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Appendix 4: Workplace Violence - Risk Assessment Form and Samples

Example 5: Mental Health and Social Rehabilitation

Section 1: Context Appendix 4: — setting the scene

Location: Mental Health Unit

Division: Mental Health and Social Rehabilitation

Area/Activity/Person: Mr Citizen (hospital no. 1###12) is an in-patient in the Mental Health Unit awaiting a psychiatric assessment to determine an appropriate rehabilitation plan. During his extensive hospitalisation Mr Citizen has experienced chronic hepatisation and, as a result of contracted meningitis, he has also sustained limited brain injury. This has left Mr Citizen with a decreased ability for cognitive reasoning and a visual impairment. Due to his cognitive difficulties Mr Citizen has the potential to: • Engage in self-harm • Spit at attending staff • Fall (recorded incidents) • Grab and attempt to break others’ fingers, and • Present non-consented verbal and physical violence. (Recorded incidents including 17 cases of injury and 6 cases of serious harm to attending employees)

 

Section 2: Identifying Hazards — what can go wrong and who will be affected

Hazard	Something with the potential to cause harm	Persons at risk [√]
A	Physical injury to attending persons; targeting recipient’s hands.	S[√ ]  V[ ]  P[]  O[√ ]
B	Hepatitis infection from sputum (spit) targeted at employee’s face.	S[√ ]  V[ ]  P[√]  [√ ]
C	Soft tissue injury resulting from falls and acts of physical aggression directed at inanimate objects	S[ ]  V[ ]   P[√]   O[ ]
D	Inadequate diet due to any of the above factors (weight loss	S[√ ]  V[ ]  P[√]  O[ ]

S = staff; V = Visitor, P = Patient; O = Other

Section 3: Existing Control Measures —what practical steps are already in place

Hazard	Existing Control Measures
A	Mental Health unit specific training (non – injurious break away techniques)
C	Sharp or hard objects removed from room including non essential medical devices
C	Ten millimetre high density foam provided beside bed and chair to reduce injury consequence when fall occurs
B + D	There are no controls in place for these hazards

 

Section 4: Evaluating risk — not ‘worse case scenario’; takes into account existing controls

Hazard	Consequence ( 1 – 5 )	X	Likelihood (1 – 5 )	=	Risk Rating (1 – 25 )
A	3	X	2	=	6
B	4	X	3	=	12
C	2	X	3	=	4
D	2	X	4	=	8

 

Section 5: Risk prioritised action plan - applying the hierarchy of controls:

E=eliminate I=isolate M=minimise

Hazard	E /I/ M	Practicable Steps required to further control risk	Responsibility
All		Take all steps to prioritise the completion of Mr Citizen’s psychiatric review.	AUnit manager
B		Purchase splash protection spectacles for use by persons entering Mr Citizen’s room. Ensure these are cleaned between uses.	Unit manager
D		Evaluate effectiveness of diet plan with dieticians and Mrs Citizen.	Unit manager /named nurse
A + D	M	Violence triggers - Mr Citizen will sometimes share personal thoughts (triggers to violence) following care episodes with Mrs Citizen. These have included: • Being confined to a small room • The desire to walk to the toilet regardless of need • Food falling from his plate – ensure plate guards are used • Being given beakers to drink from – give cup to drink from in future and ensure beverage does not pose a scalding hazard.  It is therefore essential that communication with Mrs Citizen is an integral part of the review process.	Unit manager /senior in charge at each shift.
		Attending Mr Citizen - When Mr Citizen does become aggressive target areas that should be kept from reach include: hands, wrists and abdomen kicks from his bed. This is often accompanied by spitting during drug administration and blood letting. To manage these risks please implement the following when attending Mr Citizen: • Keep hands out of Mr Citizen’s grasp – do not offer your hand to lead him as this is the opportunity seized on to break fingers. • If hands are grasped, withdraw sharply without delay. • On escalation of aggression give Mr Citizen ‘space’ assuring him of your continued presence. • At all times wear the splash guards provided to protect eyes from sputum – to be purchased.	Unit manager/senior in charge at each shift and all persons at
D	I	Third parties - When any other person outside of the mental health unit attends Mr Citizen they must be informed of the current risk. Examples of third parties include: • Physiotherapists and occupational therapists who may be scheduled to attend Mr Citizen. If unit staff are aware of an increased level of agitation the therapy should be cancelled as it may over stimulate Mr Citizen to a point of physical aggression. • Porters should not be sent in to collect Mr Citizen without being informed of the risks. They must also be advised not to engage Mr Citizen in idle discussion as this has been known to trigger his violent episodes.	Senior in charge of each shift
		The next shift - The next shift is always at risk if changes to Mr Citizen’s care plan are not highlighted at hand-over. As a quick reference document the whiteboard on Mr Citizen’s door should include a current record of: • Mr Citizen’s current triggers of violence. • Actions to manage the hazards. • Special risks to Mr Citizen or employees.	Senior in charge of each shift.

 

Section 6: Further Information: cross-sector safety responsibilities

Who is responsible for local monitoring?

Is further competent (clinical risk, manual handling) advice required? Yes / No Comments::

Do third parties (agencies) require a copy of this risk assessment for their safety? Yes / No Comments:

 

Section 7: Assessment Sign-Off – assessment monitoring responsibilities

Assessor’s name: A unit assessor

Date of assessment: 17 July 2005

Assessor’s signature:

Review: (tick one) daily weekly monthly yearly

Reassessment date: 18 August 2005

Manager’s signature:

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