New guidelines to deal with aggressive patients at hospital

The Victorian Government has introduced new guidelines for health care staff to respond to violence but Ballarat Health Services have been improving their procedures for years. 

The new guidelines introduced by the state government set out minimum standards for health care providers responding to violent stations, known as code greys. 

However, Ballarat Health Services overhauled their response procedures and incident reporting guidelines almost three years ago and already operate above the minimum standards set out in the new guidelines. 

The systems for responses to violence at Ballarat Health Services informed much of the discussion undertaken by the government in forming the new guidelines. 

Management of Clinical Aggression (MOCA) coordinator at Ballarat Health Services, Marcus Hovey, said they have the best violence management systems in the state.

“We have roles in the response teams, we have responders that come from outside the area and people in the affected area as well and it is managed really well,” he said. 

Statistics provided to The Courier from Ballarat Health Services show there were 2261 violence and aggression incidents across the organisation in the 2016-17 financial year. 

However, 595 of those incidents were planed code grey responses where staff implemented proactive safeguards before a high risk situation escalated to violence or aggression.

Ballarat Health Services deals with an average of five to seven code grey incidents a day with a variety of factors contributing to people becoming violent or aggressive. 

Mr Hovey said the organisation has a clear policy of deescalation, education and training to ensure the safety of staff, patents and visitors. 

“The most important job is crowd control,” he said. 

“We have to manage with what we have and while we can't predict the outcomes, we can predict what might happen.”

“It will happen in some areas more likely than others and then we can put the planning in place.”

According to Mr Hovey, the most common cause of violence in health services is fear and mostly comes from patents who are experiencing delirium from illnesses such as dementia or who are drug and alcohol affected. 

While the violence and aggression response reporting systems account for physical injury to staff and others, Mr Hovey said there needs to be more emphasis on the mental impact of these incidents.

“What tends not be reported as much is the psychological harm,” he said. 

“The mental effect of a traumatic incident might not surface for a month and the high risk is PTSD; we are humans too and we can react that way.” 

He said the new guidelines will be good for health services that don’t already have them in place and gives providers a base to work from. 

“The best thing about a standard is you can exceed it.”

“It’s all about that monitoring of reporting and changing and auditing those things that inform how we are going.” 

Ballarat Health Services have started to extend their MOCA training program to surrounding regional health services.