Occupational violence and aggression incident and prosecution in healthcare

Background

A Melbourne health service has been fined $25,000 without conviction after a nurse was assaulted by a patient with aggressive and violent behavioural issues.

In December 2018 the service pleaded guilty to 1 contravention of section 21 of the Occupational Health and Safety Act 2004 (OHS Act) for failing to provide the information, instruction and training necessary to allow workers to perform their work safely and without risks to health.

The contravention related to an incident in 2015. A nurse was attending to a patient when she was physically assaulted (hair pulled, pushed, punched, head butted and kneed in the face). The nurse was unable to reach a wall-mounted duress alarm and had to scream for help. The nurse was later admitted to hospital with concussion, bruising to the eye and scratches.

The assault followed several incidents in which the patient aggressively grabbed employees.

Contributing factors

A WorkSafe investigation found employees were exposed to risk by the employer’s failure to:

• inform its employees that the patient’s behavioural issues included physical aggression and violence, and that there was a risk of injury to employees
• inform its employees that the management of the patient’s behaviour included the use of mechanical restraints, when necessary, and the wearing of personal duress alarms
• instruct its employees to develop a behaviour management plan for the patient that included the use of mechanical restraints if necessary, and wearing of personal duress alarms
• train its employees in the use of mechanical restraints and personal duress alarms

Ways to manage health and safety

Employers must, so far as is reasonably practicable, provide and maintain a working environment that is safe and without risks to health. This duty requires employers to control risks to health and safety; employers should eliminate risks where possible. This duty includes providing employees with enough information, instruction, training or supervision to do their work safely and to maintain safe systems of work.

Employers also have a duty to ensure that workplace activities don’t endanger other people, such as visitors, clients or the public.

Preventing and managing OVA are part of these duties.

Risk identification and control

When providing health services, employers should identify and assess patients or clients who may pose an OVA risk. For information about what to consider in a risk assessment, see WorkSafe’s guidance Prevention and management of occupational violence.

If a patient or client is identified as posing an OVA risk:

• develop and implement a behaviour management plan: these plans must include identification of OVA risk and appropriate control measures through consultation with families, treating health practitioners and employees
• communicate information from the behaviour management plan and implemented control measures to all employees who may have contact with the patient or client and to other health providers/facilities who may be receiving the patient on discharge
• regularly review the behaviour management plan and control measures, and update them as circumstances change (for example, if behaviour escalates or patient is transferred to a different environment), or following an incident

Information, instruction and training

Employers must identify training needs and provide all employees with information, instruction and training relevant to the risks they face and environments they work in. For more information about training, see WorkSafe’s guidance Prevention and management of occupational violence.