Occupational Violence

Incident Response Kit

Queensland Occupational Violence Strategy Unit

Children's Health Queensland

Queensland Children's Hospital

WelcomePurpose of toolkit:

There are a significant number of cases of Occupational Violence (OV) occurring in hospitals and healthcare

settings every day across the state. This toolkit has been designed specifically to support managers (e.g.,

Nurse Unit Managers, After Hours Nurse Managers, Team Leaders and/or Shift Co-ordinators) navigate the

processes following the occurrence of an OV incident and support their employees. This toolkit includes:

what is OV, what to look for, ensuring employee and patient safety, reporting incidents, and supporting

employee’s post incident.

How to use this toolkit:

The post incident process has been conceptualised into five steps. Each step is presented as a section with

the relevant pages colour referenced to the process page (outlined on the following page). Each section

includes:

• A front-page

• Highlights of what’s included in each step

• A checklist of what needs to be actioned in each step

• Supportive information relevant to each step

Initiate immediate safety response:

• Security –

• Activate Duress Alarm

• Code Black –

• Police – DIAL (0) 000

Address safety:

• Patient and staff (engage medical treatment

as required)

• Environmental hazards

OV can look like:

• Physical assault

• Verbal abuse/harassment

• Threatening behaviour

• Sexual assault/harassment

• Abuse through technology

Occupational Violence Incident Response

Process

01Occupational Violence Incident Occurs

02 Immediate Response

DIAL 555

DIAL 555

Queensland Children's HospitalV1 Effective: October 2018 Review: October 2020

• Check-in within 1-week post incident

• Consider WorkCover return to work

procedures

• Report incident via RiskMan

• Consider need for WorkCover

• Engage Police (with staff consent) and provide

support throughout the process

• Provide employee support

• Look (common response)

• Listen (understand immediate needs)

• Link (offer break/patient

reallocation/leave/support)

• Offer Employee Assistance Program (EAP)

• Provide OV Toolkit for Employees

03Psychological First Aid and OV Toolkit for Employees

04 Escalating the Incident

05 Follow-up Support

Occupational Violence Incident Occurs01

What’s Here?

Checklist:

What is Occupational

Violence?

Why does OV Occur?

What does OV look

like?

Normal Responses to abnormal

events

� An OV incident has occurred as defined

What is occupational violence?

Occupational violence (OV) is not just “part of the job”. OV is

defined as any incident where an employee is abused, harassed,

threatened or assaulted by patients, consumers, their relatives or

members of the public, in circumstances arising out of their

employment, irrespective of the intent for harm.

Occupational violence is not limited to incidents which occur within

health facilities. It can also include violence that occurs away

from work but is a result of work. For example, a nurse who

receives a threatening telephone call from a patient at his or her

home has experienced occupational violence.

Why does occupational violence occur?

Common contributory factors linked with OV include:

1. Medical conditions (e.g. fear, pain, dementia, mental

illness)

2. Individuals (e.g. patients with history of substance

abuse and violence, and cognitive impairment, patient

journey, restricted smoking routines)

3. Relationships (e.g. relationships with all hospital

employees, rules and limit setting, patient and visitor

movements)

4. Organisational and environmental factors (e.g. wait

times, availability of community health services, ease of

access to facilities)

5. Societal factors (e.g. community attitudes towards

violence and service expectations)

What does occupational violence look like?

Unfortunately, statistics indicate that OV is common within the

healthcare setting due to the multiple contributing factors which

may be present. OV can present in a range of different forms and

by no means is it just “part of the job”.

95% of healthcare workers have experienced some form of

occupational violence at least once during their career. OV can

take many forms, and may include one or more of the following:

Physical Assault

Verbal Abuse/Harassment

Personal Intimidation

Threatening Behaviour

Sexual Assault/Harassment

Abuse Through Technology

Normal responses to abnormal events

Responses to OV incidents can vary person to person.

People respond to stressful events in different ways, the best thing

you can do to help is offer your support. Listed are some examples

of the range of responses employees may experience in response

to incidents of OV.

Behaviour changeSleep disturbances

Withdrawal

Avoidance of reminders Alcohol/drug use

Apathy

Easily irritable

Confusion

Anger

Feelings of dreadAnxiety

Sadness

GuiltHelplessness

Numbness/Shock

Aches and pains

Nausea

ShakingSweating

Heart Palpitations Headaches

Intrusive thoughts

Memory blanks

FlashbacksThoughts of self-blame

Ruminating thoughtsDifficulty concentrating

EMOTIONSBEHAVIOUR

PHYSICAL COGNITIVE

Immediate Response

02

Is it my Responsibility

to Call for Help?

What’s here?

Which Safety Option

Should I Choose?

Immediate Safety

Response to OV

Injury & Patient

Management

Environmental Safety

Concerns

Process for Delayed Care

Checklist:

� The appropriate safety response was engaged

� Injuries sustained as a result of OV incident have been

attended to

� If the injury was sustained by the aggressive

patient/consumer/visitor, the treating team have been notified

of the incident

� Environmental concerns have been addressed

Is it my responsibility to call for help?

Check with the person/s involved to ensure an immediate safety

response occurred. Typically, this would have occurred

immediately, in the event that it has not, ensure that the

appropriate response is engaged (refer to next page).

Engaging security, even in low risk situations, can ensure

proactive interventions are implemented.

The below safety options are available to you if an OV incident

has occurred.

Which safety option should I choose?

The most appropriate safety option will depend on the

circumstances and the severity of the incident.

For further information, the following page provides a detailed

outline of each of the safety responses, how to engage, and who

is engaged at each step.

Security

Police

Duress Alarm

Code Black

Immediate Safety Responses to OV

The boxes below illustrate the safety options available to respond to an OV incident. The appropriate pathway will entirely depend on the

circumstances and the severity of the incident. Engaging security early can allow measures to be taken to prevent the aggression/abuse from

escalating.

Security

Trained in de-escalation and

minimum force techniques to help

prevent potential injury/harm. If the

situation cannot be contained security

will call the police.

The earlier security is engaged,

the better the outcome for all

involved. Provide security with as

much relevant information as

possible.

ACTIVATE

Duress Alarm

Typically located under desks or

near work stations. When

activated, a duress alarm alerts

Security Officers.

If unable to dial code black or

security, locate a duress alarm near

you or direct a colleague to activate

the alarm if the situation requires.

Code Black

Dial the number and state “CODE

BLACK”. Security will respond

immediately.

A code black alarm is raised where an

employee, patient, or visitor is

behaving in a manner perceived by

employees to pose an immediate

threat to the safety of others, or to

hospital property.

DIAL (0) 000

The incident requires immediate police

intervention when the

patient/consumer/family member is

engaging in aggressive/abusive

behaviour, causing harm and/or

the situation is unable to be

contained.

Further information on making a

complaint to the police in step 05

Escalating the Incident.

Police

DIAL 555 DIAL 555

South Bank Police Station DIAL (0) 3020 8377

Injury Management Process

OV incident resulted in an injury

EmployeePatient/Consumer/Family

Member

Engage appropriate medical care

Notify treating team of incident and any safety

precautions they may be able to engage

Engage appropriate medical care

Who was injured?

Environmental Safety Concerns

Biohazardous material: Ensure any biohazardous material

(blood, urine, saliva) is cleaned up appropriately as per hospital

policy.

Furniture/ Objects: Ensure any misplaced or damaged assets

(e.g., furniture, objects) have been removed from the area. If

damage has occurred, consider reporting to Police.

Spills: Ensure any spills or food materials have been

addressed as per hospital policy.

Managing Patient Post-Incident

The following considerations should be made to reduce the risk of

further incidents occurring:

Patient Handover: Ensure all employees assigned/in contact

with the patient are informed of the patient’s behaviour and any

triggers which might have been identified.

Consultation Between Managers: If the incident occurred

after hours, then the After Hours Nurse Manager / Hospital Co-

ordinator should contact the NUM and ensure they are aware

of the incident, who was involved, and if any injuries were

sustained.

Psychological First Aid & OV Exposure Kit

03

What’s here?

Psychological First Aid

Employee Assistance

Program (EAP)

OV Toolkit for

Employees

Support Hotlines

Checklist: � Look out for signs of distress

� Listen and normalise responses

� Encourage, support and provide information

� Provide the Occupational Violence Toolkit for Employees

What is Psychological First Aid?

Psychological First Aid (PFA) refers to a simple and practical skill set

aiming to support employees in times of stress. The Psychological First

Aid model presented here follows the Australian Red Cross and the

World Health Organisation’s approach which focusses on Look,

Listen and Link.

The key aims of the Look, Listen and Link approach include:

The next few sections will help give you a brief understanding of what

Look, Listen and Link involves and how you can use these steps to

help others feel safe, calm, connected, empowered and hopeful.

LOOK

It’s normal to experience strong reactions after exposure to violence and aggression in the workplace. Some common responses include:

COGNITIVE

Intrusive thoughts, memory blanks, flashbacks, thought's of self-blame, ruminating thoughts and difficulty concentrating

EMOTIONS

Confusion, anger, feelings of dread, anxiety, sadness, guilt, helplessness

and numbness/shock

BEHAVIOUR

Behaviour change, sleep disturbances, withdrawal, avoidance of

reminders, alcohol/drug use, finding it hard to empathise and easily irritable

PHYSICAL

Aches and pains, nausea, shaking, sweating, heart palpitations and headaches

Some factors to keep an eye out for:

• Limited social supports at home

• Experience with similar events in the past

• Perceived threat to life

• Poor physical health (e.g., feeling run down)

• Other stressful life events

LISTEN

Listen focusses on understanding the immediate needs:

Introduce yourself, your role, and what kind of support you can offer to

them right now

Don’t underestimate how important having someone physically with you

can be

Find out what is most important to them in the moment and ask them about

their needs/concerns right now

Avoid the compulsion to jump to task or to find the quick fix. Make the

decision to be present and listen

LINK

Linking in practical information and support:

COPE WITH IMMEDIATE PROBLEMS

Provide guidance regarding information in this pack: Police, leave/break,

patient allocation, travel allowance and escalation

GIVE INFORMATION ABOUT SUPPORT SERVICES

Provide information about support services as well as what to expect next

CONNECT WITH SOCIAL SUPPORTS

Encourage connection with partner, family members, friends, peers, or

religious/spiritual connections. Let the employee know that you will contact

them in the days following

Avenues of Support

Employee Assistance Program (EAP) OV Toolkit for Employees

Manager to provide OV Toolkit to Employee:

The OV Toolkit for Employees includes:

EAP is a confidential, short term counselling and support service

for employees. EAP provide up to 6 counselling sessions per

year. These sessions are free to QLD Health employees and their

family members.

Manager EAP Support:

EAP also offer a telephone based ‘helpline’ called Manager

Hotline, specifically tailored to support Managers. The service

provides confidential support to managers in navigating critical

incidents and more. This hotline can be reached by calling the

EAP number and asking for the Manager Hotline.

1800 604 640

https://www.livewell.optum.com/public/welcome.asp

auchhs

Support HotlinesThe following services provide counselling and support over the phone. These services may be of assistance to you and/or your employees.

Support Hotline Contact 24/7 In Person Online Additional Information

Beyond Blue 1300 224 636 www.beyondblue.org.au � �Online chat offered between the hours of 3pm and 12am. You may remain anonymous.

DV Connect 1800 811 811 www.dvconnect.org � Crisis hotline for anyone affected by domestic/family violence.

Griefline 1300 845 745 www.griefline.org.au � � �

Confidential counselling services to anyone who may need support through bereavement. Contactable midday- 3.00am, 7 days a week. Offers online 24/7 counselling.

Mensline 1300 789 978 www.mensline.org.au � � Support for men with family and relationship concerns.

Mindspot 1800 614 434 www.mindspot.org.au �

Service for Australian adults experiencing symptoms of anxiety or depression. Contactable 8am-8pm Monday to Friday and 8am-6pm Saturday.

QH Victim Support Service 1800 208 005 www.health.qld.gov.au/qhvssStatewide service that provides specialised counselling, support and information to victims of crime when the person charged has been assessed as having a mental illness or intellectual disability.

Queensland Doctors Health Program

(07) 3833 4352 www.dhasq.org.au �

Helpline staffed by Senior General Practitioners, supporting Doctors/Medical Students suffering from a wide range of health or stress related problems.

National Sexual Assault, Domestic & Family Violence Counselling

1800 737 732 www.1800respect.org.au � �

Provides information, support and counselling to assist people experiencing the effects of sexual assault, domestic or family violence.

Nurses and Mid-wife support

1800 667 877 www.nmsupport.org.au �National support service providing access to confidential advice and referral.

Suicide Call Back Service 1300 659 467 www.suicidecallbackservice.org.au � �Nationwide service for anyone who may be suicidal, caring for

someone who is suicidal, or anyone bereaved by suicide.

Lifeline 13 11 14 www.lifeline.org.au � � � Access to crisis support and suicide prevention services.

Victims Counselling and Support Services

1300 139 703 http://www.vcss.org.au � � �

Face to face, telephone, and online counselling for Queenslanders, 24/7, who have been affected directly or indirectly by any criminal act.

Escalating the Incident

04

What’s here?

Checklist: � Incident reported via RiskMan

� Consider WorkCover process and explain to employee

� A complaint has been made to the Police with the

consent of the employee

� Support has been provided to the employee throughout

the complaint process

Reporting an OV Incident via RiskMan

WorkCover Process

Police Complaint Process

Relatable Offences

RiskManRiskMan is an integrated, web-based system utilised for the collection

and management of incidents. It is a safety information system that is in

place across Queensland Health facilities. Employees are required to

report all incidents, including near misses.

How to enter an OV incident into RiskMan

My Workspace > New > Incident

(Your screen should resemble the image below)

General tips when entering an incident

• All fields highlighted yellow need to be completed

• When selecting a classification, be sure to click Occupational

Violence, however, you may select more than one classification

• Ensure there is sufficient detail provided in the details section

How do I report an OV incident if the RiskMan

system is down?

In the event that RiskMan is down, the relevant RiskMan

downtime form should be completed. This form can be

accessed by searching Staff/Worker Incident – Reporter

Form on QHEPS.

When the RiskMan system is available again:

1. Enter the data into RiskMan system

2. Date and sign the downtime form

3. Scan and upload the form into the record

4. Submit the record

WorkCover Process

If an employee is injured as a result of an OV incident, they may

be eligible to claim compensation benefits from WorkCover

Queensland.

Benefits of early and safe return to work

Earlier Recovery

Reduction in Long Term Impairment

Minimal Interruption to

Weekly Earnings

Early Re-engagement

with Team

Reduced Impact to

Family

Increased Physical and

Emotional Wellbeing

(Franche, Baril, Shaw, Nicholas & Loisel, 2005)

Manager’s role in WorkCover claims Ensure that the employee receives appropriate and timely

medical assistance. Attend to the Incident Management Process

as outlined below.

Employee and manager to complete the relevant sections of the

Worker’s Compensation claim form. Forms can be accessed through:

• WCQ online: www.workcoverqld.com.au• Health and Safety Unit

• Employees Medical Practitioner

Completed WorkCover claim kit to be sent to:

Email to:

Employee’s will be assigned to an Injury Management Advisor (IMA). IMA will contact the employee

Work with the employee’s IMA to identify suitable duties to assist

with the employee’s early and safe return to work (RTW)

Provide the Payroll Injury and Rehabilitation Claims Team

(PIARCT) with accurate information pertaining to the employee’s hours of work during the RTW process to ensure the correct

payment of wages

Maintain contact with the employee while they are off work

Ensure provisions of suitable duties in accordance with medically

certified restrictions are provided, and Workplace Rehabilitation and RTW processes are followed

CHQ_SafetyWellbeing@health.qld.gov.au

Engaging the Queensland Police Service

The investigation process begins with a complaint to the Police

specifying that an assault/harassment incident occurred.

Offer the employee the option to contact the Police if they have not

already been contacted. You or a colleague may contact the local

Police Station on behalf of the employee, with their full consent.

However, you or a colleague may not make a statement on

behalf of the employee involved in the OV incident. The Police can

be contacted to make a complaint in the following way:

PoliceLink will guide you through the process and will connect you

with the local Police.

What does the investigation process look like?

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t • The Police will take a detailed statement from the employee, and

any witnesses including specific details of what occurred and what was said during the incident

• The Police will document any injuries acquired as a result of the incident

• The Police will examine forensic evidence and body worn camera or CCTV footage if it is available

• The offender may be charged with assault, but this will depend on

the specific incident (refer to relatable offences for more

information)

• The perpetrator (defendant) has a right to legal representation

• You can withdraw your complaint at any point, however after the

offender has been charged, the decision to discontinue

prosecution will rest with the prosecuting authority

Where to for legal supportYour local Legal Services can provide support to employees. They are available to assist employees in preparing their statement, liaise

with Police, and at times, escort employees to Court. Legal Services can be contacted via:

What to wear in court• If the employee attends Court they will be provided with advice

on what to wear. Often employees attend in their work uniform

CHQ_Legal@health.qld.gov.au

PoliceLink

131 444

PoliceLink via Smartphone or App

https://www.police.qld.gov.au/programs/policelink/

Where do statements get taken?

The Police will work with the employee and you as their manager, to

obtain the statement at an appropriate time during work hours. The

Police can take a statement at:

� the Hospital

� the Police Station

Is the employee required to disclose their home address?

All personal particulars are treated by the Police as strictly

confidential. The personal details of the impacted employee and

witnesses such as their residential address or personal contact

number are not divulged to suspects or persons of interest. A

statement commonly begins with, “I am [name of employee], and I

reside at an address known to Police.”

As the prosecutor has access to the employee’s statement, this helps

to maintain the employee’s privacy and prevents exposure of personal

details.

What if the patient was of impaired capacity?

Assaults by patients who have impaired capacity will be investigated

as per any assault that occurs within Queensland. Impaired capacity

does not prevent an offender from being charged with a criminal

offence.

Patient’s with a mental illness may be eligible to have their case heard

at the Mental Health Tribunal, as opposed to traditional Court. Police

will advise if this is the case.

FAQs Regarding the Queensland Police Service

Reporting and recording of Injuries

If the employee suffered injuries they will be required to promptly attend

a doctor who will document their injuries. Police may ask the employee

to sign a medical consent form so they can access the employee’s

medical records of the assault and provide to the Court. The Doctor may

be called to attend Court to give evidence regarding the extent of the

employee’s injuries.

If the employee suffered visible injuries, Scenes of Crime (SOC) Unit will

contact you and arrange to have the employee’s injuries photographed

to present to the Court at a later date. This is required to be done within

24 hours to 48 hours of the assault. Additionally, damage to property will

be photographed by a SOC Officer. Where the property is likely to be

repaired prior to a SOC Officer’s attendance, you should photograph the

damage and advise Police that you have done so.

Who can access body worn camera and CCTV footage?

If security attended the incident, there may be body worn camera or

CCTV footage of the event. If the employee makes a complaint to the

police, the police will contact security directly to obtain this footage.

Due to the large amount of footage captured across the hospital 24

hours a day, security footage is managed on a time loop and is deleted

approximately every 28 days.

If the employee is unsure if they wish to make a complaint to QPS at the

time of the incident, security can be contacted and asked to save the

footage for use at a later date.

Relatable OffencesSome offences where a proceeding may be commenced against a person who commits an offence on a hospital employee are listed

below. This list is for your reference and the Police will assist in ensuring the correct charge is laid for the specific incident.

Relatable Offences Description

s.6 Public Nuisance

If a person behaves in:i) a disorderly way; or

ii) an offensive way; oriii) a threatening way; oriv) a violent way and

the person's behaviour interferes, or is likely to interfere with passage of a public place.

s.335 Common Assault

Any person who unlawfully assaults another. This includes the threat to carry out an assault, however it must include the gesture or bodily act associated with the

words, indicating the intention of assault.

s.340 Serious Assault

Same as Common Assault, however includes assault on:* Any person over 60 years; or anyone who relies on a guide dog, wheelchair or other remedial device;

* A Police Officer;* A public officer employed under the "Ambulance Service Act 1991" or “Hospital and Health Boards Act 2011"Therefore all assaults on health employees should be classed as Serious Assault.

s.339 Assaults Occasioning Bodily Harm The same as s.335 Common Assault, including "any bodily injury which interferes with health and comfort".

s.320 Grievous Bodily HarmGrievous bodily harm is defined as "the loss of distinct part or an organ of the body; serious disfigurement; or any injury that could cause, or be likely to cause permanent injury to health".

s.395E Unlawful Stalking

Acts that constitute stalking include:* Following, loitering, or watching a person (including approaching or entering the home or workplace of a person)

* Giving offensive material to a person (directly or indirectly)* An intimidating, harassing or threatening act against a person.

s.474 Menacing Harassing threatening phone calls

This includes a person who engages in menacing, harassing or offensive verbal behaviour via the means of a mobile or landline service.

Follow-up Support

05

Wellbeing Check-in

Follow-Up Processes

Self-Care Check

How to Engage in Self-Care

What’s here?

� The employee has been contacted within one-week post

incident

� Check-in with employee using Look, Listen and Link

approach

� Employee has been offered the opportunity to engage the

Police

� Return to work procedure has been engaged if applicable

� Manager has completed the self-care check

Checklist:

Follow-up Processes (if applicable)

• Engaging the Police: If the employee has not reported the

incident to Police, offer to engage with employee’s consent

• WorkCover: Continually review the WorkCover return to work

procedures and adapt as necessary

Wellbeing Check-In

1. Contact the Employee: Within one week of the incident

2. Wellbeing Check: Check in following Psychological First

Aid principles

Look: It is normal to experience strong reactions after

exposure to violence and aggression in the workplace

Listen: Listen to understand the immediate needs of the

person. These may be different compared to their needs

immediately post incident

Link: Linking in with the employee within one week of the

incident promotes a sense of connectedness and support.

This can be over the phone or face to face. Reiterate

support options and the helpful information available in the

OV Toolkit for Employees. Ongoing support and review of

the employee’s welfare is likely to be required

Refer to Section 03 PFA & OV Toolkit for Employees for further information.

Self-Care Check

Your wellbeing is also important, so don’t forget to

check-in on yourself. Supporting employees after OV

incidents can be emotionally draining. Hearing about the

specifics of an OV incident may negatively impact you.

Witnessing/being involved and/or supporting an employee

after an OV incident may put you at higher risk of:

What to look for:

BurnoutCompassion

Fatigue

Secondary Traumatic

Stress

Feelings of Tiredness/Exhaustion

Feelings of Hopelessness

Finding it Difficult to Empathise

Feelings of Anxiety

Illness/Susceptibility to Illness

How to engage in self-care:

Engaging in self-care has proven effective in reducing risk of the above.

Self-care practices look different for everyone and are about finding

what works for you.

Engage in regular supervision or consult with a colleague

How to: Identify a colleague you feel comfortable discussing your experience

with. This can be a great opportunity for self and professional development

Contact EAP or other support hotlines

How to: A list of support hotlines and your EAP can be found in section 03

Psychological First Aid and OV Toolkit for Employees

Take regular breaks when possible

How to: Take time to pause, try and find a space where you won’t be

interrupted with work duties

Participate in regular exercise

How to: This doesn’t need to be vigorous exercise, but can be a walk outside

Participate in mindfulness exercises

How to: The Headspace and Smiling Minds app offer useful mindfulness

exercises

Notes

Notes

Notes

This resource kit has been developed by the Queensland Occupational

Violence Strategy Unit (QOVSU). QOVSU is a statewide team focussed

on the design and delivery of initiatives targeting occupational violence within healthcare. This toolkit has been intended as a post incident tool to assist managers in supporting affected employees.

If you have any questions contact QOVSU via: QOVSU@health.qld.gov.au V1 Effective: October 2018 Review: October 2020