Risk Profile: Care – Security/assault

Risk Profile: Care – Security/assault (PDF version)

This risk profile relates to safety and security and the risk of harm to patients, visitors or staff.  Assaults, threats, or environmental security challenges can stem from a variety of sources. Keeping patients and staff safe is a top priority in healthcare and part of everyone’s job. This document contains information entered by your peers in the Risk Register application to help you manage this risk.

Ranking/ratings[1]

  • Likelihood – 2.65
  • Impact – 3.40  

The Risk Register allows for risks to be assessed on a five-point likelihood and impact scale, with five being the highest.

Key controls/mitigation strategies

  • Policies/procedures/protocols
    • Abuse and harassment
    • Workplace violence prevention
    • Code of ethics
    • Code of conduct
    • Professional boundaries
    • Critical safety event/incident reporting
    • Least restraint
    • Vulnerable sector/criminal reference/regulatory college checks for new staff or volunteers, and annual declarations
    • Visitor restriction
    • Custody and access
    • Acting out behavior
    • Emergency codes
  • Emergency codes related to security/assault which may be province specific, utilized for response, and emergency exercises, such as
    • Code Yellow  - Missing patient/person
    • Code Amber – Missing child/child abduction
    • Code Pink – Abduction infant, child, dependent adult
    • Code Black – Bomb threat/suspicious package or object
    • Code Purple – Hostage taking
    • Code Silver – Persons with a weapon
    • Code White – Violent/behavioural situation
  • Care strategies
    • Plan of care and behavioural response strategy for patients exhibiting sexual, aggressive behavior or those who are a risk to themselves or others
    • Plan of care identifying triggers or previous history of aggressive acts and mitigation strategies
    • Strategies for visitors exhibiting sexual or aggressive behaviour
    • Trained sitters or security guards for risk of physical aggression
    • Specialized consultation team for suspected child abuse or neglect 
    • Engagement with organizations external to healthcare (e.g. victim services) and healthcare organizations with a focus on behavioral issues (e.g. behavioural support groups)
    • Patient and/or family involvement in nursing shift handover to encourage a transparent approach
    • Harm reduction strategies related to drug users while on an IV line
    • Fostering a culture which encourages speaking up about potential risks or concerns related to safety or security
  • Environmental
    • Parking lot panic stations, cameras and/or security guard patrol
    • Renovations to create safe physical spaces
    • Alarms, cameras, personal alert devices, panic buttons, loud sound devices, random security rounds, wander guard devices
    • Locked nursing stations
    • Staff check-in on regular basis in high risk remote areas
    • Ongoing relationship development with police for environmental and security process consultation
  • Education/training
    • Abuse prevention
    • Non-violent crisis intervention
    • Policies, procedures and emergency codes

Monitoring/indicators

  • Search ability and employee awareness audit of existing policies and tools supporting safety  
  • Incident/safety report reviews, escalation protocol, analysis of trends
  • Joint Occupational Health and Safety Committee reporting and subcommittee specific to workplace violence
  • Policy compliance monitoring through scheduled inspections, records reviews and policy refresh (% completion)
  • Accreditation, required organizational practices guidelines, to implement new tools, procedures and improve practices
  • Emergency planning committee review of emergency code procedures
  • Education/training or appropriate certifications (% completion)
  • Debriefs related to what went well and what can be improved; analysis of reports related to codes (e.g. Code White)

[1] As of January 1, 2018

Note: information presented in this document has been taken from the shared repository of risks captured by HIROC subscribers participating in the Integrated Risk Management program.

© 2018 HIROC. For quality assurance purposes.