History of Violence (HOV)
What is the criteria for assigning a History of Violence (HOV)?
History of Violence – will be “patient” or “other”
An HOV is assigned when a client, family member, or visitor has injured, threatened, or attempted to injure someone in an Island Health workplace or when a documented History of Violence is known outside the health care environment.
What do Behavioural Precautions mean?
It means they are currently at increased risk of violence as per their last Violence Risk Assessment (VBACT) – their score was either Moderate or High.
When is a Code White activated?
If you feel unable (or potentially unable) to de-escalate the situation by yourself.
There are 3 levels of response –
Call police anytime Code White responders or PSOs do not feel they have the capacity to safely manage the situation, there is a weapon involved, or the escalated resident is off the property.
Who is responsible for completing the PSLS after a violent incident
Anyone involved or that witnessed the violent incident
How long may a stress reaction last?
Stress reactions may last days or weeks depending on the severity and circumstances of the trauma and available supports. There is the potential for the event to trigger traumatic events from the past and take time to subside. Take the time you need to heal before returning to work.
In what instances can the HOV alert be removed?
Rarely - only certain circumstances:
Where can you find out if your resident has Behavioural Precautions?
Care Compass
Resident Overview
LTC Workflow Tab: Under Safety Risk
Results Review: under the Safety Risk tab
Safety Communication Board
How do you activate a Code White?
Press the Aeroscout Duress button
Yell Code White
Throw your screecher into the hall
Broadcast on the Vocera
Call for Help
What should you do if you witness a near miss?
Complete a PSLS (and call Workplace Health Call Center as appropriate)
Should I call the Workplace Health Call Center for a near miss?
Yes – always call the Workplace Health Call Center for all Near Misses or Injuries.
What are 3 places can we see the HOV alert?
Resident’s chart in the Blue Banner Bar
Resident Overview: under Safety Alert
Safety Communication Board
Results Review: under Safety Risk tab
Bedside ADL sheet will be purple
What must you do before providing care to someone with Behavioural Precautions?
You MUST read and follow the Behavioural Care Plan before entering the room.
What behaviours might you see that may require calling a Code White?
Signs of Emotional Crisis: Invasion of personal space, clenched fists, waving arms, intense staring, easily provoked, poor control over reaction, paranoia, not following simple commands, poor insight, resistive, throwing items, slamming doors, destruction of property, sudden or unpredictable behaviour, inappropriate comments or gestures
Your resident threw her hairbrush at your head. What are your next steps?
Debrief with team
What debriefing options are available after a violent incident?
Critical Incident Stress Management Services (access via Leadership)
My resident is swearing and yelling – is this considered violence?
No, they are expressing their anger and frustration.
Who is responsible for filling out the Behaviour Care Plan (BCP)?
Everyone is responsible for contributing to the Behaviour care plan! Those that know the resident’s triggers and effective strategies must ensure it is reflected in the BCP.
What should you do when someone is a behavioural emergency and threatening others and/or damaging property?
A behavioural emergency is unsafe. You should remove yourself from the situation. Call 911.
When should you call the Police?
The following list provides examples of violent incidents when the local police authority/RCMP should be called to assist:
• The use of a firearm (or a threat of a firearm);
• The use of an edged weapon (or a threat of an edged weapon);
• Worker assault (or the threat of an assault);
• A bomb threat (Code Black);
• A suicide attempt;
• Unlawful entry and/or theft;
• Significant vandalism or property damage;
• Where an individual (employee or other) expresses a desire to press criminal charges (as a result of a violent incident).
What are some things you can do to look after yourself and promote recovery from violent incidents?
My resident grabbed me and hurt me unintentionally – is this considered violence?
Yes, even if the intention wasn’t to hurt you, you were injured and this could happen to someone else. It would be important to communicate this risk to others and care plan to try to prevent future incidents.
What can we do if the Behaviour Care Plan (BCP) is not working?
Fill out PSLS reports. Ask for a PIECES meeting and complete BSO DOS monitoring. If necessary, after PIECES/BSODOS, referral to complex care planning consults can be made to the Person Centered Support team which has access to Addictions medicine and Adult Psychiatry consults.
What is the difference between an Emotional Crisis and Behavioural Emergency?
Yelling, crying pacing and glaring are signs of an emotional crisis and it is appropriate to try to de-escalate the situation, calling a code white if help is needed.
Threatening others and damaging property are signs of a behavioural emergency, you should remove yourself from the situation as it is unsafe to try and de-escalate. Call 911
What documentation is required when there is an incidence of violence – for the first time?
Call manager on call if there has been damage to building, injury to staff or other resident.
What are some signs (or symptoms) that would indicate you could benefit from additional supports? (EFAP or counselling)