Inquiry into Violence and Security Arrangements in Victorian Hospitals

241 Pages·2011·1.62 MB·English

RLIA MENT
A O
P F
VICTORIA
PARLIAMENT OF VICTORIA
DRUGS AND CRIME PREVENTION COMMITTEE
INQUIRY INTO VIOLENCE AND SECURITY
ARRANGEMENTS IN VICTORIAN HOSPITALS
AND, IN PARTICULAR, EMERGENCY DEPARTMENTS
Final Report
December 2011
ORDERED TO BE PRINTED
by Authority
Government Printer for State of Victoria
No 88 Session 2010–2011
The Report was prepared by the Drugs and Crime Prevention Committee.
Drugs and Crime Prevention Committee
Inquiry into Violence and Security Arrangements in Victorian Hospitals and,
in particular, Emergency Departments — Final Report
DCPC, Parliament of Victoria
ISBN: 978-0-9804595-7-9
Drugs and Crime Prevention Committee
Parliament House, Spring St
Melbourne Vic 3002
Phone: [phone]
Fax [phone]
Email: [email protected]
Website: http://www.parliament.vic.gov.au/dcpc
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Drugs and Crime Prevention Committee — 57th Parliament
Members
Mr Simon Ramsay M.L.C. Western Victoria — Chair
Mr Johan Scheffer M.L.C. Eastern Victoria — Deputy Chair
Mr Brad Battin M.P. Gembrook
Mr Shaun Leane M.L.C. Eastern Metropolitan
Mr Tim McCurdy M.P. Murray Valley
Staff
Ms Sandy Cook — Executive Officer
Mr Peter Johnston — Senior Legal Research Officer
Ms Danielle Woof — Committee Administrative Officer
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Functions of the Drugs and Crime Prevention Committee
The Victorian Drugs and Crime Prevention Committee is constituted under the Parliamentary
Committees Act 2003 (Vic) as amended.
Section 7
The functions of the Drugs and Crime Prevention Committee are, if so required or permitted
under this Act, to inquire into, consider and report to the Parliament on any proposal, matter
or thing concerned with:
a. the use of drugs including the manufacture, supply or distribution of drugs;
b. the level or causes of crime or violent behaviour.
Terms of Reference
Under s 33 of the Parliamentary Committees Act 2003, an inquiry into violence and security
arrangements in Victorian hospitals and, in particular, emergency departments, be referred
to the Drugs and Crime Prevention Committee for consideration and report no later than 30
September 2011, including:
(a) the incidence, prevalence, severity and impact of violence in Victorian hospitals and, in
particular, emergency departments;
(b) the effectiveness of current security arrangements to protect against violence in Victorian
hospitals and, in particular, emergency departments;
(c) an examination of current and proposed security arrangements in Australia and
internationally to prevent violence in hospitals and, in particular, emergency departments,
including the appropriateness of Victoria Police Protective Service Officers in Victorian
hospital emergency departments;
(d) a recommendation of initiatives to enhance the overall security arrangements and safety
in Victorian hospitals, particularly emergency departments, to ensure appropriate levels of
safety for health professionals and the general public without compromising patient care.
Acknowledgements
The Committee wishes to acknowledge the valuable contribution of Matt Clare at Mono Design
for the cover design, Luke Harris from Chameleon Print Design for laying out the report and
Phil Balzer from Tenderprint Australia for printing it.
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Chair’s Foreword
Violence in hospitals is an ongoing problem in Victoria. Such violence can take the form of
verbal abuse, threats and physical assault and in most cases is directed at health workers who
have immediate contact with patients. Nurses are most at risk and particularly those who work
in Emergency Departments of hospitals.
This Reference to the Drugs and Crime Prevention Committee allowed the Committee to
examine, in detail, strategies to reduce the risk of violence and to best manage any violent
incidents that do occur. The Committee was also able to investigate the most effective forms of
security in a hospital environment.
Initially, the deployment of Protective Service Officers in Emergency Departments of hospitals
was seen as a way to help combat violent behaviour. As is detailed in this Report, health
clinicians, hospital staff in general and security personnel have unanimously opposed the
placement of armed PSOs in hospitals. Conversely, there has been wide support for various
mechanisms that help prevent antisocial behaviour and, consequently make hospitals a safer
place for staff, patients and visitors.
The Committee also spent considerable time investigating the under-reporting of aggression
and violence towards hospital staff and has made a number of recommendations aimed at
encouraging the reporting of such incidents and improving the data collection system.
This is a comprehensive Report which examined all facets of security in Victorian hospitals.
The Committee has made a number of recommendations which will help prevent and reduce
the impacts of violence and provide a greater sense of security and safety in Victoria.
The Committee would like to thank the many people who provided verbal and written
submissions to this Inquiry and who attended as witnesses at the public hearings in Melbourne,
Geelong, Ballarat, Sydney and Perth.
The Committee would also like to thank the staff of the Drugs and Crime Prevention Committee
— Sandy Cook, Pete Johnston, Danielle Woof and Mignon Turpin — for their dedicated and
hard work and cooperation to deliver this Report to the Parliament.
I would personally like to thank my Committee members for their time and effort on this
Inquiry.
Simon Ramsay M.L.C.
Chair
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Executive Summary and Recommendations
The following principles are based on the deliberations on the Drugs and Crime Prevention
Committee and the evidence it has received. These principles underlie and support the
recommendations that follow.
Principles informing the recommendations
1. The Committee believes that all hospital staff are entitled to a safe and secure
working environment that is free of all forms of violence.
2. The Committee recognises that, given the multifaceted environmental dynamics,
hospital administrations face a complex challenge in reducing violence in especially
in some large emergency departments (EDs).
3. The law should support clinical and security staff in their work environments.
4. The Committee believes that in addressing violence and security issues in Victorian
hospitals:
a) A ‘one size fits all’ approach does not address the specific issues, needs and
requirements of individual hospitals and health facilities.
b) Proactive policies based on prevention strategies are the key to addressing violence
in hospitals.
c) A holistic and tailored approach is required that meets the specific requirements
of each hospital. Such a holistic approach should draw upon strategies including:
• strong leadership, support and encouragement by the senior management
team at the hospital
• appropriate policies and infrastructure that promote a ‘zero tolerance’
approach to violence towards hospital staff, allied health professionals
such as paramedics, patients, visitors and all persons located in the hospital
premises or environment
• accredited comprehensive education and training programs to address
violent behaviour in hospitals for both clinical and security staff, and public
awareness programs for patients, their families and visitors
• approaches that recognise the specific factors that contribute to hospital
violence, such as clinical causes, alcohol and other drug use and mental
illness, and promotes strategies to address these.
• environmental and design strategies that address the situational factors that
may exacerbate violence in the hospital setting, particularly the emergency
department.
d) Strategies to prevent and address violence in hospitals are most effective
when clinical staff, security staff, management and external workers such as
paramedics and police work collaboratively as part of a team.
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e) Effective security strategies to prevent and address violence in hospitals are
underpinned by a ‘patient focused’ approach that draws on interpersonal skills
to defuse, minimise and manage aggressive behaviour.
f) Effectively addressing violence in the hospital setting requires uniform
reporting procedures and data collection across the Victorian hospital system.
5. The Committee believes as a general principle that security staff should be licensed
specialists in the area of hospital security and appointed by individual hospitals as
determined by the hospital’s specific needs.
6. The Committee believes that firearms should not be used as a security measure in
Victorian hospitals by security personnel.
7. The Committee believes that as a general principle, capsicum spray and tasers should
not be used as a security measure in Victorian hospitals, by security personnel.
However, individual hospitals should have the power to decide what other forms of
restraint and security mechanisms should be employed.
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Recommendations
State-wide Recommendations
1. The Committee recommends that the Victorian government ensure current policies and
frameworks to prevent violence in Victorian hospitals such as the Department of Human
Service’s ‘Preventing occupational violence in Victorian health services’ and WorkSafe
Victoria’s ‘Prevention and Management of Aggression in Health Services’ are fully
implemented and complied with in Victorian hospitals and health services.
(Chapter 5)
2. The Committee recommends that the Victorian government requires that hospitals complete
the implementation of the recommendations emanating from the Victorian Taskforce on
Violence in Nursing: final report.
As a result of the research and deliberations of the Victorian Taskforce on Violence in Nursing, a
comprehensive set of recommendations was delivered in the final report. The Government has implemented
all but three of them in part or in full. This has resulted in the introduction of comprehensive frameworks
to address violence in Victorian hospitals and health services. In particular, subsequent to the findings
of the Report the Department of Human Services developed the ‘Preventing occupational violence in
Victorian health services’ framework, a comprehensive document that gives clear direction to the state’s
hospitals and health services on ways to address violence occurring within their facilities. The Committee
believes this framework and the subsidiary policies and documents that form part are a useful starting
point for implementing best practice programs and procedures to deal with violence, not only against
nurses but also against all people who work within, are treated at or visit Victorian health services.
The Committee agrees with the views of a number of stakeholders who gave evidence to this Inquiry
that the remaining recommendations need to be expedited. Whilst the Department of Health may have
progressively rolled out the policies, programs and initiatives that have emanated from the Taskforce
recommendations, this does not mean that all Victorian hospitals have taken them up and implemented
them in full or in part. The Department in conjunction with hospital management must ensure that any
programs recommended by the Taskforce are effectively implemented in hospitals at local level. Moreover,
all of the programs, procedures and policies that have been developed as a result of the Taskforce Report
should be subject to independent evaluation.
(Chapter 5)
3. The Committee recommends that within 12 months of the tabling of this Report there should
be a fully independent evaluation of the policies, programs and other measures implemented
as a result of the recommendations in the Victorian Taskforce on Violence in Nursing: final report.
(Chapters 5 and 12)
4. The Committee recommends that the Victorian government provides ongoing funding which
is within the health sector budget which would provide funding for safety and security of
staff in accordance with the particular needs of health services.
A funding mechanism similar to the Occupational Violence Prevention Fund 2008–2011 may serve as
a useful model to direct funding. It should, however, apply to all staff and departments in the hospital
environment and not just nursing. Applications to the fund should also be subject to the completion of an
occupational violence risk assessment.
How money is allocated from any funding mechanism should be up to the boards of individual hospitals.
However, whatever resources are finally allocated to address this issue, it is absolutely paramount that this
money is used for the dedicated purpose of addressing violence and security issues within public hospitals.
Under no circumstances should this money be used for discretionary spending unconnected with the
priorities of security and safety of the hospital.
(Chapter 12)
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