Violent and Aggressive Patient Policy

Dr A. Lyon & Partners

September 2011

Document Control Page

Title of document / Violent and Aggressive Patient Policy
Author’s name / Anne Grundy
Author’s job title / Practice Manager
Doc. Status / Final
Signed off by / Anne Grundy
Original Publication Date / August 2011
Last Reviewed / July 2013
Next review date / 2014
Distribution / General Practice

Consultation History

Version

/

Date

/

Consultation

0.1 /

May 2010

/ Practice Manager/Partners Meeting
0.2 /

September 2011

/

Practice Manager/Partners/Reception Meeting

0.3 /

6th October 2011

/

Reception Meeting

0.4 /

July 2013

/

Revised by Practice Manager

1.0 Introduction

The NHS has a zero tolerance policy of all violence and aggression. This policy is for the protection of all NHS staff, but also for the protection of other patients, their families, visitors, etc. In order to ensure that this zero tolerance approach is adhered to, it is essential to have robust policies and procedures in place. In General Practice, this will need to cover a variety of situations in which incidents could occur.

2.0 Aims and Objectives

The aims and objectives of this policy are as follows:

  • To ensure adequate processes are in place for the protection of staff and patients
  • To ensure staff are fully aware of their responsibilities when dealing with violent or aggressive patients
  • To ensure that staff are fully aware of their rights when they have to deal with such incidents

3.0 Aggressive Patient

What is an aggressive patient? This is a patient (or relative) who exhibits one or more of the following patterns of behaviour:

  • Verbally abusive, offensive or intimidating in their behaviour towards staff
  • Threatening physical violence
  • Making excessive demands and/or maintaining certain expectations and failing to accept that these are unreasonable (e.g. wanting an immediate appointment and becoming aggressive when this is not possible)
  • insisting that a member of staff is dismissed
  • insisting that treatment is carried out on demand
  • constantly requesting a different GP
  • demands to see a particular member of staff/clinician

4.0 Dealing with an Aggressive Patient

Patients can become aggressive for a variety of reasons, and it is always advisable to try to calm down the situation as early as possible, as this may prevent an incident.

4.1 An Aggressive Incident

If the patient does become aggressive, then the following process should be followed:

  • If they continue with their aggressive behaviour, then tell them that they will not be dealt with until they calm down.
  • Remain calm and clear and keep repeating that the behaviour is unacceptable. Insist that you are trying to help, but cannot do so until they calm down.
  • In the interests of safety, it is best to stay accompanied by another member of staff. Staff should never isolate themselves with a potentially violent patient.
  • Get a more senior member of staff to speak to the patient, again keeping calm and stressing that you are trying to help.
  • Following the incident, the main points should be recorded on a significant events form
  • All incidents of violent and aggressive behaviour should be reported to the Practice Manager

4.2Repeated Incidents

If there are repeated incidents from a particular patient, then the practice should write to the patient warning them that no other incidents will be tolerated, and the patient will be removed from the list if this happens again. (See app 1 for sample letter)

Note that it is important to carry out this action once it has been written down. If the patient continues with this behaviour, even after the written warning, then they should be removed from the list for the sake of staff and other patients.

5.0 Violent Patients

Dealing with a violent patient requires a much more immediate response. As soon as a patient turns violent, then immediate action must be taken, as follows:

  • Lock the reception door
  • If the aggressive behaviour continuesand a panic alarm is available, then press this immediately
  • If the patient is in the consulting room with a clinician, then the correct procedure should implemented (see app 2)
  • Phone the police. Once violence occurs, it becomes a crime.
  • If there are other patients in the vicinity, then there is a duty to protect them. If possible remove other patients in the vicinity to another part of the waiting area or another room away from the situation.
  • Following an incident of violence, the practice should hold a significant event meeting to decide if the patient should be removed from the list.
  • If the patient is to be removed from the list, then the practice should now follow the procedure for the removal of patients.

6.0 Removal of Patient from Practice List

When it becomes necessary to remove the patient from the practice list, for reasons of violent or aggressive behaviour, then a specific process should be followed. (See info 4 Policy on removing Patients from the Practice List).

Under schedule 6 of the NHS (GMS Contracts) Regulations (2004), the PCT would be required to remove a patient from the GP practice list if it is informed by the practice that the patient has committed an act of violence against anyone present on the practice premises, or at any place where the services were provided to the patient, or that the patient has behaved in such a way that any person has feared for his/her safety.

It is essential in all cases that the incident has been reported to the police, prior to the application to the PCT to remove the patient from the list. (See appendix 4 for an extract of the GP Contract)

7.0 Following an Incident

Every incident of violence or aggression should be recorded in a log specifically used for this purpose. This log should contain the following information:

  • Patient ID (eg NHS number)
  • Time and date of incident
  • Nature of incident – particularly the trigger point (eg not able to get appointment)
  • Perspective of staff member dealing with the incident,
  • Names and statement of any witnesses
  • Record of any actions taken

8.0 Staff Support

The member of staff who was subjected to the violence or aggression will need support, even though they may not recognise this fact immediately. The way this support is handled can often make the difference to the way the staff member is able to deal with what has happened, with minimal adverse effects.

The following process should take place as soon as possible after the incident:

  • The Practice Manager should have a one-to-one discussion with the staff member, in private and as informally as possible (if the Practice Manager is the person affected, then a GP or Practice Nurse should do this)
  • The staff member should be encouraged talk about the incident from their perspective, and encouraged to write it down (this is the best time to complete the incident log)
  • Ask the staff member what support they feel they need to help them deal with the situation
  • If the staff member feels they need counselling, then provide this as soon as possible, either within the practice if there is a trained counsellor, or by referral to the appropriate service
  • If the person affected is not employed by the practice (e.g a Health Trainer) then inform their line manager immediately after the incident

9.0 When a Violent Patient Joins the Practice

Because of the length of time it takes for patient notes to come from LaSCA, it is possible that a new patient could join the practice, and only after several weeks would you discover that they have been violent in a previous practice.

In the event of this happening, it is advisable to write to the patient, to notify them that you are aware of the previous incident, and that if there is any instance of violence or aggression within your own practice, then the patient would be removed from the list. (see app 3)

10.0 Governance Arrangements

This policy will be approved by the Practice Manager. The Practice Manager will be responsible for notifying all staff of the process, ensuring all staff has up to date copies of the document and that the staff are following the processes documented within.

This policy will be reviewed 2 years from the date of publication

Appendix 1

Dr Alison L Lyon MB. CH.B. M.R.C.G.P. FPA 1st Floor, Lever Chambers Centre for Health

Dr C J Earnshaw MB. CH.B.D[OBST] RCOG Ashburner Street,

Dr R L Swann MB. CH.B Bolton BL1 1SQ

Dr Eve Haworth MB. CH.B DCH DRCOG M.R.C.G.P.Tel: Tel: 01204 462630

Dr F Thagia MB.CH. B DRCOG M.R.C.G.P Fax: 01204 462636

Dr A. Lyon & Partners

Our Ref: ALL/AMG/STW

Date:

In Confidence

To:

Dear

On your visit to the surgery on ...... , you were ......

We feel we must inform you that this behaviour is unacceptable.

It is our responsibility to point out to you that we have a zero tolerance policy across the NHS for patients who are abusive and/or violent to staff. At Dr Lyon & Partners we take this policy very seriously, and would not hesitate to remove patients from the list who do not abide by this policy.

We are happy for you to remain with the practice, but insist that you abide by the above mentioned policy in all your dealings with the practice.

We hope you understand that should such poor behaviour occur again, we will have no alternative other than to exercise our right to remove you from our List

Yours sincerely,

Dr. A. Lyon & Partners

Dr Lyon & Partners

Telephone: 462630

Web:

Please look us up at

Appendix 2

Dealing with a violent or aggressive patient if the patient is in the consulting room with a clinician requires a much more immediate response. As soon as a patient turns violent, then the correct procedure should implemented and immediate action must be taken, as follows:

If possible the Clinician should proceed to the door of the consulting room as request assistance from reception staff.

If unable to get to the door, press the panic button immediately

A member of staff must immediately respond to the clinic room to provide assistance

Another member of staff should call security to aid the removal of the patient from the premises

Phone the police. Once violence occurs, it becomes a crime.

If there are other patients in the vicinity, then there is a duty to protect them. If possible remove other patients in the vicinity to another part of the waiting area or another room away from the situation.

Following an incident of violence, the practice should hold a significant event meeting to decide if the patient should be removed from the list.

If the patient is to be removed from the list, then the practice should now follow the procedure for the removal of patients.

Following the incident, the main points should be recorded on a significant events form

All incidents of violent and aggressive behaviour should be reported to the Practice Manager

Appendix 3

Dr Alison L Lyon MB. CH.B. M.R.C.G.P. FPA 1st Floor, Lever Chambers Centre for Health

Dr C J Earnshaw MB. CH.B.D[OBST] RCOG Ashburner Street,

Dr R L Swann MB. CH.B Bolton BL1 1SQ

Dr Eve Haworth MB. CH.B DCH DRCOG M.R.C.G.P.Tel: Tel: 01204 462630

Dr F Thagia MB.CH. B DRCOG M.R.C.G.P Fax: 01204 462636

Dr A. Lyon & Partners

ALL/AMG/STW

Date ……………………………

In Confidence

To: …………………………………

……………………………………..

Dear

Thank you for registering with Dr A. Lyon & Partners

We are now in receipt of your full medical records.

We note, from these records, that you have a history of abusive and/or violent behaviour at your previous practice.

It is my responsibility to point out to you that we have a zero tolerance policy across the NHS for patients who are abusive and/or violent to staff. At Dr Lyon & Partners we take this policy very seriously, and would not hesitate to remove patients from the list who do not abide by this policy.

We are happy for you to remain with the practice, but insist that you abide by the above mentioned policy in all your dealings with the practice.

If you wish to discuss this matter further, then please do not hesitate to contact me.

Yours sincerely

Anne Grundy

Practice Manager

Practice Manager – Anne Grundy AMSPAR[DIP]

Member of Institute Healthcare Management (MIHM)

Direct Tel: 01204 462644

E.mail:

Web.

Appendix 4

Removals from the list of patients who are violent

202. Where the Contractor wishes a patient to be removed from its list ofpatients with immediate effect on the grounds that:

202.1. the patient has committed an act of violence against any of thepersons specified in clause 203 or

behaved in such a way that any suchperson has feared for his safety; and

202.2. it has reported the incident to the police,the Contractor shall notify the PCT in accordance with clause 204.

203. The persons referred to in clause 202 are:

203.1. if the Contract is with an individual medical practitioner, thatindividual;

203.2. if the Contract is with a partnership, a partner in thatpartnership;

203.3. if the Contract is with a company, a legal and beneficial ownerof shares in that company;

203.4. a member of the Contractor’s staff;

203.5. a person employed or engaged by the Contractor to perform orassist in the performance of services under the Contract; or

203.6. any other person present on the practice premises or in the placewhere services were provided to the patient under the Contract.

204. Notification under clause 202 may be given by any means includingtelephone or fax but if not given in writing shall subsequently beconfirmed in writing within seven days (and for this purpose a faxednotification is not a written one).

205. The PCT shall acknowledge in writing receipt of a request from theContractor under clause 202.

206. A removal requested in accordance with clause 202 shall take effect atthe time the Contractor makes the telephone call to the PCT, or sends ordelivers the notification to the PCT.

207. Where, pursuant to clauses 202 to 206, the Contractor has notified thePCT that it wishes to have a patient removed from its list of patients, itshall inform the patient concerned unless:

207.1. it is not reasonably practicable for it to do so; or

207.2. it has reasonable grounds for believing that to do so would beharmful to the physical or mental health of the patient or would put atrisk the safety of one or more of the persons specified in clause 203.

208. Where the PCT has removed a patient from the Contractor’s list ofpatients in accordance with clause 206 it shall give written notice of theremoval to that patient.

209. Where a patient is removed from the Contractor’s list of patients inaccordance with clauses 202 to 208, the Contractor shall record in thepatient’s medical records that the patient has been removed under thisparagraph and the circumstances leading to his removal.

GP Safehaven (Violent Patient) Scheme

Risk Assessment

CLIENT NAME DATE

DATE OF BIRTH______NHS NO______

ADDRESS______

Information sources available/accessed in completing Risk Assessment (tick all sources used and state whom)

Patient / Carer/relative / Specify
Case notes / Other / Specify

Reason for referral onto the scheme.

Name of present GP / Name of person making referral
Contact Number of referring person
Reason for referral

Section 1: Suicide.

a) Does the professional consider the individual at risk of suicide? Yes/No

b) Is there a history of suicide attempts? Yes/No

Section 2: Self Harm.

a)Does the professional consider the individual at risk of intentional self-harm? Yes/No

b)Is there a history of intentional self-harm? Yes/No

Section 3: Harm to others.

a) Does the professional consider the individual at risk of harming others? Yes/No

b) Is there a history of harm to others? Yes/No

c) If yes please provide more information

Section 4; Substance Misuse.

a) Is there evidence of substance misuse? Yes/No

b) Is there a history of substance misuse? Yes/No

c) Does the professional feel the level of misuse warrants concern for the

safety of the individual or others? Yes/No

d) If yes to ( c ) please explain further:

Section 5: Social circumstances.

a) Does the professional feel any of the social circumstances or medical

conditions warrant concerns for the individual’s safety? Yes/No

b) Have any social circumstances or medical conditions led to

deterioration in the past? Yes/No

Section 6: Neglect.

a) Does the professional consider the individual is at risk of neglect

by self or others? Yes/No

b) Is there a history of neglect (emotional, physical, mental)? Yes/No

Section 7: Treatment related indicators.

a) Does the professional consider the individual is at risk of not complying

with treatments/services? Yes/No

b) Is there a history of not complying with treatment/services? Yes/No

Section 8: Risk to staff.

a) Does the professional consider that there are any risks involved in the

individuals care? Yes/No

b) Is there a history of risk to staff? Yes/No

Please provide any further relevant information

Reviewed By______

Completed by

Designation

Date

Primary Care Support Services (Preston Office)

Incident Report Form

Please use this form for the removal of a patient following a violent incident towards a GP, a member of staff or a patient. The incident must be reported to the police and the police incident log number must be stated on this form. Without this number, immediate removal is not possible under the regulations for violent patient removal.

Practitioner’s name:
Practice address:
Practice contact number:
Patient’s name:
Patient’s NHS number: / Date of birth:
Patient’s address:
Date of incident: / Time of incident:
Police incident log number: / Date obtained:
Location of incident:
(Patient’s address/Surgery etc)

Type of incident (please tick the appropriate box)