Administrative Controls
- State clearly to employees, clients, and patients that violence is not permitted or tolerated.
- Establish liaison with local police and state prosecutors. Report all incidents of violence. Provide police with physical layouts of facilities to expedite investigations.
- Require employees to report all assaults or threats to a supervisor or manager (e.g., can be confidential interview). Keep log books and reports of such incidents to help in determining any necessary actions to prevent similar occurrences.
- Advise and assist employees, if needed, of company procedures for requesting police assistance or filing charges when assaulted.
- Provide management support during emergencies. Respond promptly to all complaints. Set up a trained response team to respond to emergencies.
- Use properly trained security officers, when necessary, to deal with aggressive behavior. Follow written security procedures.
- Provide sensitive and timely information to persons waiting in line or in waiting rooms. Adopt measures to decrease waiting time.
- Establish a list of "restricted visitors" for previous employees, relatives, and patients with a history of violence. Copies should be available at security checkpoints, nurses' stations, and visitor sign-in areas. Review and revise visitor check systems, when necessary. Limit information given to outsiders on hospitalized victims of violence.
- Establish policies and procedures for secured areas, and emergency evacuations, and for monitoring high-risk area at night.
- Treat and/or interview aggressive or agitated clients in relatively open areas that still maintain privacy and confidentiality (e.g., rooms with removable partitions).
- Use case management conferences with co-workers and supervisors to discuss ways to effectively respond to potentially violent employees or patients.
- Prepare contingency plans to handle employees, clients, or patients who are "acting out' or making verbal or physical attacks or threats. Consider using certified employee assistance professionals (CEAPs) or in-house social service or occupational health service staff to help diffuse employee, client or patient.
- Discourage employees from wearing jewelry to help prevent possible strangulation in confrontational situations. Community workers should carry only required identification and money.
- Periodically survey the facility to remove tools or possessions left by visitors or maintenance staff which could be used inappropriately by patients.
- Provide staff with identification badges, preferably without last names, to readily verify employment.
- Discourage employees from carrying keys, pens, or other items that could be used as weapons.
- Provide staff members with security escorts to parking areas in evening or late hours.
- Parking areas should be highly visible, well-lighted, and safely accessible to the building.
- Use the "buddy system," especially when personal safety may be threatened.
- Encourage home health care providers, social service workers, and others to avoid threatening situations.
- Staff should exercise extra care in elevators, stairwells and unfamiliar locations.
- Develop policies and procedures covering work at remote/other worksites including the refusal to provide services in a clearly hazardous situation.
- Establish a daily work plan for field workers to keep a designated contact person informed about workers' whereabouts throughout the workday. If an employee does not report in, the contact person should follow-up.
- Conduct a comprehensive post-incident evaluation, including psychological as well as medical treatment, for employees who have been subjected to abusive behavior.
Medical Facilities
- Ensure adequate and properly trained staff for restraining patients or clients.
- Ensure adequate and qualified staff coverage at all times. Times of greatest risk occur during patient transfers, emergency responses, meal times, and at night. Locales with the greatest risk include admission units and crisis or acute care units. Other risks include admission of patients with a history of violent behavior or gang activity.
- Institute a sign-in procedure with passes for visitors, especially in a newborn nursery or pediatric department. Enforce visitor hours and procedures.
- Supervise the movement of psychiatric clients and patients throughout the facility. Control access to facilities other than waiting rooms, particularly drug storage or pharmacy areas.
- Prohibit employees from working alone in emergency areas or walk-in clinics, particularly at night or when assistance is unavailable. Employees should never enter seclusion rooms alone.
- Ascertain the behavioral history of new and transferred patients to learn about any past violent or assaultive behaviors. Establish a system such as chart tags, log books, or verbal census reports to identify patients and clients with assaultive behavior problems, keeping in mind patient confidentiality and worker safety issues. Update as needed.
- Transfer assaultive clients to "acute care units," "criminal units," or other more restrictive settings.
- Make sure that nurses and/or physicians are not alone when performing intimate physical examinations of patients.