Care – Security / Assault

This risk profile relates to safety and security and the risk of harm to patients, clients, visitors, volunteers, employees, and healthcare providers. Assaults, threats, or environmental security challenges can be from a variety of sources. Safety is a top priority for healthcare and part of everyone’s responsibility. 

This document contains information entered by HIROC Subscriber healthcare organizations (acute and non-acute) in the Risk Register application to help you in your assessment of this risk.

Key Controls / Mitigation Strategies

• Policies/Procedures/Protocols:
  • Abuse and harassment 
  • Zero tolerance and abuse definitions
  • Workplace violence prevention 
  • Patient identification policy regarding known safety risks
  • 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
  • Security standard work – walkthroughs/walkabouts
  • Whistle-blower, duty to protect, duty to report
  • On call support for evenings/weekends: Risk Management, Occupational Health and Wellness, Communications, Security, Employee Assistance Program
  • Search protocols for potential weapons
  • Accreditation, required organizational practices guidelines, to implement new tools, procedures and improve practice

• Emergency codes related to security/assault which may be province and organization 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 behaviour or are risk to themselves or others

  • Plan of care identifying triggers or previous history of aggressive acts and mitigation strategies

  • Patient chart alerts regarding known safety risks

  • Standardized terminology for assessing, communicating and documenting observation/supervision levels of potentially abusive patients/clients

  • Strategies for visitors exhibiting sexual, or aggressive behaviours

  • 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 focus on behaviours (e.g., behavioural support groups) 

  • Patient and/or family/Substitute Decision Maker (SDM) involvement in nursing shift handover encouraging transparent approach 

  • Harm reduction strategies related to drug users while on an intravenous (IV) line

  • Speaking up about potential risks or concerns related to safety or security

  • Strong safety messaging for staff 

  • Visiting home care settings in pairs

  • Safety huddles, care rounds

  • Transfer of accountability process

  • Violence Prevention Screening (VPS)

  • Designated security for specific areas

• Environmental:

  • Parking lot lighting, panic stations, cameras and/or security guard patrol

  • Renovations to create safe physical space, Public Announcement (PA) system, higher security doors, maglocks

  • Signage to indicate premises is monitored 

  • Alarms, cameras, personal alert devices, panic buttons, loud sound devices, random security rounds, wander guard devices 

  • Secured areas (code access), 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 with preparedness exercises

  • Security to provide education to staff on personal safety

    • Test of knowledge as part of training

    • Include how to identify abuse

  • Resources and tools available and easily accessible post training

Monitoring / Indicators

• Search ability and employee awareness audit of existing policies and tools supporting safety  
• Security incident and safety report reviews, escalation protocol, analysis, and trending 
• Data transparency throughout organization
• Joint Occupational Health and Safety Committee reporting and subcommittee specific to workplace violence
• Lost time claims, number of workplace violence incidents 
• Implement formal strategies for policy compliance monitoring: scheduled inspections, records reviews and policy refresh (% completion)
• Code White reports, patient/client relations files, learning from medico-legal matters
• Emergency planning committee review of emergency code procedures
• Education/training or appropriate certifications (percentage completion)
• Debriefs for what went well and what can be improved and analysis of reports related to codes (e.g., code white)
• Workplace violence response and prevention committee