To reduce risks to the personal safety of practice staff, it is important to first assess the current situation:
- Identify potential risks and the likelihood of each risk occurring.
- Create a register of the identified risks and their consequences.
- Determine if existing controls manage each risk adequately.
Then, for each risk, decide whether you will:
- accept the risk and continue with activities that may contribute to it
- cease the activities that contribute to the risk
- implement other controls or change activities to reduce or remove the risk.
During your assessment, make sure you review all past reported incidents. Avant recommends that each workplace has policies for complaints handling and the management of actual or threatened violence.
Areas of risk
Personal safety is at greater risk when:
- consulting after hours, when there is minimal or no support staff in the practice
- making home visits without a support person
- seeing patients who are unstable, aggressive or drug seekers who are demanding prescriptions.
The greatest risk to personal safety may occur when a patient or ex-patient is stalking a doctor or staff member. This may involve a patient physically following a practitioner home, making nuisance phone calls or sending text messages or emails.
Prepare and plan your safety procedures
Implement a zero tolerance policy for abusive, aggressive and violent behaviour in the practice. Make sure all practitioners and practice staff know how to respond if they feel their safety is at risk. Develop protocols and action plans for various situations and run practice safety drills simulating different scenarios.
For example, make sure all staff know how to manage duress calls from a consulting room so there is a quick and automatic response. If each practitioner’s phone is set to speaker phone, a one-dial automated process triggered by the practitioner can allow the receptionist to hear what is going on in the consultation room when the practitioner is feeling threatened.
For potentially difficult patients, consider establishing a system where a staff member knocks and enters the consultation room at a prearranged time. Ensure feedback is sought during practice drills and refine policies where needed. At general staff meetings, have a regular agenda item to discuss potential personal safety and security issues. Consult with a security expert or a community liaison officer to assess if other measures need to be taken to increase the security in your workplace.
Safety in reception and consult room layout
Review the placement of the desk and chairs used during a consultation. If the doctor is blocked behind the desk they will be at greater risk in a threatening situation. Consider positioning the doctor’s desk and chair close to the door to provide an easy exit in the event of a threatening situation.
Similarly, review the position of the reception desk – receptionists need to have an easy exit too and not be trapped behind a desk. Identify items that can be used as weapons. Any items that could be thrown or used as weapons, such as a computer monitor or printer, should be secured. Items such as scissors and letter openers should be stored away from view when not in use.
Telephone and email safety
Try to keep your personal calls separate from your professional calls. Consider having a dual SIM mobile phone or a separate mobile phone for work-related contacts so that patients do not have your personal mobile number. Think about having your home phone number unlisted. If this is not possible, use an answering machine to screen calls and use a phone with a caller ID display.
Create a laminated list of emergency numbers and put copies near office phones. Ensure emergency numbers are programmed for speed dial in the practice phones and on staff mobile phones.
Do not give out your personal email address and only give out your practice email address when necessary.
Consider withdrawing your name from the electoral roll and only register as a postal voter.
Consider using duress alarms
Install duress alarm buttons in each consultation room and in the reception area of your practice. There are many different types of duress alarms including:
- hard-wired alarms that can be mounted under each consultation desk which are monitored by the front desk staff or a security firm
- USB alarms that are plugged into your existing computer network and alert everyone in the practice who is near a computer when activated.
It may be appropriate to wear a personal duress alarm in situations where it is known personal safety may be at risk.
Stay safe after hours
Where possible, do not consult in the practice when there is no other staff member present. If alone in the practice after hours, ask a colleague to call periodically to ensure you are safe.
Be mindful of patients seeking pain relief after hours without an appropriate assessment. If visiting a patient at home, advise someone of your anticipated time of return. Ideally, have a support person with you. Have a management plan for a threat to safety during a home visit.
If working late, move your car close to the building at the end of the day. Ensure there is adequate lighting when walking to the car after hours.
What to do following an incident
If an incident occurs, record everything that happened as soon as possible, including a profile of the offender – general appearance, gender, age, voice – and what was said.
Ensure appropriate debriefing opportunities and support systems are provided to all staff when a personal safety issue has occurred.
If necessary, Avant can assist you to take out an Apprehended Violence Order (AVO), which is a set of conditions made by the court to protect people from violence or being harassed.
Australian Medical Association Personal Safety and Privacy for Doctors – 2005 RACGP General Practice – a safe place: tips and to