zoran bukarica - australian nursing & midwifery federation

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ZORAN BUKARICA OHS OFFICER, ANMF (VIC BRANCH)

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Page 1: Zoran Bukarica - Australian Nursing & Midwifery Federation

Z O R A N B U K A R I C A

O H S O F F I C E R , A N M F ( V I C B R A N C H )

Page 2: Zoran Bukarica - Australian Nursing & Midwifery Federation

SESSION OUTLINE

1. Objectives

2. Causes and Consequences of Violence in Nursing & Midwifery

3. OVA working parties – what are they?

4. ANMF involvement – how, why, when?

5. Impact of working parties on the employer

6. Impact of working parties on the members and the general nursing workforce

7. Example of a successful case

8. Conclusion & Questions

Page 3: Zoran Bukarica - Australian Nursing & Midwifery Federation

OBJECTIVES

To explain the involvement of the ANMF in OVA

To identify positives from ANMF involvement in OVA at the workplace level

Showcase an example of a positive experience with working parties

Page 4: Zoran Bukarica - Australian Nursing & Midwifery Federation

CONTEXT

88% of Australian nurses and midwives consider occupational violence a risk (Driscoll, T, 2008)

36% - high risk

Reporting of violence incidents - approx. 50% (Farrell, Shafei and Gaynor, 2010)

Main types of occupational violence -Verbal abuse (90%)Physical (44%)Threat of harm (27%)

Page 5: Zoran Bukarica - Australian Nursing & Midwifery Federation

CONTEXT (CONT)

Main perpetrators

Patients (75%)

Visitors (19%)

Over half of perpetrators are aged

50+, and 61% are male

55% rate organisation’s management

of situations as only “fair” or “poor”

Page 6: Zoran Bukarica - Australian Nursing & Midwifery Federation

CAUSES OF VIOLENCE IN NURSING

No single factor – multifactorial

Some contributing factors include:Mental health of clients (53%)Patient’s personality (63%)Drug and alcohol-affected patients / clientsInexperience of nurse / midwife

Page 7: Zoran Bukarica - Australian Nursing & Midwifery Federation

CAUSES OF VIOLENCE IN NURSING (CONT)

Organisational contributing factors include:Management commitment to elimination of violence

Situational and/or Environmental factors

e.g. Physical layout, design

Policies and Procedures

Training

Security

Support

Page 8: Zoran Bukarica - Australian Nursing & Midwifery Federation

CONSEQUENCES OF VIOLENCE IN NURSING

Workers Compensation Claims Injuries

Physical Psychological Friends and Family

Absenteeism Loss of trust in the organisation High staff turnover Lost to profession Economic loss

Page 9: Zoran Bukarica - Australian Nursing & Midwifery Federation

WHAT ISSUES DOES ANMF FIND?

Lack of true consultation

Lack of collaboration

Short sighted

Single factorial approach

No systemic view

Too much concentration on ‘mopping up after’ (and even then poorly…)

Lack of consistency in approach across health services

MONEY

Page 10: Zoran Bukarica - Australian Nursing & Midwifery Federation

WORKING PARTIES – WHAT ARE THEY

Employee and employer organised

committees to look at system of managing

OVA (the WHOLE system)

ANMF present at meetings to represent

members

Review the system, find gaps and improve

Page 11: Zoran Bukarica - Australian Nursing & Midwifery Federation

ANMF INVOLVEMENT

Member initiated contact

Members feeling their place of work is not

safe

Generally after a number of incidents

which hasn’t resulted in improvements or

one serious incident

Page 12: Zoran Bukarica - Australian Nursing & Midwifery Federation

IMPACT ON EMPLOYERS

Negative about Union involvement at the start

External party review of management system

Provide benchmark and ideas from other

hospitals

After a few meetings, employer comes around

ANMF encourage employees to report and

follow procedures

ANMF aim to assist employers

Page 13: Zoran Bukarica - Australian Nursing & Midwifery Federation

IMPACT ON MEMBERS AND WORKFORCE

Their Union is there representing them

Regain trust in the employer

Have a voice and ensure they are heard

Page 14: Zoran Bukarica - Australian Nursing & Midwifery Federation

Working party success story

St. Vincent's Hospital

Page 15: Zoran Bukarica - Australian Nursing & Midwifery Federation

BACKGROUND

1. St Vincent’s highlighted as leading the pack in relation to violence and aggression prevention and management

2. Feb 2011 - Report re incidents of client assaults

3. 4 Feb – Urgent meeting convened to discuss, with detailed follow up letter

4. Initially some hesitation regarding ANF direct involvement -> constructively addressed

5. SVMH committed and willing to undertake collaborative approach with ANF to genuinely resolve issues – very quickly initiating actions to address many issues

Page 16: Zoran Bukarica - Australian Nursing & Midwifery Federation

BACKGROUND6. Post-incident psychological support arrangements appropriate,

but did not resolve systemic contributing factors

7. 1st working party meeting utilised Action Plan based on issues articulated by ANF, with desired actions

8. Within a week, further 4 assaults / aggression incidents on staff -> posed risk regarding nurses confidence in the collaborative approach

9. Action Plan determined generally appropriate, but no associated timeframes -> SVMH agreed to amend

10. Urgency of actions stepped up to prevent further incidents whilst longer term actions were being implemented

Page 17: Zoran Bukarica - Australian Nursing & Midwifery Federation

CONTRIBUTING FACTORS IDENTIFIED

INCLUDED:1. Delayed alert of duress alarms

2. New Medical staff not aware of policies and procedures to follow

3. Communication concerns and issues relating to risk assessment of clients

4. SVMH policies not clear / communicated to all staff

5. Resources not in place to fully implement

Page 18: Zoran Bukarica - Australian Nursing & Midwifery Federation

CONTRIBUTING FACTORS IDENTIFIED

INCLUDED:6. Inadequate refresher training of insufficient regularity

7. Security not part of training undertaken, but part of Code

Grey response

8. Delays in security attendance at Codes

9. Variable levels of tolerance of aggression

10. Poor co-ordination and inconsistent approach for breaks

to seclusion

11. Inadequate medication for clients

Page 19: Zoran Bukarica - Australian Nursing & Midwifery Federation

SOLUTIONSWorking party – ANF attending initially via HSR request for assistance

Training

Training calendar developed and distributed

Additional TRAM training scheduled across calendar year, with inclusion of medical staff

‘Blitz’ on staff who had not recently undergone training as many had recently started rotation

Local Practice drills initiated on Monthly basis, including all AIS staff, security and Code Grey Response Team

Local orientation and checklist reviewed and varied

Security to attend TRAM training to ensure consistency of message and response

Page 20: Zoran Bukarica - Australian Nursing & Midwifery Federation

MORE SOLUTIONS

Duress Alarms

Review of duress alarm system – significant software upgrade required and being implemented

Testing of all handsets part of handover

Review of policy

Development of annual competency

Purchase additional 30 handsets to account for shift overlap times

Installation of wall mounted duress alarms

Page 21: Zoran Bukarica - Australian Nursing & Midwifery Federation

MORE SOLUTIONSPolicy & Procedure Awareness, Training & Compliance

Review of all relevant policies and roll out of campaign & training to all staff, including:

Code Grey Prevention of Aggression and Violence Policy Seclusion Policy OH&S MS Critical Incident Stress Management Policy ASCOM Policy Transfer of Acutely Disturbed Patients form the ED and AIS Policy AIS Admission Guidelines Emergency Response Team (ERT)

Page 22: Zoran Bukarica - Australian Nursing & Midwifery Federation

MORE SOLUTIONSCommunication of Risk Assessment and Outcomes

Risk Assessment currently under review

Alerts to be placed onto CMI (RAPID) – centralised mental health electronic system with patient histories and use code grey stickers

Training in use of system

Inconsistency of Knowledge / Awareness amongst staff

Direction that all medical staff attend TRAM and ASCOM training prior to commencing work

Medical staff to participate in scheduled TRAM training, followed up by Inpatient Educator & Director of Clinical Services Mental Health

Page 23: Zoran Bukarica - Australian Nursing & Midwifery Federation

MORE SOLUTIONS

Practice Issues

Review of use of sedation and other medication

Acute Arousal guidelines developed

Management support to staff when activating Code Grey and Pre-Code Grey

Consistent approaches via equipment, policies, education, training, drills implemented

Increased Client Awareness Campaign regarding no tolerance of aggression

Seclusion breaks policy to be reviewed and tightened

Page 24: Zoran Bukarica - Australian Nursing & Midwifery Federation

AND MORE SOLUTIONSSecurity location

All response times to be monitored

Early Code Greys to be called

Collaborative training to assist co-ordinated response

Professional Development – ANUMs / Shift Leaders

ANUM Development Training Day scheduled to focus on supporting their leadership skills and professional development

Two days allocated for training of ANUMs / Shift Leaders including training on policies, responses, equipment, etc.

Ergonomic assessment of nurses work area

Page 25: Zoran Bukarica - Australian Nursing & Midwifery Federation

CURRENT STATUS

ANMF no longer involved

Fantastic progress and support from SVMH towards their staff

Ongoing Acute Inpatient Service Consultative Working Party

Significant improvements in collaborative working environment

Overall improvement in management of OVA

Page 26: Zoran Bukarica - Australian Nursing & Midwifery Federation

LEARNINGS

Collaborative approach is most effective

means of addressing hazards

An entire systems approach is essential –

one component alone is not going to have

the required affect

Page 27: Zoran Bukarica - Australian Nursing & Midwifery Federation

OVA PREVENTION STRATEGY FRAMEWORK

Physical environment /

workplace design

(CPTED)

Post-incident support

Pre-admission/ admission risk assessment

Security –access,

personnel, CCTV, alarms

Incident reporting,

investigation, review and feedback

Training and education

Organisationalpolicies and procedures,

including Code Grey and Black

Cross disciplinary understanding, communication and consistent

approach

Empowered staff

Management plans /

Care plans

Executive commitment to OVA

prevention

OHS Management

System

Page 28: Zoran Bukarica - Australian Nursing & Midwifery Federation

QUESTIONS???

Contact details: Zoran BukaricaOHS OfficerANMF (Vic Branch)[email protected]

Ph: 9275 9333 or 0487 277 339