by online resources such as videos.
Clinical unit and hospital managers have received training to ensure their workplaces have a zero-tolerance approach to violence.
SECURITY GUARDS
Security staff have been put through a three-day training course designed for health services and 30 additional security staff have been recruited.
The Ministry is reviewing its policy on forcible removal of non-patients from hospitals. The aim is to identify the circumstances in which security staff are able to remove people who are acting aggressively and causing disruption.
The Security Action Plan
In early 2016 health unions and the NSW government agreed to a Security Action Plan that included:
An audit of 20 hospital emergency departments to examine and recommend on a number of issues including compliance with policy and training requirements, adequacy of ED design in managing aggressive patients, adequacy of security staff, and liaison with police including handovers.
The plan also involved an “intensive program of multi-disciplinary training” of ED nursing, security and medical staff.
Clinical unit and hospital managers were to be “trained to understand and give effect to their workplace health and safety obligations and ensure their local workplaces had a zero tolerance to violence”.
Recruitment and training of security officers was to be improved.
A group of expert clinicians was to look at ways of improving the management and treatment of patients presenting to EDs under the influence of psycho stimulants such as ice.
Incident management reporting systems were to be improved.
