Violence Prevention in a Primary Health Care Setting

Violence in Primary Healthcare and its Prevention
Violence in the workplace is an important issue as can be seen by the occupational health and safety, labour and other health-related information on the topic. Also the issue seems to be receiving increasing attention, possibly in part due to the increase in litigation following incidents in the workplace. In the healthcare setting it is clear that violence or the threat of violence is perceived to be a significant issue by staff in most if not all contexts. A lot of the work that has been done on the issue of violence on healthcare providers has dealt with Accident and Emergency Department and Psychiatric services. However there seems to be acknowledgement that Community-Based workers are also at significant risk. My interest in this is that I work in primary care where, anecdotally, there is significant concern about violence. We were actually asked to put together guidlines for the prevention of violence in primary care. The challenge however is to respond to a problem for which I am aware of no organised, reliable local information. To find out what the current reality and perceptions are we will need to organise a survey, get info from police and from clinic records. There will also likely be benefit from pushing for a formal system for recording incidents of violence and aggression. We are going to need to find out what the literature says around violence in primary healthcare and its' prevention. The following are that we would have to consider topics for searching for information on: Violence in Healthcare, Violence in the workplace, Violence in the healthcare setting of this country (unlikely to find much but heard that there was a MSc thesis done by Accident and Emergency trainee), Violence in the Polyclinics, Violence Prevention strategies, Assessing the Extent and Impact of Violence in the Polyclinic/Workplace, Violence Management/Response, The Violent Patient.

Not wanting to reinvent the wheel- a fair amount of info can be taken from various source that have done reviews and have programmes/ guidelines in place:

NHS Zero Tolerance Website http://www.nhs.uk/zerotolerance/dealing/index.htm,

New South Wales in Australia Taskforce on Prevention and Management of Violence in the Health Workplace http://www.health.nsw.gov.au/communications/campaigns/antiviolence.html

The International Labour Organisation, http://www.ilo.org/public/english/dialogue/sector/techmeet/mevsws03/mevsws-cp.pdfFrom In the The USA, Occupational Safety and Health Administration Website, Violence in Healthcare Module http://www.osha.gov/SLTC/etools/hospital/hazards/workplaceviolence/viol.html

IN addition they have produced- Guidelines forPreventing WorkplaceViolence for Health Care & Social Service Workers U.S. Department of LaborOccupational Safety and Health Administration 2004

BMA : violence at work : the experience of UK doctors http://www.bma.org.uk/ap.nsf/Content/violence
Royal College of Psychiatrists' clinical practice guidelines : management of imminent violence http://www.psychiatry.ox.ac.uk/cebmh/guidelines/violence/violence_full.html

Seems like folks from the following should be on board at some stage:Epi/psyche/legal/security(police)/occupational health/labour unionThe issue is definitely within the perview of the Ministry of Health although I am not sure under which stragetic goals it best fits. The other things that increase these thoughts becoming action taken by the powers that be include: If a large number of persons perceive that the problem exists or there is a significant increase in the numbers that do so, If people perceive the problem to be very severe or of significantly increasing severity. An epi collegue has agreed to help with the survey. So the first thing is to get the information from the survey (we are looking for survey instruments that can be adapted), get info records of clinics, from police records and to call for formal systems for documenting incidents, looking at current violence prevention and documentation systems where they exist and looking at existing or potential hazards. Not much about prevention yet as we need to assess what is happening before moving on to that aspect.