Action 1.30 states

The health service organisation:

  1. Identifies service areas that have a high risk of unpredictable behaviours and develops strategies to minimise the risks of harm for patients, carers, families, consumers and the workforce
  2. Provides access to a calm and quiet environment when it is clinically required

Intent

Aspects of the environment that can increase risks of harm are identified and managed.

Reflective questions

How does the health service organisation identify and manage aspects of the environment and other factors that can worsen risks of harm?

What processes are in place to assess the appropriateness of the physical environment of the health service organisation for people at high risk of harm, such as people with cognitive impairment?

Key tasks

  • Review the design of the clinical environment to identify safety risks for patients, carers, family and the workforce
  • Conduct a risk assessment to identify service areas where there is a high risk of unpredictable behaviours, and develop strategies to manage identified risks
  • Identify areas where patients could be treated that offer a calm and quiet environment.

Strategies for improvement

Hospitals

Health service environments are stressful – they are brightly lit, noisy and constrained. In emergency department waiting rooms, people with different presenting problems are crowded together, uncertain about what is about to happen, and often frustrated by actual or perceived delays in accessing treatment. This can add to stress for people who are already experiencing stress.

This action is not intended to apply to every patient. People respond to stress in different ways, and have different needs in terms of environmental response. A calm and quiet environment is clinically appropriate for a person experiencing agitation and aggressive feelings. Access to sensory modulation resources may help a person who is experiencing psychosis or depersonalisation. Conversely, a person with thoughts of self-harm may consider being moved to a space on their own as isolating, and may require one-to-one nursing until they have been assessed and treatment has been initiated.

The Victorian Department of Health and Human Services has developed an audit tool that organisations can use to perform environmental audits and to develop action plans for improving the physical environment for older people using their services.

Examples of evidence

Select only examples currently in use:

  • Policy documents for safe work practices and emergency situations
  • Audit results of healthcare records for compliance with policies, procedures or protocols regarding unpredictable behaviours
  • Training documents about safe work practices and emergency situations
  • Observation that the physical design of the environment includes consideration of safety and quality (for example, interview rooms in high-risk areas that have double doors, use of CCTV surveillance, duress alarms, access to security services, a secure environment after hours)
  • Security contracts and surveillance systems.

Day Procedure Services

Day procedure services should use pre-admission screening processes to identify patients with a high risk of unpredictable behaviour. The screening processes listed under Actions 5.10 and 5.11 could also be used to demonstrate the management of risk for Action 1.30a.

Action 1.30b may not be applicable for many day procedure services because of the size of the service and the nature of the clinical environment.

Services should refer to the advice for hospitals for detailed implementation strategies and examples of evidence for this action, as required.

MPS & Small Hospitals

MPSs and small hospitals should:

  • Use the environment flexibly to meet the changing needs of patients, their carers and families
  • Conduct a risk assessment to identify service areas in which there is a high risk of unpredictable behaviours, and develop a risk management plan to manage identified risks.

This action is not intended to apply to every patient. People respond to stress in different ways, and have different needs in terms of environmental response. A calm and quiet environment is clinically appropriate for a person experiencing agitation and aggressive feelings. Access to sensory modulation resources may help a person who is experiencing psychosis or depersonalisation. Conversely, a person with thoughts of self-harm may consider being moved to a space on their own as isolating, and may require one-to-one nursing until they have been assessed and treatment has been initiated.

Examples of evidence

Select only examples currently in use:

  • Policy documents for safe work practices and emergency situations
  • Audit results of healthcare records for compliance with policies, procedures or protocols regarding unpredictable behaviours
  • Training documents about safe work practices and emergency situations
  • Observation that the physical design of the environment includes consideration of safety and quality (for example, interview rooms in high-risk areas that have double doors, use of CCTV surveillance, duress alarms, access to security services, a secure environment after hours)
  • Security contracts and surveillance systems.

Hospitals

Health service environments are stressful – they are brightly lit, noisy and constrained. In emergency department waiting rooms, people with different presenting problems are crowded together, uncertain about what is about to happen, and often frustrated by actual or perceived delays in accessing treatment. This can add to stress for people who are already experiencing stress.

This action is not intended to apply to every patient. People respond to stress in different ways, and have different needs in terms of environmental response. A calm and quiet environment is clinically appropriate for a person experiencing agitation and aggressive feelings. Access to sensory modulation resources may help a person who is experiencing psychosis or depersonalisation. Conversely, a person with thoughts of self-harm may consider being moved to a space on their own as isolating, and may require one-to-one nursing until they have been assessed and treatment has been initiated.

The Victorian Department of Health and Human Services has developed an audit tool that organisations can use to perform environmental audits and to develop action plans for improving the physical environment for older people using their services.

Examples of evidence

Select only examples currently in use:

  • Policy documents for safe work practices and emergency situations
  • Audit results of healthcare records for compliance with policies, procedures or protocols regarding unpredictable behaviours
  • Training documents about safe work practices and emergency situations
  • Observation that the physical design of the environment includes consideration of safety and quality (for example, interview rooms in high-risk areas that have double doors, use of CCTV surveillance, duress alarms, access to security services, a secure environment after hours)
  • Security contracts and surveillance systems.

Day Procedure Services

Day procedure services should use pre-admission screening processes to identify patients with a high risk of unpredictable behaviour. The screening processes listed under Actions 5.10 and 5.11 could also be used to demonstrate the management of risk for Action 1.30a.

Action 1.30b may not be applicable for many day procedure services because of the size of the service and the nature of the clinical environment.

Services should refer to the advice for hospitals for detailed implementation strategies and examples of evidence for this action, as required.

MPS & Small Hospitals

MPSs and small hospitals should:

  • Use the environment flexibly to meet the changing needs of patients, their carers and families
  • Conduct a risk assessment to identify service areas in which there is a high risk of unpredictable behaviours, and develop a risk management plan to manage identified risks.

This action is not intended to apply to every patient. People respond to stress in different ways, and have different needs in terms of environmental response. A calm and quiet environment is clinically appropriate for a person experiencing agitation and aggressive feelings. Access to sensory modulation resources may help a person who is experiencing psychosis or depersonalisation. Conversely, a person with thoughts of self-harm may consider being moved to a space on their own as isolating, and may require one-to-one nursing until they have been assessed and treatment has been initiated.

Examples of evidence

Select only examples currently in use:

  • Policy documents for safe work practices and emergency situations
  • Audit results of healthcare records for compliance with policies, procedures or protocols regarding unpredictable behaviours
  • Training documents about safe work practices and emergency situations
  • Observation that the physical design of the environment includes consideration of safety and quality (for example, interview rooms in high-risk areas that have double doors, use of CCTV surveillance, duress alarms, access to security services, a secure environment after hours)
  • Security contracts and surveillance systems.