- Posted Tuesday May 21, 2019
This year’s wave of knife crime within the UK should be a wake-up call to all practice managers to review, update and rehearse their Violence and Aggression policies and review how to react to a panic alarm.
It would be naive and irresponsible to think that some patients entering the consultation room are not carrying some form of “blade”. Depending on their mental state and the outcome of a consultation, an aggressive response may be triggered and result in the use of a “blade” on either the GP or other members of staff.
A recent news story involved GP in Montrose, Scotland was attacked and stabbed last year and the patient concerned has recently been sentenced to four years for the assault. It really does happen.
Anticipating and being ready for these scenarios
Incidents like this are thankfully rare within general practice; however when they do happen it is normally without warning and can be extremely stressful and upsetting for all concerned. It is therefore vitally important any practice policy is not only communicated to staff but also rehearsed on a regular basis to ensure every member of staff knows what to do instinctively.
Any incident of this nature usually generates a lot of raised voices and interest from other staff and clinicians work in the building. For their own safety and protection, anyone not involved directly in the incident should know to remain in their own rooms and secure their doors until told to come out.
Additional intervention by other staff can only serve to confuse the process and inflame the violent patient. If it does not involve you directly - stay out of the way. No attempts should be made to block the exit route out of the consultation room or to restrain the patient. Always give the violent patient a clear route to exit the building while minimising any danger to patients and staff - we know who they are, so leave it to the police to follow up.
A book full of policies is only useful if staff know the contents, are trained in them, and action them when called to do so. Remember your responsibilities under Health and Safety Law - to give appropriate safety information, instruction, training and supervision.
What to bear in mind in the event of an incident
- Test your panic alarms regularly and from different rooms to ensure they all work and that all staff know how to silence them and where the keys are kept.
- On activation of the alarm, ensure one member of staff is immediately sent to the waiting room to secure the room and stop all patients entering or leaving. This should ensure no other patients get involved or exposed to the potential threat.
- A minimum of one member of staff should go immediately to the room which activated the alarm. The member of staff should immediately open the door to the consultation room.
- If possible, staff responding to a panic alarm should carry an item such as a coat, as this can be used as a distraction should the patient lash out with a knife.
- Every situation will be different and very hard to legislate for. Therefore on opening the door, staff should make an assessment of the situation and respond accordingly - taking guidance from the clinician involved.
- Angry and disturbed patients have a tendency to pick up objects to throw or break as they exit the building. Therefore review your exit routes from the consultation rooms and try to ensure they are clear of any potential missiles. Keep all reception staff clear of the front desk until the patient has left the building.
- Ensure all staff are clear on who has responsibility to call the police using 999 and ask for an immediate response. Have a prepared crib sheet so staff can give the police clear instruction on details of the incident, such as the location.
- Once the patient has left the building, all staff involved should be prepared to make a statement to the police. Some staff and patients may be extremely distressed by the incident and should be counselled and supported accordingly.
Incident like this will happen with no warning – practice your policies to ensure a safe and appropriate response. Keep your staff and patients safe.
Keith Buckingham was the general manager for a large inner-city practice in Dundee for 14 years and retired from General Practice in 2018. Keith completed 25 years service in the Royal Marines and has been a trainer with Thornfields since retiring from practice management.
FPM members can access a downloadable Violence and Aggression Policy from the Policies and Procedures Library. Interested in Health and Safety training for your practice? Learn more about award-wining primary care trainers Thornfields’ course by clicking here.