How can our practice team respond to an act, or threat, of aggression or violence?
It is recommended that all practices have an agreed policy in place about how to manage incidents of patient aggression and/or violence.
Immediate response
If you are in an unsafe situation, follow your practice’s response policy, which may include:
- calmly asking the aggressor to leave
- activating a duress alarm or phone alert system, if installed
- retreating to a safe location and alerting other people on site to the risk
- calling 000 for police.
Follow-up response
Debriefing, reporting and investigation
It is important to debrief the practice team after any violent or threatening event. This will help to ensure the wellbeing of those involved and give everyone the opportunity to discuss the event and help identify any triggers or possible future safeguards.
This can generally be done as a group exercise with the practice team; however, depending on the circumstances, some team members may require additional individualised support. You should also check in with any patients or visitors who were present at the event.
An incident report should be completed by staff involved in any event and added to your practice’s incident or event register.
Your practice should have a process to formally review incidents on a regular and ongoing basis. You could establish a practice committee with the responsibility to review all incidents, not only those relating to patient violence. The benefits of such a committee (or similar) include:
- consistency of approach by the practice in response to events
- clear delegation of responsibilities for initiating incident review and follow-up of identified actions
- giving all team members the opportunity to participate and be consulted
- embedding a culture of safety and continuous improvement in the practice team.
The committee (or persons delegated to review incidents in your practice) should investigate the event, considering:
- What happened?
- What factors may have triggered the event?
- What are the ongoing risks?
- Could the incident have been prevented?
Determine if any changes or additional safeguards need to be made at the practice as a result of the investigation. If you implement changes, you should monitor their outcome, considering:
- What worked, and why?
- What did not work, and why?
- Is the change sustainable?
- What alternatives can be trialled?
Any changes should be included in an amended practice policy.
Flagging patient records
As a general rule, you should flag the health records of patients who demonstrate aggressive or violent behaviour.
Where in use, practices should have an agreed policy in place for file flagging. The policy should include:
- clearly defined criteria for file flagging
- a clearly articulated purpose for use of a flag (for example, to protect the health and safety of practice team members and other patients)
- a standard procedure for flagging patient health records that makes the information readily available to those who need it but is discreet in the event the patient’s record is accessed by other parties, including the patient (for example, via a short, clinically relevant note in the patient health record and a separate, more detailed, note kept on file external to the patient record)
- a mechanism to review flagged files to ensure ongoing relevance.
A copy of the incident report should be kept separate from the patient’s health record.
Determining ongoing care arrangements
If you believe the behaviour or act warrants it, you may also consider:
- giving the patient a formal warning (see 'Letter templates' section below)
- placing the patient on an acceptable behaviour agreement (see 'Letter templates' section below)
- discontinuing care for the patient at your practice (see 'Letter templates' section below).
It is recommended that you seek advice from your medical defence organisation (MDO) when considering these measures.