P r o v i n c i a l V i o l e n c e P r e v e n t i o n C u r r i c u l u m M o d u l e 7 P o s t - I n c i d e n t R e s p o n s e

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P r o v i n c i a l V i o l e n c e P r e v e n t i o n

C u r r i c u l u m

M o d u l e 7 – P o s t - I n c i d e n t

R e s p o n s e

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Acknowledgements ... iii Course Overview ... 1 Course introduction ... 1 Course objectives ... 1

What I Need to Do Post-Incident ... 2

Introduction ... 2

How can I take care of myself immediately after the incident? ... 2

What am I required to do once the incident is over? ... 2

How can I help support someone involved in an incident? ... 3

Test Your Knowledge #1 ... 4

Manager Post-Incident Responsibilities ... 5

Introduction ... 5

What is my manager’s immediate responsibilities after a violent incident occurs? ... 5

What is an incident investigation? ... 5

Why are incidents investigated? ... 6

What is included during an incident investigation? ... 7

Test Your Knowledge #2 ... 8

Documentation ... 9

Introduction ... 9

What documentation is required? ... 9

How can I best complete this documentation? ... 10

Why should I document? ... 10

Test Your Knowledge #3 ... 11

Support Resources ... 12

Introduction ... 12

What are common reactions to a violent incident? ... 12

What are more severe reactions to a violent incident? ... 12

What support resources can help me? ... 13

Who can help me find support resources? ... 13

What You’ve Learned ... 14

Module 7 Quiz ... 15

Test Your Knowledge – Answer Keys... 18

Test Your Knowledge #1 ... 18

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Test Your Knowledge #3 ... 18

Module 7 Quiz Answer Key ... 19 Notes ... 20

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C K N O W L E D G E M E N T S

This Violence Prevention Curriculum was developed as a project of the Provincial Violence Prevention Steering Committee (PVPSC) to fill a need for effective, recommended and provincially-recognized violence prevention training for all British Columbia healthcare workers across a range of care settings, including affiliate organizations. The Curriculum includes eight online and five classroom modules.

The PVPSC wishes to acknowledge the generous support and commitment of the management and the subject matter experts representing the following health authorities and healthcare unions. Without their expertise the development of this curriculum would not have been possible.

British Columbia Nurses’ Union Union of Psychiatric Nurses of BC Hospital Employees’ Union Health Sciences Association of BC Fraser Health Authority

Interior Health Authority

Vancouver Coastal Health Authority Northern Health Authority

Vancouver Island Health Authority Providence Health Care

Provincial Health Services Authority WorkSafeBC

Occupational Health and Safety Agency for Healthcare (OHSAH) in BC

The PVPSC would also like to acknowledge the British Columbia Ministry of Health funding received through the Joint Quality Worklife Committee and the financial support provided by OHSAH for the Provincial Violence Prevention Curriculum Project.

The copying, reproduction and distribution of this guide to promote effective Violence Prevention activities in the Healthcare Industry is encouraged; however, the current owner, the Provincial Health Services Authority (PHSA), should be acknowledged. Written permission must be received from PHSA if any part of this curriculum is used for any other publication. This curriculum, whether in whole or in part, must not be used or reproduced for profit.

This course has been developed by Andrea Lam, Ana Rahmat, Chris Back, Charles Ballantyne, Dailaan Shaffer, Deb Niemi, Helen Coleman, Joe Divitt, Kathryn Wellington, Lara Acheson, Larry Bryan, Leslie Gamble, Lynn Vincent, Marg Dhillon, Marty Lovick, Michael Sagar, Peter Dunkley, Phil Goodis, Rob Senghera, Sheile Mercado-Mallari, Sherry Moller and Tara McDonnell. The information on the fight/flight/freeze response and self settling strategies was contributed by Shayna Hornstein.

Bringing a group of subject matter experts to the table to develop a curriculum such as this takes vision, passion and a diversity of experience and practice. The creators of this curriculum drew on their skill in and knowledge of the following disciplines:

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o Mental Health and Addictions o Occupational Health and Safety

o Social work

o Healthcare Violence Prevention programs

o Geriatric care

o Nursing o Psychiatry

o Physical strategies and team response training

Course Materials Designed by Tanya Schecter and Brad Eastman. Photographic contributions by fotografica studio ltd.

This curriculum was developed during 2010 by the Provincial Violence Prevention Curriculum Team at Vancouver, British Columbia, Canada.

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Post-incident response refers to actions you must take after the violence has ended. These steps, however, are part of the process of completing the actual incident: without completing these steps, the incident is not considered to be over.

In this module, you will learn about:

 Post-incident steps that must be completed

 The post-incident investigation process

CO U R S E O B J E C T I V E S

By the end of this course, you will be able to:

 Identify what you need to do post-incident

 Describe manager post-incident responsibilities

 Identify the importance of documentation

 Describe support resources

In order to complete this course, you need the following materials:

 This participant guide

 Optional: a computer with internet access to look up additional resources (e.g., glossary, references)

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After a violent incident occurs, you need to take several steps.

HO W C A N I T A K E C A R E O F M Y S E L F I M M E D I A T E L Y A F T E R T H E I N C I D E N T?

Immediately after the incident takes place, you need to conduct a wellness check by asking yourself:

 Am I feeling safe?

 Am I hurt?

 Do I need first aid?

 What support do I need?

 Who do I want to support me?

 Can I continue to work?

 Who can I talk to?

You then take appropriate actions based on your answers.

WH A T A M I R E Q U I R E D T O D O O N C E T H E I N C I D E N T I S O V E R? Once the violent incident is over, you are required to:

 Scan the environment to make sure it is safe

 Call for medical attention if anyone is injured

 Inform your co-workers, manager, and/or team about the incident

 Report any violent incident where there were injuries or potential injuries (near misses) using the Employee Incident Report or call centre

 Document the violent incident (e.g., patient’s care plan, patient’s chart, Patient Incident Report)

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Page 3 M o d u le 7 P o s t-In c id e n t R e s p o n s e HO W C A N I H E L P S U P P O R T S O M E O N E I N V O L V E D I N A N I N C I D E N T? Even if you were not involved in the incident, you can help support someone who was by:

 Asking them what they need

 Notifying the supervisor or manager that an incident happened

 Looking for signs of shock

 Listening

 Helping them to access available resources

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# 1

Select all statements that are TRUE. Once you’ve completed the quiz, you can go to the end of this guide to check your answers.

1. You should participate in a wellness check immediately after experiencing a violent incident.

2. You are ONLY required to report violent incidents where there were injuries.

3. You must report all violent incidents using the EMPLOYEE incident report or the call center.

4. You cannot help support someone who was affected by a violent incident if you were not involved in the incident.

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Once a violent incident occurs, it is your manager’s responsibility to make sure that the incident is investigated. You are responsible for participating in this process.

WH A T I S M Y M A N A G E R’S I M M E D I A T E R E S P O N S I B I L I T I E S A F T E R A V I O L E N T I N C I D E N T O C C U R S?

Once a violent incident occurs, your manager or designate is responsible for:

 Assessing the situation and putting any immediate safety measures in place

 Checking in with all workers who were involved and/or witnessed the incident to:

 Check on their well-being

 Provide support resource information

 Making sure that all required documentation is completed

WH A T I S A N I N C I D E N T I N V E S T I G A T I O N?

Incident investigation is the process of reviewing an incident and taking action after an incident occurs. Your manager is responsible for doing an incident investigation in conjunction with the Joint Occupational Health and Safety Committee. Workers affected by the incident are also involved in this process.

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Page 6 P r o v in c ia l V io le n c e P r e v e n ti o n C u r r ic u lu m WH Y A R E I N C I D E N T S I N V E S T I G A T E D?

Incidents are investigated in order to:

 Determine the causes and other contributing factors

 Make related organizational and/or procedural changes that may prevent future violent incidents from occurring (e.g., changes to care plans, procedures, and practices, etc.)

 Prevent unresolved emotional trauma that may have long-term impacts for workers and the organization

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Page 7 M o d u le 7 P o s t-In c id e n t R e s p o n s e WH A T I S I N C L U D E D D U R I N G A N I N C I D E N T I N V E S T I G A T I O N? The investigation process looks at:

 Clinical factors such as:

 Patient risk factors

 Risk assessment, including history and/or presence of violence alerts

 Patient stressors

 Pattern(s) to the person’s behaviour known before the incident

 Signs of escalating behaviour

 Care plan’s effectiveness

 Environmental risk factors

 Education and training

 Policies and procedures

Recommendations for change are then developed based on the investigation’s findings.

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# 2

Select all statements that are TRUE. Once you’ve completed the quiz, you can go to the end of this guide to check your answers.

1. Incident investigation is the process of reviewing and taking action after an incident occurs.

2. Only managers participate in the incident investigation process.

3. After a violent incident occurs, your manager is responsible for doing an incident investigation in conjunction with the Joint Occupational Health and Safety Committee.

4. Incident investigations are conducted in order to make related

organizational and/or procedural changes that may prevent future violent incidents from occurring.

5. Incident investigations are conducted in order to prevent unresolved emotional trauma that may have long-term impacts on workers and the organization.

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IN T R O D U C T I O N

All incident documentation can be used to communicate about the risk of violence and help prevent future violent incidents.

WH A T D O C U M E N T A T I O N I S R E Q U I R E D?

After a violent incident takes place, you need to complete:

 Employee incident report (e.g., accident exposure form, event form, call center, etc.) – design to document incidents involving risk or harm to workers

 Patient incident report (e.g., Patient Safety Learning System) – designed to document incidents involving risk or harm to patients  Any other documentation that your organization requires

Patient records (including the care plan, a detailed violent behaviour assessment and violence alert) must be updated and/or completed.

Talk to your supervisor to find out which form(s) you need to complete and the process and timelines for submitting them.

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Page 10 P r o v in c ia l V io le n c e P r e v e n ti o n C u r r ic u lu m HO W C A N I B E S T C O M P L E T E T H I S D O C U M E N T A T I O N? When documenting information:

 Be factual and objective

 Describe specific behaviours and verbal outbursts (e.g., patient struck nurse on left shoulder with a closed fist)

 Avoid subjective labels (e.g., do NOT use the terms violent +++ or aggressive +++)

 Provide complete information with as much detail as possible (e.g. complete all boxes on incident report forms)

Fill out the required documentation with managerial assistance if you have experienced violence.

WH Y S H O U L D I D O C U M E N T?

Documenting the violent incident helps:

 Meet legal and regulatory requirements

 Prevent future violent incidents

 Promote staff and patient safety

 Support WorkSafeBC claims that are made

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# 3

Select all statements that are TRUE. Once you’ve completed the quiz, you can go to the end of this guide to check your answers.

1. Documenting the incident can help prevent future violent incidents. 2. A patient incident report is designed to document incidents involving risk

or harm to patients.

3. An employee incident report is designed to document incidents involving risk or harm to workers.

4. When documenting a violent incident you must provide factual and objective information.

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It is common to have emotional and/or physical reactions after a violent incident. Support resources are available to help lessen the impact of these reactions.

WH A T A R E C O M M O N R E A C T I O N S T O A V I O L E N T I N C I D E N T?

If you were directly involved in a violent incident or witnessed one, you may experience some or all of the following:

 Fear  Shakiness  Anger  Frustration  Disappointment  Tears  Self-doubt  Trouble concentrating WH A T A R E M O R E S E V E R E R E A C T I O N S T O A V I O L E N T I N C I D E N T?

If you were directly involved in a violent incident or witnessed one, you may also experience one or more of the following severe reactions:

 Intrusive memories

 Nightmares

 Flashbacks

 Distress with events that resemble the past event

 High sensitivity

 Change in eating/sleeping patterns

 Overall feeling of being unwell

 Fatigue

 Irritability/anger/rage

 Obsessive self-doubt

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Page 13 M o d u le 7 P o s t-In c id e n t R e s p o n s e WH A T S U P P O R T R E S O U R C E S C A N H E L P M E?

If you are experiencing troublesome symptoms:

 Access the Employee and Family Assistance Program (EFAP) and/or Critical Incident Stress Management (CISM) program

 Talk to your physician

 Talk to your manager or supervisor

WH O C A N H E L P M E F I N D S U P P O R T R E S O U R C E S?

The following can help you find support resources:

 Your manager and/or supervisor

 Occupational Health and Safety/Wellness department

 Your union representative

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In this module, you've learned the following key points:

 After a violent incident, you are required to: 1) inform your co-workers, manager, supervisor, and/or team about it, 2) report injuries or potential injuries using the Employee Incident Report or call center, and 3) document the violent incident.

 Incidents involving risk or harm to patients should be documented in a patient incident report. Incidents involving risk or harm to workers should be

documented in an employee incident report.

 Documenting violent incidents helps: 1) meet legal and regulatory obligations, 2) prevent future violent incidents, 3) promote staff and patient safety, 4) support WorkSafeBC claims, and 5) ensure accountability.

 Once a violent incident occurs, your manager is responsible for:

1) assessing the situation and putting any immediate safety measures in place, 2) checking in with all workers that experienced or witnessed the incident to check on their well-being and provide resource information, and 3) making sure that all required documentation is completed.

 Incident investigation is the process of reviewing and taking action after a violent incident takes place. Your manager is responsible for doing an incident investigation in conjunction with the Joint Occupational Health and Safety Committee. Workers affected by the incident are also involved in this process.

 It is common to have emotional and/or physical reactions after a violent incident. If you are experiencing troublesome reactions, access the Employee and Family Assistance Program (EFAP) and/or the Critical Incident Stress Management (CISM) Program, talk to your physician, or talk to your manager or supervisor.

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Please complete the following quiz once you have finished this module. Circle the correct answer(s) for each question.

1) A violent incident is not over until all of the post-incident steps are completed.

o True

o False

2) Immediately after a violent incident has happened, you should take care of yourself by conducting a wellness check and taking appropriate actions to address your needs.

o True

o False

3) Once a violent incident is over, you are required to: A. Scan the environment to make sure that it is safe

B. Report incidents where there were potential injuries to workers using the Patient Incident Report

C. Inform your co-workers, manager and/or team about the incident D. Document the incident (e.g., in the patient chart)

E. Call for medical attention if anyone is injured F. All of the above

4) You can only help someone that has experienced a violent incident if you were directly involved.

o True

o False

5) Incidents involving risk or harm to patients should be documented in a patient incident report. Incidents involving risk or harm to workers should be documented in an employee incident report.

o True

o False

6) Once a violent incident occurs, your manager has the following responsibilities: A. Conducting an incident investigation

B. Assessing the situation and putting immediate safety measures in place

C. Checking in with all workers who were involved in the incident and providing them with information about supporting resources

D. Completing all required documentation E. All of the above

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7) An incident investigation should be conducted by your manager and the Joint Quality Worklife Committee.

o True

o False

8) Violent incidents are investigated to:

A. Determine who should be held criminally and financially responsible for the incident B. Determine the contributing factors and causes of the incident

C. Make organizational and/or procedural changes to prevent future incidents from occurring D. Prevent physical trauma that may have long-term impacts on workers and the organization E. Meet regulatory and legal obligations

F. All of the above

9) If you are involved in an incident, you are responsible for participating in an investigation of the incident.

o True

o False

10) Incident documentation is used to: communicate about the risk of violence; meet legal and regulatory requirements; support WorkSafeBC claims; and help prevent future violent incidents.

o True

o False

11)The following documentation should be completed or updated when a violent incident occurs: A. Employee incident report (e.g., call centre, incident report form, event form)

B. Patient care plan C. Behaviour assessment D. Violence alert

E. Patient incident report F. All of the above

12)The following is an example of how you should document a violent incident: “Patient hurt care aide and other people. Patient is aggressive +++.”

o True o False

13) When documenting a violent incident you should: A. Be factual and objective

B. Provide brief, point-form descriptions of the incident C. Use abbreviations and acronyms

D. Describe specific behaviours and what was said

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14)You will only experience emotional and/or physical reactions if you were directly involved in a violent incident.

o True

o False

15)The following people or resources can help you after a violent incident:

A. Employee and Family Assistance Program or Critical Incident Stress Management Program B. Your physician

C. Your manager/supervisor

D. Your human resources department E. All of the above

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1. True - You should conduct a wellness check immediately after experiencing a violent incident.

2. False - You are required to report violent incidents where there were injuries and potential injuries.

3. True - You must report all violent incidents using the EMPLOYEE incident report or the call center.

4. False - Even if you were not involved in the incident, you can help support someone who was by: 1) asking them what they need, 2) listening, 3) helping them to conduct a wellness check and access available resources, 4) notify the supervisor or manager that an incident happened, and 5) looking for signs of shock.

TE S T YO U R KN O W L E D G E # 2

1. True - Incident investigation is the process of reviewing and taking action after an incident occurs.

2. False - Workers impacted by the violent incident are involved in the incident investigation process.

3. True - Your manager is responsible for doing an incident investigation in conjunction with the Joint Occupational Health and Safety Committee. 4. True - Incident investigations are conducted in order to make related

organizational and/or procedural changes that may prevent future violent incidents from occurring.

5. True - Incident investigations are conducted in order to prevent unresolved emotional trauma that may have long-term impacts for workers and the organization.

TE S T YO U R KN O W L E D G E # 3

1. True - Documenting the incident can help prevent future violent incidents. 2. True - A patient incident report is designed to document incidents involving

risk or harm to patients.

3. True - An employee incident report is designed to document incidents involving risk or harm to workers.

4. True - When documenting a violent incident you must provide factual and objective information.

5. True - Documentation about the incident can help support WorkSafeBC claims.

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1) True 2) True 3) A, C, D, E 4) False 5) True 6) E 7) False 8) B, D, E 9) True 10)True 11)F 12)False 13)A, D 14)False 15)A, B, C

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