// Working Alone

Working Alone - Working With Patients

What are some of the risks associated with working alone with patients? When working alone, health care and social service workers face a risk of violence for many reasons: Isolated work with patients or clients during examinations and treatment.

What are some of the risks associated with working alone with patients?

When working alone, health care and social service workers face a risk of violence for many reasons:

general Isolated work with patients or clients during examinations and treatment.
general Nature of certain medical procedures can make a patient nervous, agitated, etc.
psychosocial Working alone in remote locations (including within the hospital or clinic), patients' homes, incident scene, etc.
safety Availability of drugs and other medicines at hospitals, clinics and pharmacies, or in emergency response vehicles.
general Public access to most areas of a hospital or clinic.
general Hospitals and clinics that are open to the public 24 hours a day (including the higher risk times of late night or early morning).

What can employers do?

It is very important to acknowledge that there is a potential for violence to workers before an incident occurs. Employers should conduct a full assessment of the working conditions, locations, and staff safety. Information is also available in other OSH Answers documents:

context Working Alone - General
context Working Alone - Off-Site
context Violence and Harassment in the Workplace

What are some prevention tips?

requirement Assessment of the patient should include items that relate to staff safety, such as social circumstances, history of substance abuse, psychiatric illnesses, or tendency for aggressive or violent behaviour. Keep in mind that patient confidentiality and worker safety issues must be balanced.
requirement Ensure there is enough staff to safely manage areas or patients that pose a higher risk of violence.
requirement Consider assigning more experienced staff, or staff with a demonstrated ability to handle potentially violent situations, to areas or patients that pose a higher risk of violence.
administrative Implement procedures so patients are not repeatedly asked for the same information. For example, chart all information that needs to be passed to the attending staff.
requirement Ensure all counselling and patient care rooms have two exits, where possible. Staff should be seated between the door and the patient with unimpeded access to exit.
administrative Identify the circumstances in which the use of physical restraint is appropriate and provide training.
administrative Establish procedures for assessing, recognizing, and monitoring high-risk patients.
administrative Establish lock-up procedures for prescription drugs.
administrative Provide appropriate training and education for all workers. Establish an emergency call system to announce specific situations (e.g., fire, staff needing immediate assistance) and prepare written policies and procedures for responding to these situations.
requirement Make available additional help or back-up support for workers who request it.
administrative Encourage workers to report all incidents or near-misses of workplace violence, including threats.
requirement Discourage workers from carrying keys, pens or other items that could be used as weapons where possible.

What are some tips for working with patients?

If a patient becomes hostile during a procedure: If you are concerned about the actions of a family member:

requirement Review the patient's profile before meeting. Take note of any potential concerns and use precautionary measures if necessary (e.g., have another person in the room).
requirement Approach patients in a non-threatening, respectful manner.
requirement Provide the right information at the right time. DO NOT overload patients or family members with too much medical information or technical jargon.
requirement What is involved.
requirement How long it will take.
requirement Whether it will hurt.
administrative Clearly and fully explain to the patient before and during the procedure; for example,
requirement If you feel threatened, DO NOT conduct intimate examinations of patients alone. Arrange to have a colleague in the room or close by.
requirement If you can, leave the door open during any potentially violent consultation to allow for visual or verbal contact with other staff.
administrative Record instances of abuse immediately following the event so that details are not forgotten when reporting.
requirement Consider transferring aggressive patients to more secure or restrictive settings if possible.
administrative Investigate all reports. Take corrective actions and review prevention measures.
requirement Comply with applicable legislation for your jurisdiction.
requirement Stop what you are doing, if possible.
requirement Ask the patient to tell you what is wrong.
requirement If you can, correct the situations. Otherwise, explain why you cannot.
administrative End the procedure in a safe way if you are still concerned about your safety.
administrative Politely communicate that the procedure cannot continue if the patient continues their behaviour.
requirement Let them know in clear and simple terms what is expected of them.
requirement If their behaviour continues or escalates, ask them to take a seat in the waiting room.
requirement Call security if you feel threatened.

What are some tips for working in a patient's home?

Before you go on a home visit, make sure that you are: Do: Do Not: (Adapted from CCOHS Violence in the Workplace Prevention Guide)

administrative Trained in the prevention of violence and how to work alone safely.
administrative Trained in the use of the check-in procedure.
requirement Briefed about the areas where you will be working.
requirement Given all the relevant information about the client.
administrative Follow procedures for working alone off-site by having a check-in procedure and conducting an assessment of working conditions.
requirement Preview your cases ahead of time. Assessment of the patient should also include the location of the home (apartment building, private residence, retirement residence, etc.), condition and location of parking lot, other persons in the home, number and nature of pets, etc.
requirement Know the potential risks of the geographical area you are working in.
requirement Dress appropriately. Decide if a uniform will help to show who you are or if it will create additional risk.
requirement Decide if having identification signs on your vehicle will be a benefit or create additional risk for your geographical area.
requirement Use your judgement. Call your contact person before and after leaving a potentially risky situation.
requirement Use positive body language.
requirement Maintain a 'reactionary gap' - a distance that allows you time to react to any movements the other person makes.
requirement Be aware of your surroundings. Know the location of doors and other exits.
requirement Visit during the day, especially for the first visit.
administrative Have training appropriate to your tasks, location and prevention of violence.
ppe Carry an incident reporting form and fill it in as soon as possible if anything happens. Filling in the form immediately will help you remember more details.
requirement Do not wear expensive jewellery or carry large amounts of cash.
requirement Do not touch the other person without permission.
requirement Do not enter a situation where you feel you are at risk. Contact your office for assistance or more information.