1. Procedure description

The Royal Children's Hospital (RCH) is committed to the provision of a safe and healthy work environment for all employees, contractors and visitors and the continuous development and improvement of its safety management system in order to:

• Achieve best practice Workplace Health and Safety (WHS) performance for the health sector.
• Identify, assess and control risks.
• Incorporate WHS considerations into all work processes.
• Consult with staff on WHS issues.
• Provide WHS training and instruction.
• Set WHS performance targets for the organization and management.

 RCH actively supports zero tolerance towards aggression and violence in the workplace. RCH will achieve this by establishing an environment that promotes identification of hazards, assessment and control of risks, preventative training and education, reporting and effective management of all incidents and incorporating safety into facility design. These harm minimising practices, and the active reduction in the use of restrictive interventions will assist RCH in achieving a safe and effective work environment. 

This Procedure applies to all RCH employees, students and contractors. 

Employee to employee violence, bullying or harassment is not included in the scope of this Procedure.  These behaviours are covered by the RCH Safe and Positive Workplace Behaviours Procedure. 

2. Definition of Terms 

Occupational Violence
An incident in which an employee, student or contractor is abused, threatened or assaulted. This includes incidents of clinical aggression and family/visitor aggression and violence. It may include:

• Verbal, physical or psychological abuse.
• Intimidating or threatening behaviours.
• Aggravated assault.
• Threats with a weapon or object.
• Sexual harassment and/or sexual assault.

Assault as defined below 
The direct or indirect application of force by a person to the body, clothing or equipment worn by another where the application of force is without lawful excuse and with the intent to inflict or being reckless as to the infliction of bodily injury, pain, discomfort, damage, insult or the deprivation of liberty and results in infliction of any such consequence. It is also an act that causes reasonable fear in another person of injury or intimidation.

Code of Conduct  
The agreed set of minimal standards of behaviour that all staff, patients, families and visitors are expected to comply with to ensure the RCH is a safe, professional and friendly environment. See RCH Code of Conduct for details. 

Identified Individual
A patient, family member or visitor who has been identified by RCH as posing an ongoing risk of aggression and/or violence to staff.

Aggression & Violence Prevention Committee 

Formed to provide organisational leadership in the prevention, intervention and management of aggression & violence at RCH. 

3. Responsibilites

Chief Executive Officer

• Ensure that the RCH program to manage occupational violence complies with all statutory and common law requirements.
• Provide leadership and support for zero tolerance of occupational violence.

Aggression & Violence Prevention Committee

• Provides leadership in the prevention, intervention and management of aggression and violence at RCH.
• Develops and review policies, procedures relating to occupations violence and aggression.
• Review incidents of aggression and violence within organisation, and make recommendations following critical incidents.

Executive Directors

• Ensure compliance with governing policies and procedures of occupational violence.
• Ensure that appropriate risk management actions are taken where risk of occupational violence is identified.
• Ensure that all front line staff receive appropriate training and instruction.

Department Heads /Unit Managers / Supervisors

• Identify violence and aggression risks in your work area.
• Ensure compliance with occupational violence policies and procedures.
• Encourage staff to report all incidents of occupational violence and aggression through VHIMS. 
• Investigate all incidents of occupational violence and aggression including risk controls. 
• Promote a culture that does not accept violence and aggression. 
  

Emergency Management and Planning Manager

• Manage and maintain Code Grey/Code Black response capability at RCH in collaboration with the Clinical Nurse Consultant – Aggression Management/Code Grey Coordinator.

Aggression Management/ Code Grey Coordinator

• Coordinate and manage response to occupational violence during business hours (After hours response managed by After Hours Hospital Manager). 
• Oversight of all incidents of occupational violence and initiates appropriate follow-up and investigation (as per critical incident review procedure).
• Coordinate The RCH’s management of clinical aggression training.

Clinical Lead

• Coordinate critical incident review following code black incidents.
• Coordinate a multi-disciplinary team debrief post OVA incidents to improve the measures taken to reduce the likelihood of aggression 

WHS Team

• To ensure systems and procedures are established and implemented to effectively provide a proactive means of preventing and reducing incidents of workplace aggression and violence.
• To provide guidance on hospital wide risks and means for control. 
• To ensure that systems of harm reduction post event (EAP and trauma counselling) are made available to all staff exposed to occupational violence.
• To support staff suffering injury/illness post event.

Employees 

• Comply with this procedure and RCH Emergency procedures. 
  
• Participate in training in the management of violence and aggression in the workplace. 
• Report all incidents and potential incidents of violence and aggression via VHIMS . 
  

4. Procedure details 

Risk Identification and Assessment

• Incidents of occupational violence will be reported in accord with the Incident, Injury and Hazard Reporting procedure procedure
• Incidents of occupational violence will be managed in accordance with the Emergency Procedures, Code Grey and Code Black
• Following incidents of aggression and violence with patients or families, a security alert on the Electronic Medical Record (EMR) should be considered.

Risk Control

• The establishment of an ongoing management plan for all patients/families exhibiting aggressive/violent behaviour.
• This plan will be reviewed and modified regularly in order to implement appropriate risk control measures.
• This plan should be developed by the lead clinician/ treating team for the patient, in collaboration with the Clinical Nurse Consultant - Aggression Management (Code Grey Co-ordinator) as required.

Post-incident

• A system to reduce harm resulting from exposure to occupational violence will be available to all staff.  This may include EAP and other internal or external services i.e. Critical Incident Debrief, Restorative Review 
• If police are involved, appropriate RCH hospital management will be notified as required.

Reporting an assault or threat to the police   

In circumstances where an employee has been assaulted or threatened, employees are entitled to make a formal report of the incident to Victoria Police.

RCH takes a zero tolerance approach to Occupation Violence and does not believe that being assaulted or threatened is part of the job. There is specific legislation that relates to protecting hospital staff from assaults. The legislation treats threats to kill or inflict serious injury seriously which carries the risk of imprisonment for between 5 – 10 years. A mental illness does not exclude a person from being interviewed and/or being charged by the police with a criminal offence.

To make a report to the police, employees are not expected to request permission from the hospital prior to making a report. RCH does however recommend that employees discuss their intentions with their managers prior to making a report so that all relevant information is presented and the employee is given the support they require. To make a report to the police, employees may report an assault by attending North Melbourne Police Station. The police will need the following sort of information:

• Your name
• Contact details
• The parties involved in an incident
• Details of the nature of the incident
• The level of injury 

5. Related Policies and Procedures 

Critical Incident Review Process

Terms of Reference - Aggression and Violence Prevention Committee

Safe and Positive Workplace Behaviours 

Incident, Injury and Hazard Reporting 

Code of Conduct

Code Grey

Code Black

Emergency Behavioural Assessment Room EBAR

Restorative Review Toolkit

6. References 

Acute behavioural disturbance: Acute management Acute behavioural disturbance: code grey

Victorian Government Department of Human Services (Final Report): Victorian taskforce on violence in nursing 2005

WorkSafe Guidebook: Prevention and management violence and aggression in health services

DHHS Organisational framework: Framework for preventing and managing occupational violence and aggression

ANMF New guide for health services to create safe workplaces: 10-Point Plan to End Violence and Aggression: A Guide for Health Services