Violence Prevention
- Complete a Violence Risk Assessment and Clinic Inspection
- Develop a Violence Prevention Policy
- Establish a Patient Code of Conduct
Violence Prevention
A violent incident, whether verbal or physical, can cause significant negative impacts on health workers. Physician employers must ensure they are doing as much as possible to maintain a workplace that is free from violence. If there is a risk of violence, the employer must complete a risk assessment, create procedures to eliminate or minimize the risks, and provide workers with training on prevention strategies.
Workplace Violence
Physical harm done to a worker by someone other than a worker. Situations where harm is only attempted, or where workers are threatened or intimidated and believe they are at risk of injury are also considered to be workplace violence.
*Remember, your safety is the top priority, and you have the right to refuse unsafe work. If you have reasonable cause to believe that performing a work task puts you or someone else at risk, you must not perform the job or task and notify your supervisor or employer right away.
Clinic Violence Prevention Safety Plan
Community physicians and their staff often face challenging interactions with patients, family members, and other visitors. To reduce risk and better support your staff, complete a violence risk assessment and clinic inspection, then establish a violence prevention policy and procedure for your clinic. Train staff on the violence prevention policy and procedures and provide refresher training as required.
Complete a Violence Risk Assessment and Clinic Inspection
The Occupational Health and Safety (OHS) Regulation requires employers to perform a violence risk assessment in any workplace where a risk of injury to workers from violence may be present.
A violence risk assessment is required at the beginning of operations, when a significant change to operations occurs (e.g., new location or renovation), or following a violent event.
In a medical clinic, the following factors should be considered in a violence risk assessment:
- Previous experience and past incidents in the clinic by reviewing incident reports, near misses, and anecdotal experiences.
- Layout and workplace conditions, including fixtures and equipment, furniture, barriers, lighting, and doors.
- Exits and emergency procedures.
- Interactions with patients and the public.
- Age, gender, experience, and skills of staff.
- Enforcing policies with the public (e.g., no public washroom; not accepting patients).
- Staff working alone or in isolation, and the availability of backup staff.
- Experience in similar workplaces by consulting peer clinics and neighbouring businesses on their incidents (if any), severity, and outcomes.
- Neighbourhood safety, parking lots, and public transit near the clinic.
Develop a Violence Prevention Policy
The clinic employer must create a violence prevention policy that outlines the roles and responsibilities of the employer and staff, and the standards and procedures to prevent violence in the clinic. Staff should receive training on this policy and its procedures. This template can help you establish the violence prevention policy.
Establish a Patient Code of Conduct
Prevention Strategies to Further Reduce Your Clinic’s Risks
Adopt some or all of these prevention strategies to further reduce your clinic’s risks:
- Have clear sightlines to patients in the reception area (e.g., convex mirrors to improve visibility in blind spots).
- Control access to staff-only areas (e.g., lockable doors in staff room).
- Install effective physical barriers between the public and staff in the reception area (e.g., Plexiglas above the reception counter, side doors for staff access).
- Ensure office furniture is arranged to allow providers a clear path to the exit, where possible.
- Clear workspaces of potential weapons (e.g., scissors or heavy potted plants).
- Install emergency alert systems (e.g., panic buttons).
- Ensure there is adequate lighting at entrances and in parking areas.
- Provide training to staff.
How to manage violent behaviour in patients and the public
State clearly that the behaviour is unacceptable and outline the consequences if it continues. Remind patients of the patient code of conduct.
Involve support resources, including other clinic personnel, or call 9-1-1.
If faced with imminent violence or threats, move to safety and prioritize protecting yourself, staff, and others in the clinic.
Call the police. Always make sure you are in a safe place before you call 9-1-1.*
Document any relevant statements or behaviours in patient’s medical records using clear, factual language.**
* Call the police. Always make sure you are in a safe place before you call 9-1-1. When reporting to police, provide only essential information (e.g., the individual’s name and the nature of the incident) and avoid disclosing medical details to protect patient privacy.
** Document any relevant statements or behaviours in patient’s medical records using clear, factual language. Include verbatim statements in quotation marks. Also, document the incident using the clinic’s Incident Report Form, including the incident details and contributing factors, to support internal tracking and team communication.
Post Incident Recommendations
When dealing with patients with a history of inappropriate or violent behaviour, consider the following:
- Review the patient’s chart before their appointment (document history and triggers for aggressive behaviour).
- Take note of any potential concerns and use precautionary measures if necessary.
- Ensure the workspace is arranged for safety (e.g., clear exit path, free from items that could be used as weapons).
- Inform another staff member when and where the appointment will take place.
- Have another person in the room or leave the door slightly ajar. (If available, use a room with a panic button to call for assistance).
Training
SWITCH BC, with funding from the Ministry of Health, recently updated the Provincial Violence Prevention Curriculum eLearning for physicians (1.5-hour course) and eLearning for health workers (3.5-hour course). The courses are available through health authorities, and you can ask to register for the course that applies to your work.
Physicians course: Provincial Violence Prevention Training for Physicians (course #35688 – receive up to 1.5 Mainpro+/ MOC Section 3)
All health worker course: Provincial Violence Prevention Training for Health Care Workers in Low Risk Departments (course #7557)
Get Support
Following a violent incident you or your staff may want to seek out mental health help.
While care has been taken in the creation of these materials, reviewing the content may trigger unpleasant feelings or memories of past harm and/or violence. Practice good self-care and step away from the material and seek support as needed.
Physicians or staff who require emotional support can contact:
- B. C. Physician Health Program: call 1-800-663-6729, available 24/7.
- 310 Mental Health support: dial 3-1-0, available 24/7.
- Crisis Centre of BC: call or text 9-8-8, available 24/7.
- WorkSafeBC Crisis Support Line: call 1-800-624-2928, available 24/7.
- Care to Speak: call or text 1-866-802-7337, available Monday – Friday 9 a.m. to 9 p.m. PT.
First Nations, Inuit, and Métis peoples who require emotional support can contact the Hope for Wellness Help Line and On-line Counselling Service toll-free at 1-855-242-3310 or through hopeforwellness.ca.
The Métis Crisis Line is available 24 hours a day at 1-833-MétisBC (1-833-638-4722).
The KUU-US Crisis line is available 24/7 at 1-800-588-8717 or through kuu-uscrisisline.com to provide support to Indigenous people in B.C.
