PDF Behaviour Documentation Toolkit revised 10-06-09

Behaviour Documentation Toolkit

Assembled by the Provincial Violence Prevention Steering Committee's Violence Prevention Advisory Group

Occupational Health & Safety Agency for Healthcare in BC #301-1195 West Broadway, Vancouver, BC V6H 3X5

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Acknowledgements

We would like to thank the Provincial Violence Prevention Steering Committee and the Violence Prevention Advisory Group for their time and effort in developing the Behaviour Documentation Toolkit. We would also like to thank the following individuals for their assistance in assembling the Behaviour Documentation Toolkit:

Robert Gill, FH Kathleen Strath, Kinsmen Place Lodge Liezel Hippsley, Kinsmen Place Lodge

We would like to thank Sheile Mercado-Mallari, Robert Gill, Leslie Gamble, Fraser Health and Interior Health for sharing their valuable resources with the PVPSC. We respectfully ask that individuals who use this resource appropriately recognize those who developed the materials for the work they have done. We ask that you please acknowledge the author and/or author organization, even if you modify or adapt the resources. The resources on the Responding to Excessive and Aggressive Behaviours (REAB) Program, the InterRAI Program and the Medical Legal Charting were not developed by the PVPSC, and distribution should not be interpreted as endorsement of the resources as "best practices" or joint agreement. Any use, modification, or adaptation of this resource is done at the user's discretion and the user assumes responsibility for the outcome.

Revised June 2009

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Table of Contents

Acknowledgements .........................................................................................................................................................3 Introduction to BC's Provincial Violence Prevention Steering Committee ...........................................................5 Introduction to the Behavior Documentation Toolkit ..............................................................................................5

Scope of the Problem: Underreporting of Violent Incidents.............................................................................. 5 Overview of Behaviour Reporting and Documentation...................................................................................... 6 The General Behaviour Documentation and Reporting Process ....................................................................... 6 Behaviour Documentation Tools..................................................................................................................................7 Responding to Excessive and Aggressive Behaviours (REAB) Program ...............................................................8 REAB Behaviour Documentation Process ............................................................................................................ 8 CPG Summary Flowchart......................................................................................................................................... 9 Identification of Behaviours and Guidelines for Interventions ........................................................................ 11 Behaviour Pattern Record....................................................................................................................................... 12 Client 7-Day Observation Record ......................................................................................................................... 13 InterRAI Assessment Systems.................................................................................................................................... 14 Clinical Assessment Protocols (CAPs).................................................................................................................. 14 Behaviour CAP......................................................................................................................................................... 15 Outcome Scales ........................................................................................................................................................ 15 Minimum Data Set (MDS) 2.0? Canadian Version (Long Term Care) ? Section E: Mood and Behaviour Patterns ...................................................................................................................................................................... 16 Minimum Data Set (MDS) Home Care (MDS-HC)? Canadian Version ? Section E: Mood and Behaviour Patterns ...................................................................................................................................................................... 16 Minimum Data Set (MDS) Home Care (MDS-HC)? Canadian Version ? Section E: Mood and Behaviour Patterns ...................................................................................................................................................................... 17 Behaviour Observation Sheet (BOS)......................................................................................................................... 18 Behaviour Observation Sheet (Long Term Care) ............................................................................................... 22 Behaviour Observation Sheet (Home and Community Care)........................................................................... 23 Behaviour Observation Sheet Instructions .......................................................................................................... 24 Appendix A ? Behaviour Observation Summary Sheet ......................................................................................... 25 Appendix B - Bank of Expressions/Behaviours, Example Triggers and Events, and Follow-Up Actions for the BOS.......................................................................................................................................................................... 27 Expressions ............................................................................................................................................................... 27 Behaviour .................................................................................................................................................................. 27 Example Triggers/Events....................................................................................................................................... 27 Example Follow Up Actions .................................................................................................................................. 28 Appendix C - Recommendations on How to Identify Potential Underlying Causes of Potentially Violent Patient Behaviour.......................................................................................................................................................... 29 Appendix D ? Care Planning Tips for Managing Violence ................................................................................... 31

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Introduction to BC's Provincial Violence Prevention Steering Committee

The healthcare sector represents 10% of the provincial workforce, yet 40% of all province-wide WorkSafeBC claims due to "violence" arise out of the healthcare sub-sector. To address the issue of violence in healthcare, the Provincial Violence Prevention Steering Committee (PVPSC) was created with the support of BC's healthcare stakeholders. The PVPSC is coordinated by the Occupational Health and Safety Agency for Healthcare in BC (OHSAH). The PVPSC's purpose is to develop and oversee implementation of a comprehensive, cohesive, and effective provincial violence prevention strategy for healthcare worksites in BC.

In many healthcare workplaces, violent behaviour is commonly not reported because it is not recognized as "violence." The PVPSC definition of violence (in box at right) includes intentional or unintentional behaviour, regardless of illness/injury. It also includes behaviour that is often called "aggression". All violence must be reported so that appropriate corrective action(s) can be taken to keep healthcare staff safe.

For more information about the PVPSC, please visit: .

PVPSC definition of Violence

Incidents where persons are abused, threatened or

assaulted in circumstances related to their work,

involving a direct or indirect challenge to their safety, well-being or health.

Introduction to the Behavior Documentation Toolkit

Scope of the Problem: Underreporting of Violent Incidents

Often when there is a violent incident involving a patient (here the term `patient' is used inclusively to mean `resident' or `client' as appropriate), incident investigation reveals several warning signs or indicators of escalation (sometimes over days) that were not reported or documented. Reporting escalating or unusual behaviour is central to preventing violence; even when the behaviour on its own is not physically threatening. Reporting allows for other workers to be warned of risks, for preventative measures to be put in place, and to call attention to violence as an important issue. However, in discussions with healthcare workers and Occupational Health and Safety (OHS) specialists, there are several barriers to reporting violent behaviour that come up repeatedly:

The perception that reporting a violent incident does not result in any feedback or improvement. Lack of support from managers, supervisors and co-workers. The perception that it takes too long to fill in forms. The high frequency of near-misses and minor violent incidents are so common that a worker could

spend as much time reporting violence as doing patient care activities. Workers fear reprisal, being blamed for the attack and being re-victimized. Complexity of filling out the appropriate reporting forms. Violent behaviour that is not intentional due to illness/injury is not recognized as "violence."

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