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									(Practice Name) Policy & Procedure Manual                                     Section Three


3.1      Occupational Health & Safety
Policy

This practice is committed to preventing workplace injury and illness and
ensuring a safe and secure working environment for doctors, staff,
patients and all other visitors.

We recognise that health and safety is an integral part of every activity we
perform and as such we maintain current knowledge of our obligations under
State/Territory and Federal OH&S legislation and we understand that non
compliance with these legal requirements can result in being prosecuted and
fined.

It is a legal duty of every workplace to maintain standards to protect the
health, safety and welfare of every person within the workplace This
includes staff, patients, visitors and anyone else who may enter the
premises.

As an employer we must provide a safe and healthy workplace for our
workers and contractors.

All our workers have a duty of care to ensure that they work in a manner
that is not harmful to their own health and safety and the health and safety
of others.

The Occupational Health and Safety Act 2004 (the Act) is the cornerstone of
legislative and administrative measures to improve occupational health and
safety in Victoria. The Act sets out the key principles, duties and rights in
relation to occupational health and safety.
The Occupational Health and Safety Regulations 2007 are made under the
Act. They specify the ways duties imposed by the Act must be performed, or
prescribe procedural or administrative matters to support the Act, such as
requiring licenses for specific activities, keeping records, or notifying certain
matters.
Effective OHS regulation requires that WorkSafe provides clear, accessible
advice and guidance about what constitutes compliance with the Act and
Regulations.

 Hint
To find out your obligations for your state go to .
http://www.business.gov.au/BusinessTopics/Occupationalhealthandsafety/pages/E
mployerobligationsinyourstateorterritory.aspx

For detailed examples relating to the Health and aged care sector go to:


_________________________________________________________________________________
                                               Nov-1999, Feb-2001, Dec-2001,
                                               Feb-2002, Feb-2003, Feb-2004,
                                    Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                     Section Three


http://www.worksafe.vic.gov.au/wps/wcm/connect/wsinternet/worksafe/home/safety
+and+prevention/your+industry/health+and+aged+care+sector/d_health+and+aged
+care+sector

Procedure

This practice has a designated elected health and safety representative (HSR).
The name and telephone extension of our HSR is kept on the staff
noticeboard. Information relating to OH&S issues are posted on the notice
board/conveyed to all members of staff and updated regularly by the HSR. We
consult with employees on matters that may directly affect their health, safety
or welfare and the HSR, is also involved in the consultation

  Hint
– It is unlawful to “force” anyone to be the designated health and safety
representative.
- All elected HSRs are entitled to undertake Worksafe approved OHS training to
equips HSRs with the confidence, skills and knowledge to represent their co-
workers and to help make their workplace safer.
-Matters and updates in relation to OH&S should be a standard item on staff
meeting agendas. If staff members are not at staff meetings, ensure the information
is passed onto them via an email, memo or a communication book.
-Minimum requirements for complying with the employer duty to consult.
http://www.worksafe.vic.gov.au/wps/wcm/connect/809abd004071f29f8bcbdfe1fb554
c40/Minimum+requirements+achieving+compliance.pdf?MOD=AJPERES

   We have current workplace Injury Insurance. We keep a Register of
    Injuries to keep track of work-related injuries and illnesses and for
    workplace incidents that cause or could have caused serious injury or
    death we understand that we must notify WorkSafe on 13 23 60.
    When an injured worker records an injury or illness in the Register of
    Injuries, we acknowledge this registration in writing to the worker.

   „If you are injured” poster is displayed where all workers can read it. s
    and related topical Work cover posters are displayed.
  Hint
This poster is required under the OH&S legislation and is to be displayed where all
staff can see it. Penalties of up to $35,835* for a body corporate and $7,167* for a
natural person may apply.

   The Practice Manager informs new staff, in writing of the nature of their
    work and asks if they have any pre-existing injury that may be affected
    by the new job. New staff are also notified, in writing that failure to
    inform or hiding a pre-existing injury which might be affected by the
    nature of the proposed new job, could result in that injury not being
    eligible for future compensation claims.
   We ensure workers have adequate information, instruction, training and
    supervision to work in a safe and healthy manner.

   We maintain the workplace in a safe condition (such as ensuring fire exits
    are not blocked, emergency equipment is serviceable, and the worksite is
_________________________________________________________________________________
                                               Nov-1999, Feb-2001, Dec-2001,
                                               Feb-2002, Feb-2003, Feb-2004,
                                    Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                   Section Three


    generally tidy) and provide staff with adequate facilities (such as clean
    toilets and hygienic eating areas)..

To support the safety health and wellbeing of our practice team we have
policies and procedures in the following areas.

   Tasks involving manual handling are identified and measures are
    taken to reduce or eliminate the risk of injury to doctors and staff as far
    as reasonably practical.

   Incidents and all injuries involving all staff and patients and others that
    occur in the workplace are documented and managed professionally
    and ethically, according to relevant medical standards and guidelines.

   At induction and periodically all staff are instructed in safety and
    infection control protocols ensuring risks are known and precautions
    taken, including staff immunisation.

   We strive to work together to maintain a safe physical work
    environment and that supports the health and wellbeing of Doctors,
    staff, patients and visitors. Including ensuring regular breaks,
    adequate staffing levels and a smoke free environment.

   We have a duty of care to safeguard the health of employees which
    also covers psychological as well as physical health

   We strive to encourage consultation between management and staff
    on all matters pertaining to OH&S matters as obligated under the
    legislation.

   We endeavour to provide a working environment in which all Doctors,
    staff, patients and visitors are not subject to unlawful discrimination,
    sexual harassment, violence or bullying.

   Audits are undertaken to ascertain that all practice and office
    equipment is appropriate for its purpose. Records of maintenance,
    including electrical safety checks and calibration schedules are
    maintained.

   Records of updates and training provided to all staff in relevant
    equipment operation and maintenance, manual handling skills, and
    compliance with OH&S requirements are maintained.

   We strive to ensure the practice environment and facilities are
    adequate, and provide for the comfort, safety and security of Doctors,
    staff, patients and visitors.

_________________________________________________________________________________
                                             Nov-1999, Feb-2001, Dec-2001,
                                             Feb-2002, Feb-2003, Feb-2004,
                                  Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                     Section Three


   We will not tolerate violence of any nature.

   Non medical emergency procedures and fire safety precautions are
    clearly documented and designated members of the emergency team
    have a reference and a basis for their decisions and actions within that
    role.

   We have appointed one member of staff with primary responsibility for
    the development and consistent implementation of our infection
    control systems and procedures which includes environmental
    cleaning. (Refer Section 4 Principles of Infection control) Specific
    areas of responsibility may be delegated to nominated members of the
    practice team and these particular responsibilities should be
    documented in the relevant position descriptions

   To minimise harm to our patients we have clear lines of accountability
    and responsibility for the delivery of safe and effective quality care

   We have a requirement for two members of the staff to be present
    during the normal opening hours of the practice.


 Hint
– Visit Work safe website for up to date information on your obligations
www.workcover.vic.gov.au

– Recent work undertaken together with Worksafe/ Victoria Police/RACGP/ANF/GPV
and Dandenong Casey General Practice Association has led to the development of a
checklist within the new Safety & Security Kit for General Practice. This can be found
by visiting our website under Hot Resources
www.dcgpa.com.au

- A fact sheet “Aggressive People” from the Safety & Security can be found on our
website www.dcgpa.com.au

Employer obligations in your state or territory
http://www.business.gov.au/BusinessTopics/Occupationalhealthandsafety/pages/Empl
oyerobligationsinyourstateorterritory.aspx

Other OH&S resources

        Australian Association of Practice Managers offers resources for AAPM
         members at www.aapm.org.au

        AMA Position statement Personal Safety and Privacy for Doctors at
         www.ama.com.au/policy/positionstatements?page=1

        Australian General Practice Network has a variety of resources available for
         network members in its Network Resource Centre at www.aGPn.com.au/home




_________________________________________________________________________________
                                               Nov-1999, Feb-2001, Dec-2001,
                                               Feb-2002, Feb-2003, Feb-2004,
                                    Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                     Section Three



Hazardous Substances

   We implement arrangements for the safe use, handling, storage and
    transport of chemicals and hazardous substances. (Refer Section 4
    Handling and Use of Chemicals)
   Regular audits of products used by the practice are undertaken and
    hazardous substances are stored, handled and documented according
    to assessed risk.
   Material safety data sheets (MSDS) and Product Data sheets (PDS)
    are maintained and visibly placed on equipment and hazardous
    substances, to describe them and give clear instructions for their use.

 Hint – A Material Safety Data Sheet (MSDS,) also referred to as a Safety Data Sheet
(SDS), is a document that describes the chemical and physical properties of a material
and provides advice on its safe storage, handling and use. It includes details of health
and physicochemical hazards, exposure controls, personal protective equipment, safe
handling and storage instructions, emergency procedures and disposal advice. It is a
requirement under the legislation to have MSDS available. MSDS sheets can be
obtained by the supplier‟s website or by phoning the supplier. Free MSDS search
http://www.msds.com/ Remember chemicals and hazardous materials are not only in
cleaning products for example - consider toners in printers/photocopiers, liquid
nitrogen, oxygen etc.

   The current manufacturer‟s, importer‟s or supplier‟s copy of the MSDS
    is used by the practice and this information is never altered.
   The practice endeavours to control risk associated with the use of
    hazardous substances which are stored in labelled containers.
   A register of hazardous substances is kept and maintained by the
    practice. (see hint above about this)
   Staff members are instructed on how to handle hazardous substances
    appropriately and documentation and ongoing training is provided
    regarding this.
   Regular risk assessment is undertaken by this practice in order to
    control risk associated with the use of hazardous substances.
         rd
RACGP 3 Ed Std. 4.1.2 http://www.racgp.org.au/standards
       th
RACGP 4 Edition Standards 4.1.2 & 5.3.3 & 3.1.3

 Hint

Workcover:
Further details concerning compliance issues can be found on the Net at
www.workcover.vic.gov.au Workcover tel: 9641 1444 or 1800 136089 (Toll Free)
Email: info@workcover.vic.gov.au - Workcover or health and safety queries.
Emergency Response – Call 13 23 60 to report serious workplace emergencies, 24
hours a day

Your local WorkCover office can access an electronic directory of external
occupational health and safety consultants and an Australia-wide electronic
directory of authorised assessors for certificates of competency.

_________________________________________________________________________________
                                               Nov-1999, Feb-2001, Dec-2001,
                                               Feb-2002, Feb-2003, Feb-2004,
                                    Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                     Section Three


If you become aware of dangerous conditions in a workplace or breaches of the
WorkCover legislation, which can‟t be fixed through requests or discussion, you
should contact your local WorkCover office.

Victorian Workcover Authority, Level 4, 628 Bourke Street, Melbourne, VIC 3000,
Phone: 03 9941 0558 Fax: 03 9941 0560 – available to assist with Workcover queries
or to provide information as required.

A useful worksafe reference may be:
“A step by step guide for managing chemicals in the workplace”

The RACGP Infection Control Standards for Office-based practices. This can be can be
obtained from the RACGP Publications Department on 03 8699 0495, or by downloading
the order form at www.racgp.org.au/publications/orders and faxing back to 03 8699
0400. This resource cannot be viewed online.

The occupational health and safety of General Practitioners and practice staff is
governed by OH & S State/Territory and Federal legislation.

Other resources may be found at:
Dandenong Casey General practice association: www.dcgpa.com.au
AGPAL QbAY: www.qip.com.au > Risk Management

RACGP GP and Practice team safety issues
http://www.racgp.org.au/gpandpracticeteamsafety/safety




_________________________________________________________________________________
                                               Nov-1999, Feb-2001, Dec-2001,
                                               Feb-2002, Feb-2003, Feb-2004,
                                    Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                    Section Three




3.1.1 Manual Handling

Policy

Manual handling is any activity requiring the use of force exerted by a
person to lift, push, pull, carry, or otherwise move or restrain any animate
or inanimate object. It includes activities involving awkward posture and
repetitive actions. Manual handling injuries account for nearly 50% of all
Workcover claims. The objectives of the Occupational Health and
Safety Manual Handling Regulations 1999, are to reduce the number
and severity of musculoskeletal disorders associated with tasks involving
manual handling.

Under these regulations, this Practice aims to identify tasks involving
hazardous manual handling and to undertake risk assessments. Risks to
staff are thus reduced or eliminated as far as practicable.

Risk factors likely to cause manual handling injuries and therefore include
in Practice Risk Assessments include:

   force applied
   actions & movements used
   range of weights
   how often & for how long, manual handling is done
   where the load is positioned & how far it has to be moved
   availability of mechanical aids
   layout & condition of the work environment
   work organisation
   position of the body whilst working
   analysis of injury statistics
   age, skill & experience of workers
   nature of the object handled
   any other risk factor considered relevant


Procedure

   Avoid tasks that involve:

        twisting, bending or extensive reaching
        repeated or prolonged stooped posture
        lifting requiring extended reach
        repetitive lifts from below mid thigh or using forceful movements
        prolonged bent neck posture when working on low flat bench
        repetitive tasks for a prolonged time
_________________________________________________________________________________
                                              Nov-1999, Feb-2001, Dec-2001,
                                              Feb-2002, Feb-2003, Feb-2004,
                                   Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                    Section Three


     using excessive force to push, pull or hold object


  Reduce the size or weight of objects to be lifted or carried
  Prevent slips or falls by wearing appropriate footwear
  Ensure adequate lighting
  Clean area regularly; spills should be wiped up immediately
  Check equipment is in good working order and there is adequate space
   in which to work
 Weight limits: Seated – 4.5 kg. Standing – 16 to 20 kg. (For ideal
   conditions and with a compact load held close to the body and with a
   short carrying distance).
Before doing any type of manual handling assess the situation.
Ask the following questions –
   -      Should two people be lifting this or am I able to lift this safely
          and without risk or injury?
   -      Is my pathway clear of all objects?
   -      What distance am I going to be going?
   -      Can I see clearly?
   -      Can I split the load to make it lighter?
   -      Size up the load – if in doubt seek assistance

Our practice has one or more height adjustable examination couch/s to
assist in the care of patients with a disability, and to reduce the risk of staff
injuring themselves when assisting patients on or off the examination
couch. Where our practice facilities are inadequate for staff and visitors to
safely assist patients with a disability we make alternative arrangements
eg Home visits.



 Hint
Visit Workcover website for fact sheets on manual handling
www.workcover.vic.gov.au

The National Standard for Manual Tasks (2007) and the National Code of Practice
for the Prevention of Musculoskeletal Disorders from Performing Manual Tasks at
Work (2007)
http://www.safeworkaustralia.gov.au/swa/HealthSafety/HazardsSafetyIssues/Manua
lTasks/ManualTasks.htm


Staff Responsibility

If you identify a task, piece of equipment, or work area that may be a risk,
report it to the Practice Manager or the OH&S representative. A further
detailed risk assessment will be conducted and if necessary, changes will
be made to reduce the risk of injury with training for staff as needed.

_________________________________________________________________________________
                                              Nov-1999, Feb-2001, Dec-2001,
                                              Feb-2002, Feb-2003, Feb-2004,
                                   Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                    Section Three

         rd
RACGP 3 Ed Std. 4.1.2 http://www.racgp.org.au/standards
       th
RACGP 4 Ed Std. 5.1.1 & 4.1.2
 Hint

A list of suggested Occupational Health and Safety Resources for Practices available
from Workcover can be located at the end of this chapter in the forms, templates and
checklists section. They have been recommended because they are applicable to the
health industry.

These publications can be viewed on line at www.workcover.vic.gov.au




3.1.2     Incidents and Injury and Adverse Patient Events

Policy

This practice has designated (*insert staff members name) with primary
responsibility for clinical risk management including following up on incidents,
injuries and adverse patient events and near misses.

It is a legal requirement under the Occupational Health & Safety legislation
and for insurance purposes, to report any injury sustained or thought to be
sustained in the workplace, recognizing that good reporting also leads to
effective prevention.

Our practice encourages the identification, analysis and prevention of errors,
failure or inadequate systems that can potentially be a risk to patient safety to
assist with risk management strategies not to apportion blame.

Incidents that should be reported (regardless of whether harm has
occurred) to assist with making improvements to minimise the risk of
recurrence, include:
     needle stick injury or mucous membrane exposure to blood or
       bodily fluids,
     slip or fall,
     drug or vaccine incident (loss, misplacement or other),
     adverse patient outcome,
     Failure or inadequate patient handover or identification of a patient
       at the point of transfer of care
     delayed treatment or delayed follow up or unnecessary repeat of
       tests
     medication errors
     any deviations from standard clinical practice,

Accidents or incidents may involve the following:
 Staff (employed directly by this practice)
_________________________________________________________________________________
                                              Nov-1999, Feb-2001, Dec-2001,
                                              Feb-2002, Feb-2003, Feb-2004,
                                   Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                   Section Three


 Non-staff (patients, vvisitors, ccontractors)
 Events (eg. theft, non-patient assault, gas leak, bomb hoax, security
  breach, medication error or patient complication following medical
  intervention, breakdown in clinical handover)

Actual and potential risks are identified and actions are taken to increase
the safety and improve quality care.

The privacy of individuals involved is maintained.


Procedure

Reporting:

Staff use the “Adverse Outcome Report” to report any slips, lapses or near
misses in clinical care or deviations in patient care that might result in harm.
The medical defence organisation is contacted for events that might give rise
to a claim.

Completed “Adverse Outcome Reports” are:
   Completed as soon as possible after incident occurs, preferably
     within 24 hours.
   Filed in the “significant event register” folder.

Any additional medical or other certificates, reports or pathology related to
the accident/incident are dealt with as soon as possible original documents
are submitted.

For injury occurring in the practice or course of work, workcover reporting
protocols must also be followed. It is a legal requirement to report all
injuries sustained in the workplace

The Doctor should refer patients to another practitioner if there is a
possible conflict of interest, for example a staff workcover claim being
managed by the employing practitioner.


Risk assessment:

The designated staff member conducts a thorough review of all the
hazards relevant to the cause(s) of any injury that has occurred with a view
to identifying appropriate controls.(Refer Section 8 Risk Assessment and
Management)

Risk control:


_________________________________________________________________________________
                                             Nov-1999, Feb-2001, Dec-2001,
                                             Feb-2002, Feb-2003, Feb-2004,
                                  Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                      Section Three


Involves identifying and implementing all the practicable strategies to
minimise subsequent similar events or eliminate/ reduce the causes(s) of
the injury or incident.

Informing relevant staff are about changes and why they have been
implemented (usually at the staff meeting) to reduce the likelihood of
recurrences.

Retaining any documentation or evidence of the implementation of any
improvements.

Conducting subsequent review/s to ascertain whether the implementation of
the improvements was successful.

Documentation:
Retain documentation of the investigation process and any agreed actions
implemented to minimise the re-occurrence of the incident and to log trends.

         rd
RACGP 3 Ed Std 3.1.2 & 4.1.2 http://www.racgp.org.au/standards
       th
RACGP 4 Ed Std 1.5.2 & 3.1.4 & 3.1.2

 Hint
Insert your practice Incident Form at end of this section or utilise the template
provided.


To report adverse reactions to medicines, or medical device failures
     Adverse drug reaction unit (ADRAC) http://www.tga.gov.au/adr/index.htm#report
     TGA: http://www.tga.gov.au/problem/index.htm
     Blue card: http://www.tga.gov.au/adr/bluecard.htm
     Reportable adverse immunization events are listed in the Australian
                                 th
       Immunisation Handbook 9 edition. Notify SaefVic on 1300 882 008.or online
       www.saefvic.org.au

Advice regarding reporting workplace injury to workcover can be found at
www.workcover.vic.gov.au Workcover telephone: 9641-1444 or 1800 136089 (Toll
Free)
Email: info@workcover.vic.gov.au - Workcover or health and safety queries.
Emergency Response – Call 132360 to report serious workplace emergencies, 24
hours a day.

It may also be prudent to advise you Medical Defence Organisation of any incident
that may potentially lead to a claim.

Australian Standard® Worksafe Australia National Standard Workplace injury and
disease recording standard
http://www.safeworkaustralia.gov.au/NR/rdonlyres/DE60BED4-D00F-47B3-9F89-
89E602A30986/0/WorkplaceInjuryDiseaseRecording.pdf

Suggest reading the “Explanation” in the RACGP 4th Edition Standards as they provide
an extended and comprehensive guide to the clinical risk management systems
practices are expected to implement. http://www.racgp.org.au/standards/312
_________________________________________________________________________________
                                                Nov-1999, Feb-2001, Dec-2001,
                                                Feb-2002, Feb-2003, Feb-2004,
                                     Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                      Section Three



The RACGP has developed a useful resource to assist practices analyse the cause of
near misses and prevent future incidences. “Using near misses to improve the quality
of care for your patients” is available at www.racgp.org.au/publications/orders.

RACGP guide “Regaining trust after an adverse event: an education module on
managing adverse events in general practice” is available at
www.racgp.org.au/safety/projects.

RACGP education module “Being human, being safer” on human factors in general
practice is a useful resource for all members of the practice team and is available at
www.racgp.org.au/safety/beinghuman.

RACGP education module “Thinking safety, being safer” is designed to help all
members of the practice team understand and utilise „near miss‟ analysis to improve
the quality of patient care and is available at www.racgp.org.au/safety/thinkingsafety.


3.1.3 Sharps Injury Management and Other Body Fluid
      Exposure
Policy

The employer is responsible to ensure that all staff:
    Are familiar with the practice policy regarding management of blood and
      body fluid exposure.
    Consider the blood and body substances of all patients as potential
      sources of infection.
    Understand how to prevent exposure to blood and body fluids
    Have access to education and regular in service training in infection
      control matters.
    Have documented their immunisation status and have been offered
      NHMRC recommended immunisations appropriate to their role.
    Analyse any incidents and modify procedures as required to reduce the
      risk of recurrence.

In our practice, we understanding that the management of occupational
exposure to blood or body fluids includes:

   Rapid assessment of the staff member and the source patient
   Documentation of the incident
   Counselling for the staff member
   Timely administration of medications where appropriate.
   Investigation of the incident to enable modification of procedures if required

Occupational exposure to needle stick injuries and body substances can be
prevented by using standard precautions, wearing personal protective
equipment (PPE) and implementing safe work processes.

Procedure
_________________________________________________________________________________
                                                Nov-1999, Feb-2001, Dec-2001,
                                                Feb-2002, Feb-2003, Feb-2004,
                                     Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                   Section Three



Preventing blood and body fluid exposure

Use standard Precautions where there is a risk or blood or body fluid
exposure.

Implement Safe work practices around the handling of sharps, specimens, and
waste, cleaning of environment and reusable items.

Assess and manage any blood and body fluid exposure immediately.

Following Occupational Exposure


     In our practice, we follow this procedure after occupational exposure:

     1. Clean/decontaminate:
         skin: wash with soap and water
         Mouth/nose/eyes: rinse well with water or saline.

     2. Notify the practice principal or GP on duty immediately.

     3. The source:
         Explain and reassure the source and offer pre test counselling.
         obtain consent to have the source patient‟s blood tested for
           Hepatitis B, Hepatitis C and HIV – the results should be available
           in 1-2 hrs if marked “urgent – needle stick” and received at an
           appropriate testing laboratory.
         Take a history from the source – maintain the source patient‟s
           confidentiality and do not interview them in front of relatives
                Unprotected sexual intercourse
                Sharing needles, tattoos, body piercing
                Sharing razor blades or toothbrushes
                Blood or body fluid exposure of mucous membranes or
                  non intact skin.
                Blood transfusion before Feb 1990 (for HCV)
                Infection with HIV, HBV, HCV
                If the source patient has a history of at - risk activities
                  inform them about the window period in diagnosis.

             If any of the staff member‟s blood went into the patient or onto
              instruments that were then used, the staff member also needs to
              be listed as a source.

     4. The Exposed person
         If the source is unknown the person needs to be tested and post
           exposure prophylaxis (PEP) needs to be considered
_________________________________________________________________________________
                                             Nov-1999, Feb-2001, Dec-2001,
                                             Feb-2002, Feb-2003, Feb-2004,
                                  Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                   Section Three


             Obtain consent from the exposed person for urgent baseline
              testing for Hepatitis B, Hepatitis C and HIV to establish if the staff
              member has previously acquired an infection from other
              exposures.
             The exposed person‟s confidentiality must be maintained
              especially if a staff member.
             The exposed person may elect to have these tests performed at
              a different facility or their own GP
             Advise them to practice safe sex until their results and the
              source‟s results and history have been reviewed
             Give the exposed person the telephone number for the
              state/territory Health department communicable disease contact
              and other advisory services.

     5. Treatment
         Needs to be commenced if it is anticipated that the sources blood
           test results will not be available within 24hrs and the source
           patient could be HIV positive or in the window period.
         If the HBV status of the exposed person is not known, and the
           sources HBV status will not be available within 24-48 hrs then
           give:
                Hepatitis B immunoglobulin
                Hepatitis B Vaccination 1st Dose
                ADT (adult Diphtheria and Tetanus)
         The exposed health care worker should be referred for
           immediate consultation with an infectious diseases specialist for
           consideration of PEP for HIV :
                if the injury is classified as high risk, or
                if the source patient has participated in at risk activities, or
                If the source patient is positive for HIV or other significant
                   blood borne infections.
                If the source patient is unknown

     6. Document Exposure:
     We have appointed one member of staff with primary responsibility for
     the development and consistent implementation of our infection control
     systems and procedures. (Refer Section 4 Principles of Infection
     control). Report any exposure to this person or delegated authority in
     addition to normal incident reporting protocols.
          what procedure was being undertaken
          how the injury happened and the name of anyone that witnessed
              it
          the nature and extent of the injury
          exactly what you were injured with (specify gauge of the needle)
          the body substance involved
          How much blood or body fluid was the health professional
              exposed to.
_________________________________________________________________________________
                                             Nov-1999, Feb-2001, Dec-2001,
                                             Feb-2002, Feb-2003, Feb-2004,
                                  Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                     Section Three


                 What personal protective equipment was being used?
                 The full name and address of the source. If the source cannot be
                  identified document “source patient not known”.
 Hint
A Needlestick injury or blood/body fluid exposure wall chart, is located at the end of
this chapter in the Forms, templates and checklist section it can also be downloaded
from the Dandenong Casey General Practice Association website www.dcgpa.com.au
(Search “needlestick”). It is recommended to laminate this and put on the wall as a
quick reference for staff.

The RACGP Infection Control Standards for Office-based practices. This can be can be
obtained from the RACGP Publications Department on 03 8699 0495, or by downloading
the order form at www.racgp.org.au/publications/orders and faxing back to 03 8699
0400. This resource cannot be viewed online.

Additional resources may be located on AGPAL QbAY: www.qip.com.au >
Treatment Room

Within Victoria advice is available from:
     Health Department Communicable Disease: 1300 651 160
     Alfred Hospital NPEP ph 1800 889 887 (community or non-occupational
        exposure only)
     The Alfred Hospital Infectious Diseases Unit (03) 9276 2000
     Southern Health Infectious Diseases Unit - Monash Medical Centre (03) 9594
        6666
     Austin Health Infectious Diseases Unit (03) 9496 6679
     Barwon Health – Department of Infectious Diseases (03) 5226 7111
     Victorian Infectious Diseases Service (VIDS), Royal Melbourne Hospital (03)
        9342 7000

The National Needlestick Hotline Phone: 1800 804 823 (free 24 hour service for
residents of NSW) provides confidential post exposure expertise in the following areas,
Risk assessment
     Management strategies
     Prophylaxis information
     Counselling
     Appropriate referral

The National Infection Control Guidelines.
http://www.health.gov.au/internet/main/publishing.nsf/Content/icg-guidelines-index.htm.
Refer chapter 23 on needlestick injuries etc and Appendix 8 – The ANCHARD bulletin.

Victorian Department of Health – this reference provides guidelines under the Health
Act for testing. http://www.health.vic.gov.au/ideas/regulations/comptest

Further advice, for people may be available from your state or territory Health
department.

Department of Health and Ageing Infection control guidelines for the prevention of
transmission of infectious diseases in the health care setting

         rd
RACGP 3 Edition Standards Criterion 5.3.4 (C) & 4.1.2 http://www.racgp.org.au/standards
       th
RACGP 4 Edition Standards 5.3.3


_________________________________________________________________________________
                                               Nov-1999, Feb-2001, Dec-2001,
                                               Feb-2002, Feb-2003, Feb-2004,
                                    Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                   Section Three


3.1.4 Staff Immunisation
Policy

We have appointed one member of staff with primary responsibility for the
development and consistent implementation of our infection control systems
and procedures which includes staff immunisaton. (Refer Section 4 Principles
of Infection control)
Specific areas of responsibility may be delegated to nominated members
of the practice team and these particular responsibilities should be
documented in the relevant position descriptions

All practice staff should be advised of the risks of infection and be
encouraged to be immunised against vaccine-preventable diseases to
prevent transmission of disease to and from practice staff and patients.
Staff should be offered additional vaccinations where appropriate
depending upon the likelihood of their contact with patients and/or blood
supply substances. These vaccinations may include Hepatitis A and other
disease vaccinations.

The practice will keep an extensive and up-to-date record of the
immunisation history of each staff member. This will assist in identifying
non immune staff to ensure they are excluded from contact with patients
during disease outbreaks.

Subject to informed consent, the immunisation status of staff is known and
recorded including the documentation of any refusal.

Procedure:

   1. A vaccination history is sought from all new staff at orientation.
   2. Staff should receive the vaccines they require within the first few
      weeks of employment with the exception of influenza which should
      be administered annually between March and May.
   3. Each staff should be individually assessed for specific vaccines,
      taking possible contraindications into account.
   4. Staff immunisation history will be recorded on the “Staff
      Immunisation consent/refusal and record form” located at the end of
      this procedure. ( Hint This form is also located in Section 2 in the “Job
         Package”)
   5. Informed consent should be obtained before screening and
      vaccination
   6. Staff will be given a personal immunisation record that documents
      vaccinations given and test results.

Guidelines for immunisation


_________________________________________________________________________________
                                             Nov-1999, Feb-2001, Dec-2001,
                                             Feb-2002, Feb-2003, Feb-2004,
                                  Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                     Section Three


Staff members are offered NHMRC recommended immunisatons as
appropriate to their duties. The following vaccines should be considered
for practice staff:


Diphtheria, Tetanus
If not immunised, give three doses of ADT at one monthly intervals
followed by booster doses at 10 and 20 years after primary course. It is
recommended to give Boostrix as the first dose to provide immunisation
against Pertussis. Give a further dose at age 50 if no booster dose in past
10 years. Boostrix is also recommended although not funded, to be used
when giving a booster against Tetanus as it will give the added protection
of Pertussis immunity.

Pertussis
Single dose of dTpa given for practice staff/healthcare workers in
paediatric settings especially maternity and neonatal.

Poliomyelitis
Offer single dose to staff that may be exposed to polio and have not
received a booster vaccination within the past 10 years.(pg 255 The Australian
                       th
Immunisation Handbook 9 Edition.)

Measles Mumps & Rubella:
Staff, with no known history of Measles, Mumps or Rubella, or vaccination
should receive 2 doses of MMR one month apart. Antibody testing to
ensure immunity should follow a few months after. Generally, those born
prior to 1966 are considered immune.
Women, however, should not be vaccinated whilst pregnant or if there is a
chance that they may be pregnant. Pregnancy should be avoid for 28 days
after vaccination. (pg 279 The Australian Immunisation Handbook 9th Edition)

Meningococcal Type C
Meningococcal infections are transmitted via respiratory droplets and have
the capacity to have a rapidly fatal course in previously healthy individuals.
Staff members not immunised should be offered immunisation.

Influenza:
Due to the highly transmissible nature of the influenza virus and possible
serious consequences for the young and elderly, offer all practice staff an
annual influenza vaccine for their own and their patient‟s protection.

Hepatitis B:
All staff should be vaccinated. This is a course of 3 injections at 0, 1 & 6
months. Female staff that are or may be pregnant should not be
vaccinated.


_________________________________________________________________________________
                                               Nov-1999, Feb-2001, Dec-2001,
                                               Feb-2002, Feb-2003, Feb-2004,
                                    Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                        Section Three


For staff who may deal with contaminated medical equipment and blood or
body fluid spills, Hepatitis B vaccination is essential. All staff should have their
Hepatitis B antibody status documented.

Chicken Pox:
Varicella history or serology to confirm immunity is recommended for all staff. If
seronegative, vaccination should be offered in a 2 dose schedule. (pg 315. The
                                  th
Australian Immunisation Handbook 9 Edition)

Staff Records
    Records are initiated for all staff employed detailing their
       immunisation status. These will be maintained and include details
       of:
    disease history
    vaccination
    antibody results
    Test (e.g. Serology results) results,
    A record of vaccines consented/refused.
    These records remain confidential, secure and accessible by
       authorised practice staff 24 hours a day, 7 days a week.
    Records are maintained by a designated staff member and are
       routinely updated whenever new vaccinations, tests or disease
       occur.
    For all work related immunisations, staff should be given a verbal
       explanation about each disease (and its effects), from the General
       Practitioner.
    To further enhance informed consent, It is strongly recommended
       that staff are given a „Fact Sheet‟ for all work related immunisations,
       similar to those which are available on the Immunise Australia
       Program website (Refer to Hints at end of this section)
    Staff are required to sign the forms attached, providing written
       consent for either:
        Vaccination
        Serology
        Supply of record
        Refusal of vaccination

      If vaccination is given the following details must be recorded:
        informed written consent
        date vaccine administered
        brand name
        batch number
        expiry date

RACGP 3rd Edition Standards 5.3.4 (FG) & 4.1.2, http://www.racgp.org.au/standards
       th
RACGP 4 Edition Standards 5.3.3

Reference:
_________________________________________________________________________________
                                                  Nov-1999, Feb-2001, Dec-2001,
                                                  Feb-2002, Feb-2003, Feb-2004,
                                       Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                      Section Three


 The Australian immunisation Handbook, 9th Edition (2.3.8 Vaccination of those at
occupational risk)
 http://www.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook-
home

 The RACGP Infection Control Standards for Office-based practices. This can be can
be obtained from the RACGP Publications Department on 03 8699 0495, or by
downloading the order form at www.racgp.org.au/publications/orders and faxing
back to 03 8699 0400. This resource cannot be viewed online.

 Hint

 A staff Immunisation consent, refusal and record of administration chart , is located at
 the end of this chapter in the Forms, templates and checklist section It can also be
 downloaded from the Dandenong Casey General Practice Association
 www.dcgpa.com.au

Immunisation Myths and Realities: responding to arguments against immunisation 4th
Edition http://www.health.gov.au/internet/immunise/publishing.nsf/content/uci-myths-
guideprov

Immunisation for health care workers fact sheet- Victorian Government Health
Information.
www.health.vic.gov.au/immunisation/general/guide_hcws

Immunisation fact sheets can also be downloaded at
www.health.vic.gov.au/immunisation and are available in other languages.

Please telephone Anne Nunan at the DCGPA on 8792 1900 for updates or queries
relating to vaccination.

Privacy of Employment related health information
http://www.health.vic.gov.au/hsc/infosheets/employ.pdf




3.1.5       Smoking, Drugs & Alcohol

Policy

As a prominent health care provider our aim is to promote the health and
well being of all staff, patients and others whilst they are on our premises.
Smoking is therefore not permitted in this practice and is discouraged on
the premises or the surrounding environs. The use of illegal drugs and
alcohol is prohibited on and around the site.

Staff should not present for work if under the adverse effects of alcohol or
illegal drugs.

Procedure



_________________________________________________________________________________
                                                Nov-1999, Feb-2001, Dec-2001,
                                                Feb-2002, Feb-2003, Feb-2004,
                                     Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                     Section Three


Staff members who are smokers should make an effort to remove any
nicotine odour on or about clothing and self prior to returning to duty.

No smoking signs are visible in the waiting and reception area. Signs are
not to be removed, except to replace worn or frayed items.

Brochures and posters for „QUIT” and related no smoking, drug free
strategies are to be placed in waiting room and visibly displayed to ensure
our valued patients are aware of our commitment to better health
strategies.

☺Hint- A fact sheet “Drug Related Incidents” from the Safety & Security kit can be
found by visiting DCGPA‟s website www.dcgpa.com.au

GUIDANCE NOTE ON THE ELIMINATION OF ENVIRONMENTAL TOBACCO SMOKE IN THE WORKPLACE
http://www.safeworkaustralia.gov.au/NR/rdonlyres/7479E22B-EC1D-41D2-B939-
657775661681/0/GNNOHSC30192003.pdf


         rd
RACGP 3 Ed Std. 5.1.1 (J) & 4.1.2 http://www.racgp.org.au/standards




3.1.6          Staff Health and Wellbeing (including GPs)
Policy

This practice is committed to providing and maintaining a safe and healthy
workplace for doctors, staff, patients and all other visitors. This includes
psychological as well as physical health.

Health and safety is an integral part of every activity we perform, and as
such, the occupational health and safety of General Practitioners and
practice staff is a priority of this practice, and is governed by Occupational
Health & Safety State/Territory and Federal legislation and regulations.

The practice has implemented strategies to ensure the occupational health
and safety of the General Practitioners and staff, and in addition, there
should be current information on programs that support the health and
wellbeing of General Practitioners.




_________________________________________________________________________________
                                               Nov-1999, Feb-2001, Dec-2001,
                                               Feb-2002, Feb-2003, Feb-2004,
                                    Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                    Section Three


This practice recognises that that breaks may reduce fatigue and support
the health and wellbeing of both the General Practitioner and practice staff,
as well as enhancing the quality of patient care.

Our Doctors and practice team can discuss concerns about violence in the
practice and we have to right to discontinue care. (Refer to Section 7
Refusal to treat a patient)

 Hint Visit Workcover website for further information on the new requirements for
psychological stress issues www.workcover.vic.gov.au

Procedure

   When staff of this practice require a break or are unexpectedly absent,
    the practice should have strategies in place for managing work flow,
    that are known to all staff. Cover should be organised by the Practice
    Manager or another senior member of the team.
   Regular breaks should be scheduled for all staff members, dependent
    upon the hours or shifts worked, and during consulting sessions for
    General Practitioners. The practice should schedule appropriate
    breaks for all staff both during and/or between the sessions undertaken
    by the same General Practitioner.
   When a work break has been organised, where possible, a relieving
    staff member will complete the workload of an absent staff member, in
    addition to their own workload.
   Strategies should be been implemented to manage workflow whenever
    a General Practitioner or practice staff member is unexpectedly absent,
    or scheduled for leave. Unplanned leave will be covered by existing
    practice staff or by agency or locum staff as required.
   The practice should ensure that r staff take regular leave and that leave
    is not permitted to accrue to an excessive amount.
   The practice should have current information on programs that support
    the health and wellbeing of staff, including General Practitioners.
   Occasionally staff may be confronted by physically or verbally
    aggressive patients or other stressful incidents or situations, including
    assisting with emergencies. The practice should provide emotional
    debriefing or counselling in these situations within a reasonable period
    of time after the incident.
   During normal practice hours at least one staff member, who is trained
    to take telephone calls and make appointments, assess the urgency of
    requests for appointments and assist with medical emergencies and
    CPR, must be present in addition to the GP(s).
   Outside normal practice opening hours, for emergency surgeries,
    appropriate staffing is encouraged to assist in providing security and
    safety for patients and doctors.

(*Insert the contact details for agency staff or locum services)
_________________________________________________________________________________
                                              Nov-1999, Feb-2001, Dec-2001,
                                              Feb-2002, Feb-2003, Feb-2004,
                                   Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                      Section Three




 Hint

Practices might find the following resources useful for the health and wellbeing of
General Practitioners and practice staff:

     The Victorian Nurses Health Program is a free independent support service for
      nurses and students of nursing experiencing health issues related to substance
      use or mental health problems. http://www.vnhp.org.au/VNHP/Welcome.html
     RACGP Health Doctor initiative http://www.racgp.org.au/peersupport
     The RACGP Provides counseling for Gps facing crisis in their professional or
      personal lives. Appointments for face-to-face or telephone counselling can be
      made by calling 1300 366 789 during business hours (prebooking is essential).
     Contact details for doctors‟ health advisory services in each state and territory are
      available at www.dhas.org.au/content/view/1/21.
     For traumatic incidents or crisis counselling call 1800 451 138 (24 hours/7 days).
      For more information on consultations and a full list of locations visit:
      www.racgp.org.au/Content/NavigationMenu/educationandtraining/racgpMentalHeal
      th1/MentalHealthReviewnewsletterMHR/200812MHRnewsletter.pdf
     The RACGP has published a useful tool to assist practices to deal with distressing
      situations. Entitled General practice: a safe place, it is available at
      www.racgp.org.au/gpsafeplace.
     The RACGP acknowledges the pressures of working in general practice and has
      developed a special self care guide for GPs. Keeping the doctor alive: A self care
      guidebook for medical practitioners provides strategies to deal with stress and is
      available at www.racgp.org.au/peersupport.
     Recent work undertaken together with Worksafe/Victoria Police/RACGP/ANF/GPV
      has led to a development of a new Safety & Security Kit for General Practice which
      can be found by visiting our website. www.dcgpa.com.au

Other organisations providing resources include:
    Australian Association of Practice Managers offers resources for AAPM
       members at www.aapm.org.au
    AMA Position statement Personal Safety and Privacy for Doctors at
       www.ama.com.au/policy/positionstatements?page=1
    Australian General Practice Network has a variety of resources available for
       network members in its Network Resource Centre at www.aGPn.com.au/home
    Worksafe www.workcover.vic.gov.au

Employers and education providers are all mandated by law to report notifiable conduct
relating to a registered practitioner (GP, nurse or Allied Health) or student to AHPRA
Australian Health practitioner regulation agency (AHPRA) http://www.ahpra.gov.au/

          rd
RACGP 3 Ed Std. 4.1.2 (B) http://www.racgp.org.au/standards
       th
RACGP 4 Ed Std. 4.1.2

3.2      Practice Facilities
Policy

The practice premises, including the facilities and equipment are safe and
adequate to meet the needs of the staff and patients.

_________________________________________________________________________________
                                                Nov-1999, Feb-2001, Dec-2001,
                                                Feb-2002, Feb-2003, Feb-2004,
                                     Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                       Section Three


The facilities at our practice make adequate provision for, and encourage
patient auditory and visual privacy.

Facilities are well maintained and visibly clean with surfaces accessible for
cleaning.

Every reasonable effort is made to make the environment safe and
comfortable for staff and people who use the practice.

Where possible the practice has heating and/or air conditioning to assist in
the comfort of staff, patients and visitors.

Our waiting area/s are sufficient to accommodate the usual numbers of
patients who would usually be waiting at any given time.

Our practice has one or more height adjustable beds
The physical conditions in our practice support patient privacy and
confidentiality.

 Hint

The disability sector has had experts review height adjustable beds available
currently on the market to ensure they meet the needs of people with disabilities.
Simple, functional specifications for appropriate beds are available at
www.racgp.org.au/standards/factsheets

Additional resources may be located on AGPAL QbAY: www.qip.com.au >
Treatment Room

Worksafe www.worksafe.vic.gov.au – Office Wise

The RACGP publication Rebirth of a clinic assists practices with the design and layout
of practice facilities which are fit for purpose and address security needs. It is available
at www.racgp.org.au/publications.

Australian standards regarding access to buildings for people with disabilities are
available at www.standards.com.au

For information regarding the Federal Disability Discrimination Act (1992) and
legislation regarding the right to access general Practice visit www.hreoc.gov.au

RACGP General practice a safe place tips and tools
http://www.racgp.org.au/Content/NavigationMenu/PracticeSupport/Runningapractic
e/GPandPracticeTeamSafety/gptipsandtools/Asafeplace-tipsandtools.pdf

DCGPA Safety and security kit
http://www.dcgpa.com.au/_misc/Safety%20and%20Secuirty%20Kit%20Sept%2008.p
df

         rd
RACGP 3 Ed Std. 5.1.2(A) & 5.1.1(F) & 4.1.2 http://www.racgp.org.au/standards
       th
RACGP 4 Ed Std.5.1.1 & 5.1.2

_________________________________________________________________________________
                                                 Nov-1999, Feb-2001, Dec-2001,
                                                 Feb-2002, Feb-2003, Feb-2004,
                                      Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                    Section Three


3.2.1 Consulting Rooms
Policy

        Practice facilities should be safe for General Practitioners, staff and
         patients
        The practice has at least one dedicated consulting or examination
         room for every doctor working at any one time. Areas where
         consultations or treatment occur are appropriate for the health and
         safety of General Practitioners, staff and patients
        The consulting rooms should have sufficient space, and are free
         from excessive extraneous noise and have adequate lighting for
         observation
        The temperature in the consulting rooms should be maintained at a
         comfortable range to allow for the patient to undress if necessary for
         an examination
        There must be an examination couch in each consulting room or an
         attached examination room (At a minimum one examination couch
         in the practice must be height adjustable)
        Consultations with patients must be confidential and private. The
         practice ensures that both visual and auditory privacy is afforded to
         all patients in all examination areas, treatment rooms and consulting
         rooms
        Provision must be made in the examination areas and treatment
         rooms for maintaining patient privacy when undressing or receiving
         treatment. Where required a gown or sheet is made available to
         patient to the privacy during an examination or procedure.
        Visual privacy will be afforded to patients during clinical
         examinations and when patients are required to undress/dress in
         the presence of the General Practitioner or the general practice
         nurse. In situations where there is a door opening to an area where
         the public may have access a curtain or screen is used.
        The practice should provide appropriate care and privacy for
         patients and others in distress during the consultation, examination
         or treatment of a patient.
        Privacy and confidentiality of patient information should be
         considered at all times, including during telephone conversations
         between staff and patients
        Computer screens are not readily visible to patients and visitors and
         screen savers are activated.
        Patient health information is treated with respect and letters, forms
         or notes concerning patients are not readily visible to other patients.
        Examination couches should be able to be cleaned and are cleaned
         regularly
        Linen (including gowns and sheets), curtains and screens should be
         laundered or cleaned regularly by the practice

_________________________________________________________________________________
                                              Nov-1999, Feb-2001, Dec-2001,
                                              Feb-2002, Feb-2003, Feb-2004,
                                   Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                      Section Three


        The consulting room should be well maintained and visibly clean
         with surfaces accessible for cleaning.
        Storage areas for sterile/non sterile items should be dust proof and
         dry and be able to maintain their sterility and prevent exposure to
         blood and body substances.
        The security of the practice (and the staff) is an important issue and
         strategies should be in place in the event of a breach of security
 Hint

Additional resources may be located on AGPAL QbAY: www.qip.com.au
>Consulting Room
          rd
RACGP 3 Ed Std. 5.1.1(A), (B), & 5.1.2(B) & 4.1.2 http://www.racgp.org.au/standards
       th
RACGP 4 Ed Std.5.1.1& 5.1.2




_________________________________________________________________________________
                                                Nov-1999, Feb-2001, Dec-2001,
                                                Feb-2002, Feb-2003, Feb-2004,
                                     Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                     Section Three


3.2.2 Hand Washing Facilities
Dedicated hand washing facilities with hot and cold water, liquid soap and
single use paper towel should be readily available in every clinical
management or treatment area.

Ideally every consulting room should also have a basin dedicated for the
purpose of washing hands. Where this is not possible, washbasins are
situated within close proximity.

Appropriate facilities for drying hands are provided. Hot air dryers are not used
in clinical areas. Single use towels (paper or cloth) are provided in shared
locations and clinical areas. Disposable paper towel is used prior to aseptic
procedures.

Hand disinfectants designed for use without water, such as alcohol based
hand gel are available in:

   The Doctors Bags to use when hand washing facilities are inadequate, eg,
    home visits
   In all treatment and examination areas to encourage hand hygiene in
    addition to hand washing facilities.
   In patient and staff areas during flu season to encourage hand hygiene

All new staff are informed about our Hand washing procedures (Refer
Section 4) and we provide regular updates and training in infection
prevention.

 Hint

Additional resources may be located on AGPAL QbAY: www.qip.com.au
>Consulting Room



RACGP 3rd Ed Std. 5.1.1(E) & 5.3.4(C) http://www.racgp.org.au/standards
         th
RACGP 4       Ed Std. 5.3.3




_________________________________________________________________________________
                                               Nov-1999, Feb-2001, Dec-2001,
                                               Feb-2002, Feb-2003, Feb-2004,
                                    Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                     Section Three


3.2.3 Waiting Area

   The practice waiting room area is sufficient to accommodate the usual
    number of patients and others who would be waiting at any one time.
   The health and safety of GPs, staff, patients and visitors is considered
    when selecting seating, furniture and toys for the waiting room, and the
    area is kept tidy and clean to maintain a safe environment.
   The practice is able to provide appropriate and respectful care for
    patients and others in distress. Strategies should be in place to deal
    with distressed patients. i.e. vomiting, upset or in severe pain. Privacy
    for such patients could be provided by allowing them to sit in an
    unused room, staff room or other designated area, rather than waiting
    in the general waiting area.
   Auditory privacy within the waiting area can be enhanced by staff
    discretion and the use of background music or a television to mask
    conversations.
   Conversations with a member of the clinical team cannot be overheard
    by patients in the waiting room.
   Privacy and confidentiality of patient health information is considered
    when staff are discussing patients health information at the reception
    area.
   Computer screens are not readily visible and screen savers are used.
   Where appropriate our waiting area caters for the specific needs of
    children with play equipment or toys that can be washed regularly.
   The waiting room furniture and toys are in good condition, without
    sharp edges, and the room is maintained in a clean and tidy state with
    surfaces easily accessible for cleaning.
   A range of posters, leaflets or brochures about health issues relevant
    is available or on display in the waiting room for patients to self select.

 Hint

Additional resources may be located on AGPAL QbAY: www.qip.com.au
>Reception area


         rd
RACGP 3 Ed Std 2.1.1(F) & .5.1.1(C&D) & 5.1.2(A) & 1.3.1(B) & 4.1.1& 4.1.2& 5.3.4
(D)
http://www.racgp.org.au/standards
          th
RACGP 4 Ed Std.5.1.1 & 5.1.2




_________________________________________________________________________________
                                               Nov-1999, Feb-2001, Dec-2001,
                                               Feb-2002, Feb-2003, Feb-2004,
                                    Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                     Section Three


3.2.4 Toilets

   Toilets should be located within the practice. Where this is not
    possible they need to be adjacent or within very close proximity.
   The toilets need to be easily accessible and well signposted.
   Hand washing facilities, including liquid soap and single use paper
    towel or hand air dryers need to be readily available for use by patients
    and others and situated in close proximity to the toilets.
   There should be separate toilets for staff and patients if possible.
   The toilets should be well maintained and visibly clean with surfaces
    accessible for cleaning and if a baby change room is provided then
    that also must be kept adequately maintained and located close to
    hand washing facilities.

 Hint

Additional resources may be located on AGPAL QbAY: www.qip.com.au
>Reception area


RACGP 3rd Ed Std. 5.1.1(E) & 5.3.4(D) http://www.racgp.org.au/standards
       th
RACGP 4 Ed Std.5.1.1




_________________________________________________________________________________
                                               Nov-1999, Feb-2001, Dec-2001,
                                               Feb-2002, Feb-2003, Feb-2004,
                                    Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                    Section Three


3.2.5 Telecommunication System

Our practice‟s telecommunication system facilitates patient access to the
practice services and aims to adequately meet the needs of patients and
staff.

It is recognised that the telecommunications needs of the practice may
change over time, in line with staffing changes and growth of the practice.
Strategies should be in place, designed to monitor, review and make the
appropriate changes to the telecommunications system as required. This
may include patient and staff feedback.

The auditory privacy and confidentiality needs of patients have been
considered when locating our telephones and facilities for electronic
communication.

      A telephone line must be available for staff to summon assistance in
       an emergency. A dedicated line is provided for this purpose.
       (*insert details of how to access this line)
      The telephone system must provide sufficient inward and outward
       call capacity and needs to have the capacity for electronic
       communication (either email or Facsimile).
      The practice has (*insert number) of lines dedicated for telephone
       calls and (*insert number) of lines for electronic communication.
      Patient feedback is sought on a regular basis to ensure that
       „access‟ to the practice facilities and services is easily available by
       telephone.
         rd
RACGP 3 Ed Std. 5.1.1(G&H) & 5.1.2 http://www.racgp.org.au/standards
         th
RACGP 4 Ed Std.5.1.2




_________________________________________________________________________________
                                              Nov-1999, Feb-2001, Dec-2001,
                                              Feb-2002, Feb-2003, Feb-2004,
                                   Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                      Section Three


3.2.6 Unauthorised Access Areas
General Practitioners and staff need to ensure the confidentiality and
security of patient health information and other sensitive practice materials.

        Signage is present to prevent unauthorised public access to
         specified areas in the practice where patient health information and
         other sensitive practice materials are stored.
        The presence of an additional person in the practice (besides the
         GP(s) on duty) will increase security and safety for patients, GPs &
         staff and reduces the risk of unauthorised access to patient health
         information or sensitive practice materials.
        The confidentiality and security of medical records, prescription
         pads/paper, letterhead, administrative records and other official
         documents must be maintained by all staff and storage in a
         restricted access area is recommended.
        Patient personal health information is stored in an area or manner
         that is not accessible to unauthorised persons.
        Facsimile machines, printers and other communication devices are
         not readily accessible to people other than the General
         Practitioner(s) and authorised staff.
        All sensible security measures are taken to prevent unauthorised
         access to medications and the Doctor‟s bag.

 Hint

The RACGP „Handbook for the Management of Health Information in Private
Medical Practice‟, (2002) (www.racgp.org.au) provides minimum safeguards and
procedures that must be followed by general practices in order to meet appropriate
legal and ethical standards concerning privacy and security of patient records.

Practices are encouraged to become familiar with relevant Federal and
State/Territory privacy legislation (www.privacy.gov.au) as this will also impact on
the way in which practices manage patient health information.

Familiarity with State and territory legislation governing the storage of medications
is recommended.
Victoria: Drugs, Poisons and controlled substances Act 1981; Drugs, Poisons and
controlled substances regulations 1995
The Drugs and poisons unit phone: 1300 364 545 or email dpu@dhs.vic.gov.au

Additional resources may be located on AGPAL QbAY: www.qip.com.au
>Reception Area and Treatment Room

Fact Sheet “Description form template” & “Patient Alert Template” from the DCGPA
Safety & Security Kit is available from www.dcgpa.com.au

          rd
RACGP 3 Ed Std. 4.1.2 & 4.2.1 & 4.2.2 & 5.1.1(I) & 5.2.2 & 5.3.1
http://www.racgp.org.au/standards
          th
RACGP 4 Ed Std.5.1.1

_________________________________________________________________________________
                                                Nov-1999, Feb-2001, Dec-2001,
                                                Feb-2002, Feb-2003, Feb-2004,
                                     Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                   Section Three




3.3      Security
Policy


Our practice ensures as much as possible that our facilities provide
appropriate security for patients, staff and visitors. All practice staff are
aware of, and are able to, implement protocols to ensure the safety and
security of all persons within the practice.

Procedure

The premises are protected by a computerised alarm system that has
motion detection sensors located at various points on the site. Refer to
plan in the office for further details. A „Panic‟ button, linked to the security
system, is located under the reception desk. Our security firm also patrols
the site after hours.

During routine practice hours at least one other practice staff member, in
addition to the General Practitioner(s), is present in the practice.

Another staff member, in addition to the General Practitioners can provide
practical help in an emergency situation, reduce the risk of unauthorised
access to patient health information, ensure the security of sensitive
practice resources, and provide security and safety for patients, General
Practitioners and staff.

Staff rosters are checked daily and staffing is then planned for the next
workday. Where possible, this same strategy is strongly encouraged to be
implemented outside of normal working hours (e.g. at weekends and on
public holidays or when non-routine „emergency surgeries‟ are conducted
for patients needing urgent care).

Equipment on site is engraved with practice name and item number. The
Practice Manager maintains the number register.

Contracts and warranties for medical, office and other site equipment are
securely locked, maintained and updated by the Practice Manager.

Security codes are routinely changed for computers and the security
system.

Patients, visitors and trades people are to report to the reception desk.
Where appropriate visitor‟s and trades people should wear an identification
name badge on site. The Reception staff and Practice Manager are

_________________________________________________________________________________
                                             Nov-1999, Feb-2001, Dec-2001,
                                             Feb-2002, Feb-2003, Feb-2004,
                                  Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                   Section Three


informed of the presence of all visitors (except patients and relatives who
report to reception only).

Confidential waste is placed in a locked storage box prior to shredding or
secure destruction by our security documentation storage and destruction
firm.

All drugs of dependency and Schedule 8 medications are locked in the
safe. See Section 7: Clinical Management – Drug Storage.

Staff members are encouraged to be vigilant whilst on duty and act to
ensure the continuing safety of all Gps, patients, visitors and other staff.

Open and Lock up protocol

At start of day:

   After unlocking premises, deactivate security alarm system, using
    security code
   Check all exits for unimpeded access and unlock/open windows as
    required for routine practice operation
   Turn on lights, heating/cooling system, computers, photocopier, unlock
    medical record filing cabinets, checking for items out of place or for any
    unusual objects not in correct placement
   Turn off answering machine and retrieve messages left after hours
   Check fax machine for any incoming messages and action as required
   Report unusual issues or missing items to Practice Manager or
    Principal, documenting same

At end of day:

   Lock all windows and doors
   Ensure computer back up is complete or scheduled after hours as
    required
   Switch off designated computers, photocopier, heating/cooling system
   Check drug cabinet & safe is locked
   Check that bins are empty
   Check that no-one is in toilets and windows are locked
   Check offices for unsecured confidential documents including medical
    and finance records. Lock medical record filing cabinets
   Ensure prescription pads, prescription computer generated paper,
    letterhead, medications, health records, and other administrative
    records or official documents are out of view.
   Secure the cash box
   Check that answering machine is on
   Turn off all lights, keeping the security lights on
   Activate security system
_________________________________________________________________________________
                                             Nov-1999, Feb-2001, Dec-2001,
                                             Feb-2002, Feb-2003, Feb-2004,
                                  Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                      Section Three



          rd
RACGP 3 Ed Std. 4.1.2(B) & 4.2.2 & 5.1.1 http://www.racgp.org.au/standards
       th
RACGP 4 Ed Std.5.1.1 & 4.1.2


 Hint

Recent work undertaken together with Worksafe/ Victoria Police/RACGP/ANF/GPV has
led to a development of a new Safety & Security Kit for General Practice. This free kit
can be found by visiting DCGPA website under Hot Resources www.dcgpa.com.au or
fact sheets are included in the forms and templates at the end of this section


Identify the security firms contracted by the practice.
If you have a checklist for closing and securing the practice, then put a copy in this
section.

Remember, your own safety is paramount and should be the first thing to consider.
Do not be a victim. If feeling unsafe or at risk contact the Police immediately.

RACGP General practice a safe place tips and tools
http://www.racgp.org.au/Content/NavigationMenu/PracticeSupport/Runningapractic
e/GPandPracticeTeamSafety/gptipsandtools/Asafeplace-tipsandtools.pdf



3.4      Non Medical Emergencies

Policy

Non medical emergencies may occur that will require a quick, informed
and effective staff response.

Types of non-medical emergencies include: failure of electricity supply,
telephone or water, fire or false fire alarm, property damage, break-in,
abusive or threatening telephone calls or persons at the practice, leakage
of toxic chemicals, bomb threats and letter bombs.

We also have a contingency plan for unexpected events such as natural
disasters, national or local infection outbreaks or the sudden, unexpected
absence of clinical staff or computer system failures. (Refer to Section 8 Risk
Assessment and Management and Section 6 Compute Information security)

We have mechanisms in place to ensure the timely acquisition and
dissemination of information (including regular updates) about alerts, emerging
diseases, local disasters or emergencies.

The practice has appointed a designated member of staff to have primary
responsibility for our risk management systems. These may include clinical
and non clinical risks and events. Specific areas of responsibility can be
delegated to other nominated members of the practice team and these
particular responsibilities should be documented in the relevant position
_________________________________________________________________________________
                                                Nov-1999, Feb-2001, Dec-2001,
                                                Feb-2002, Feb-2003, Feb-2004,
                                     Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                     Section Three


descriptions. (*insert name refer Section 8 Risk assessment and
Management)

Procedure

Our practice has a “Non medical Emergency Manual‟ which reflects the
relevant Australian Standards, as per occupational health and safety
regulations eg Fire protocols .
(*insert where to find your practices Non medical Manual”)

The purpose of this manual is to formalise emergency procedures, and fire
safety precautions within the practice, so that those who are required to
take actions related to the protection of life and property have a reference
and a basis for their decisions and actions.

Designated members of the Emergency team are familiar with procedures
in the manual and all staff knows the correct emergency procedures and
are able to carry them out in times of emergency.


We also have a business continuity plan for unexpected events that may
disrupt care or stretch practice resources to the limit, including disasters (eg
bushfires, prolonged power failure) or Infectious disease outbreak (eg
pandemic), or unexpected staff absenteeism (eg illness. This includes how we
notify our staff and patients of such events or local disasters or emergencies.
(*insert where to find your practices business continuity plan)


We have a system for monitoring and obtaining information and alerts about
national and local infection outbreaks, disasters, emergencies and other
relevant matters. We are registered on local networks to receive alerts and we
check on a daily basis for any new or updated alerts and disseminate these to
all staff.
(*insert your procedure for the timely receiving and dissemination of any important
communication or updates. Include the name of the designated staff member who has
this responsibility)



         rd
RACGP 3 Ed Std. 4.1.2(D) http://www.racgp.org.au/standards
       th
RACGP 4 Ed Std. 4.1.2, 3.1.2

 Hint

You may have a number of contingency plan/s for adverse and unexpected events.
Some suggestions are: pandemic or infectious disease plan (Refer section 4), Business
continuity plan (Refer Section 3) and Computer disaster plan (Refer Section 6)
 To help understand what to include in business continuity plan please refer to the
following power point presentation. Being Prepared: Understanding Business
Continuity/Resilience Planning.


_________________________________________________________________________________
                                               Nov-1999, Feb-2001, Dec-2001,
                                               Feb-2002, Feb-2003, Feb-2004,
                                    Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                     Section Three


http://www.health.vic.gov.au/agedcare/downloads/seminar_jul09/patrickow_leannet
oby.pdf

Additional resources may be available at AGPAL QbAY: www.qip.com.au >Risk
Management

All primary health care providers, whether general practice or other community
settings, should develop a pandemic plan (Refer Section 4 Transmission Based
Precautions)
             th
The RACGP 4 Edition Standards 4.2.2 “Where a practice uses computers to store
patient health information the practice needs to have a sound backup system and a
contingency plan to protect practice information in the event of an adverse incident
such as a system crash or power failure.”

Suggest reading the “Explanation” in the RACGP 4th Edition Standards Indicator 3.1.2
as they provide an extended and comprehensive guide to the clinical risk management
systems practices are expected to implement. http://www.racgp.org.au/standards/312

When developing your disaster management plan and Pandemic Plans contact your
local division for support and advice.




3.5    Forms, Templates & Checklists


                   Forms, Templates & Checklists
      These are also available to download from www.dcgpa.com.au
 Section 3.1.1             Table of suggested Occupational Health and
                           Safety Resources
 Section 3.1.2             Adverse Outcome Report Template
 Section 3.1.3             Blood or Body Fluid exposure Wallchart
 Section 3.1.4             Staff Immunization Consent/refusal and record
                           form
 Section 3.3               General practice health, safety & Security
                           Assessment checklist

                                Fact Sheets
                                -Security of Practice
                                -Aggressive People
                                -Patient Alert Systems- file flagging & Patient
                                Alert Template
                                -Personal safety
                                -Robbery & Drug related Incidents and
                                Description form

_________________________________________________________________________________
                                               Nov-1999, Feb-2001, Dec-2001,
                                               Feb-2002, Feb-2003, Feb-2004,
                                    Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                                      Section Three




Title of                             Description                              Available from
Publication/Resource
              These publications can be viewed on line at www.workcover.vic.gov.au
“If you are injured” Poster         By law all employers must display this   Your Workcover insurance Agent
                                    poster in the workplace where all
                                    workers can see it.
“Manual handling” Poster                                                     National Safety Council of Australia
                                                                             Ph 1800 816 459
Obligations Checklist for employers Summarises the legal obligation of       Workcover phone: (03) 9641 1333
                                    employers                                Email:
                                                                             publications@workcover.vic.gov.au
Guide to the OHS Act 2004, 1st      Designed to be read in conjunction with Workcover phone: (03) 9641 1333
Edition                             the Act, this guide provides an overview Email:
                                    of the Act.                              publications@workcover.vic.gov.au
Health and safety – the best        This publication is designed to assist   Workcover phone: (03) 9641 1333
investment for small business       those in small business to provide a     Email:
                                    safe and healthy workplace and to        publications@workcover.vic.gov.au
                                    recognise, assess and control risks.
Officewise: A guide to health and   This booklet is designed to help         Workcover phone: (03) 9641 1333
safety in the office                employers take a fresh look at their     Email:
                                    workplace and raise awareness of         publications@workcover.vic.gov.au
                                    health and safety issues in the office
Return to work guide for Victorian  This guide will help you manage return   Workcover phone: (03) 9641 1333
employers                           to work at your workplace, by informing Email:
                                    you of your legal obligations and        publications@workcover.vic.gov.au
                                    providing you with practical advice

All About Workcover for Employers This booklet details how Workcover Workcover phone: (03) 9641 1333
_________________________________________________________________________________
                                                        Nov-1999, Feb-2001, Dec-2001,
                                                        Feb-2002, Feb-2003, Feb-2004,
                                             Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                                          Section Three


                                       works for you. It includes information      Email:
                                       on making your workplace safe, health       publications@workcover.vic.gov.au
                                       and safety representatives, who must
                                       have a policy, how to take out a policy,
                                       how premium is calculated, what to do
                                       if a worker is injured, return to work
                                       practices and dispute resolution.

All About Workcover for Workers        This booklet details how Workcover          Workcover phone: (03) 9641 1333
                                       works for you. It includes information      Email:
                                       on making your workplace safe, who is       publications@workcover.vic.gov.au
                                       entitled to Workcover compensation,
                                       how benefits are calculated, what to do
                                       if you are injured, returning to work and
                                       resolving Workcover disputes.

A guide to risk control plans          This guide has been written for             Workcover phone: (03) 9641 1333
                                       employers to help them prepare an           Email:
                                       effective risk control plan.                publications@workcover.vic.gov.au


Incident notification at a glance      This document provides information on       Workcover phone: (03) 9641 1333
                                       the incident notification process, when     Email:
                                       the regulations apply, what to do, when     publications@workcover.vic.gov.au
                                       to notify and what record keeping is
                                       required.


Title of                               Description                                 Available from
Publication/Resource
Transferring people safely             A practical guide to managing risk -        Workcover phone: (03) 9641 1333
                                       handling patients, residents and clients    Email:
                                       in health, aged care, rehabilitation and    publications@workcover.vic.gov.au
                                       disability services.

Getting started with workplace         Explores the key features of effective      Workcover phone: (03) 9641 1333
health and safety. Series of 4         health and safety management                Email:
books                                  arrangements, and is designed to show       publications@workcover.vic.gov.au
                                       that getting started in improved health
Introduction to hazard                 and safety in the workplace is not
management, workplace                  difficult
inspections and selecting a health
and safety consultant

Introduction to health and safety
responsibilities, roles and
functions, training, information and
records

Introduction to workplace
consultation

Introduction to workplace health
and safety policies, procedures and
evaluation

Manual Handling Code of practice When you use the process in the Code Workcover phone: (03) 9641 1333
_________________________________________________________________________________
                                                           Nov-1999, Feb-2001, Dec-2001,
                                                           Feb-2002, Feb-2003, Feb-2004,
                                                Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                                       Section Three


                                     of Practice to assess and plan controls    Email:
Use with                             for hazardous manual handling tasks,       publications@workcover.vic.gov.au
                                     you can document this on the
Assessing and controlling manual     Assessing and controlling Manual
handling risk                        handling risk publication

Guidance Notes Managing manual       This step by step approach is designed     Workcover phone: (03) 9641 1333
handling risk in a small             to assist employers in small               Email:
organisation                         organisations to effectively manage        publications@workcover.vic.gov.au
                                     manual handling risk in their workplace.
Designing workplaces for safer       Guidelines for the design of health and    Workcover phone: (03) 9641 1333
handling of patients and residents   aged care facilities                       Email:
                                                                                publications@workcover.vic.gov.au




                           ADVERSE OUTCOME REPORT
                      (Must be reported within 24 hours of incident)
Reported by:

Who was involved:                     Staff                        Patient                    Visitor
Details of any Witnesses


When:                                         Date:                                    Time:

Incident Classification

    Fall
    Exposure to body                Spill / Needlestick / Mucous membrane / other
     fluid
    Adverse response to             Vaccination / Medication / Other
     procedure *
    Breach of Privacy
    Act of Aggression               Verbal / Physical
    Equipment Failure*              Computer / Fridge / Phone / Banking / Medical
                                     Equipment
    Complaint
    Theft/Missing Property
    Emotional Distress
    Slip, Lapse or mistake

_________________________________________________________________________________
                                                        Nov-1999, Feb-2001, Dec-2001,
                                                        Feb-2002, Feb-2003, Feb-2004,
                                             Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                      Section Three


Brief Description of Incident:



Immediate Action:
 Medical treatment (Outline briefly) (Exposure-refer to chart attached)
 Investigation (Outline briefly)
 Assistance      Police / Fire / Ambulance / CAT Team / Other
 Debriefing      On site / Referred

For discussion at Practice Meeting:        Yes               No

Report to Medical Defense Organisation:          (Must be within 24 hours)
If yes – details of time,
contact


Remedial Action to be Taken:




Signature of Reporter                               Signature of Principal

* May need to comply with additional reporting obligations (Eg TGA, ADRAC, workcover)




_________________________________________________________________________________
                                                Nov-1999, Feb-2001, Dec-2001,
                                                Feb-2002, Feb-2003, Feb-2004,
                                     Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
              (Practice Name) Policy & Procedure Manual                                     Section Three




                                      PROTOCOL
                               TO BE FOLLOWED AFTER
     NEEDLESTICK INJURY OR BLOOD/BODY FLUID EXPOSURE
FIRST AID
   Contaminated wound: Gently encourage bleeding from the skin wound and wash the injured area with
   copious soapy water, disinfectant, scrub solution or water.
   Contaminated skin: Wash the area with soap and water.
   Contaminated eyes: Gently rinse the eyes while open with saline or water.
   Contaminated mouth: Spit out any fluid – rinse the mouth with water and spit out again.

                  REPORT ACCIDENT
BLOOD TESTING (Mark as “urgent” tests)
   Heath Care Worker: HBV                       Source (consent required): HBV
                      HIV                                                  HIV
                      HBC                                                  HBC


                                  IMMEDIATE ACTION
    Take a history from the source to identify the risk of disease exposure.
    If the source is known to be HIV positive, or in a high risk group, or “unknown” then the
    exposed healthcare worker should be given counselling and offered post exposure prophylaxis
    (PEP) from the nearest Infectious Disease Physician/Clinic.
    PEP drugs are best given within 1 – 2 hours following exposure.

               PEP Drugs and Infectious Disease Physician Advice
                  Monash Medical Centre Ph (03) 9594 6666
   If the healthcare worker is known to be HBV immune then no further Hep B Vaccine is required.
   If the healthcare is not HBV immune or HBV susceptible, then treat with Hyperimmune Hep B
   Imunoglobulin and offer Hep B vaccine course.
   Provide healthcare worker with the Health Department Communicable Disease contact: Victoria
   1300 651 160
   Give dTpa if indicated & advise safe sex until blood test results and source history reviewed
FOLLOW UP
   Complete the course of Hepatitis B Vaccine
   Follow up HIV serology 6 weeks and 3 months
   Complete Workcover/Adverse Outcome report and medical records
             _________________________________________________________________________________
                                                             Nov-1999, Feb-2001, Dec-2001,
                                                             Feb-2002, Feb-2003, Feb-2004,
                                                  Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
 (Practice Name) Policy & Procedure Manual                                                                        Section Three




Staff immunisation consent / refusal and record form
 This document remains strictly private and confidential and will be filed with your staff records.

 Name of staff member…………………………………………Date of birth …………

 Position in practice .........................................................................................

 Duties may include (please tick and add as appropriate):

  Handling specimens
  Wound dressings
  Instrument cleaning and reprocessing
  Cleaning of blood and body fluids
  Administration of vaccinations/injections
  Venipuncture/venisection
  Pap smears
  Diabetic testing
  Removal of sutures
  Spirometry testing
  ……………………...........
  ……………………………..

 Consent to discuss immunisation history provided
  Yes Signature required ……………………..
  No Please complete Immunisation refusal section

 Immunisation risks and benefits advice
 I,............................................................................................ have received information about
 the risks of infection that this position at the practice poses and have also had the benefits of
 vaccination explained to me by ............................................ .

 Immunisation refusal (please also complete above statement)

 I do not wish to (please tick the appropriate statements):

  Have the vaccinations listed below

  Undertake any recommended serology testing to determine my antibody levels

  Disclose my vaccination history

 I agree to be immunised against the vaccines recommended and accepted below

 Please list any known allergies………………………………………………..

 Name of staff member…………………………………

 Signature…………………………Date……………….


 Name of person providing advice………………………

 Signature…………………………Date……………..
 _________________________________________________________________________________
                                                                   Nov-1999, Feb-2001, Dec-2001,
                                                                   Feb-2002, Feb-2003, Feb-2004,
                                                        Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                   Section Three




_________________________________________________________________________________
                                             Nov-1999, Feb-2001, Dec-2001,
                                             Feb-2002, Feb-2003, Feb-2004,
                                  Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
            (Practice Name) Policy & Procedure Manual                                              Section Three



Disease         Vaccine       Date of          Serological    Recommend         Signature,    Post-         Date next
                              previous         testing if     vaccination ()   Date given,   vaccination   vaccination
                              vaccination or   required                         batch no. &   serological   due
                              exposure                        and acceptance    expiry date   testing if
                                                              (initial)                       required

Diphtheria,     ADT
tetanus

Diphtheria,     dTpa
tetanus,
                Boostrix/Ad
pertusssis
                acel
Hepatitis A     VAQTA
                Adult
                Havrix
Hepatitis B     H-B-Vax II
                Adult
                Engerix
Hepatitis A &   Twinrix
B               (720/20)


Poliomyelitis   IPV(IPOL)


Influenza       Influenza
                vaccine


Measles         MMR


Mumps           MMR


Rubella         MMR


Meningococc     NeisVac-C
al C

Chicken Pox     Varicella




            _________________________________________________________________________________
                                                                  Nov-1999, Feb-2001, Dec-2001,
                                                                  Feb-2002, Feb-2003, Feb-2004,
                                                       Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
          (Practice Name) Policy & Procedure Manual                                           Section Three




Disease       Vaccine    Date of          Serological    Recommend         Signature,    Post-         Date next
                         previous         testing if     vaccination ()   Date given,   vaccination   vaccination
                         vaccination or   required                         batch no. &   serological   due
                         exposure                        and acceptance    expiry date   testing if
                                                         (initial)                       required




          _________________________________________________________________________________
                                                             Nov-1999, Feb-2001, Dec-2001,
                                                             Feb-2002, Feb-2003, Feb-2004,
                                                  Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                      Section Three




General Practice
Health, Safety and Security
Assessment Checklist
Practices should consider undertaking a safety and security risk assessment, using
the material outlined in this Kit.      A safety and security assessment could be
undertaken in conjunction with practice team members including your practice‟s
OHS representative. Use this checklist to assess your practice‟s risk management
strategy. Practices may consider seeking the advice of their local Crime Prevention
Officer.


Although the following checklist covers potential areas of risk it does not
guarantee that all safety and security risks have been identified. The checklist
does not replace the need for analysis of the safety and security risks and action
relevant to your particular practice, involving those working in your practice.
Experienced consultants with expertise in the prevention and management of
violence and aggression and security could assist with your assessment.


                                1.        Legislation
Question                                                   Yes No NA What will
                                                                     you do
                                                                     about
                                                                     this?
Are Practice Principals /Practice Managers aware of
their obligations under the Victorian Occupational
Health and Safety Act 2004 and Accident
Compensation Act 1985?
Are practice team members who sustain an injury
encouraged to submit an incident report?




_________________________________________________________________________________
                                                Nov-1999, Feb-2001, Dec-2001,
                                                Feb-2002, Feb-2003, Feb-2004,
                                     Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                    Section Three




                             2.    Policy & Procedures
Question                                                Yes No NA What will
                                                                  you do
                                                                  about
                                                                  this?
Does the practice have a written policy on zero
tolerance towards violence and aggression
endorsed by management and aimed at protecting
practice team members and others?
Does the practice policy:
      Apply to all staff?
      Define work place violence as an
       occupational health and safety hazard?
      Include specific risk factors which are
       associated with violence?
      Include measures in place to prevent and
       manage violence?
      State clearly that practice team members
       should not be put, or put themselves, at
       risk of violence?
      Include assistance for all practice team
       members who have contact with the public
       during potentially violent situations?
      Include a statement that (potentially)
       violent patients or visitors will be managed
       appropriately; and that practice team
       members will be made aware of their
       identities?
      Include the physical environment?
      Include staffing as an important aspect in
       the effective prevention and management
       of occupational violence?
      Include a statement of support for practice
       team members?

_________________________________________________________________________________
                                              Nov-1999, Feb-2001, Dec-2001,
                                              Feb-2002, Feb-2003, Feb-2004,
                                   Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                    Section Three


      Encourage practice team members to
       report all incidents or “near misses” of work
       place violence, including threats?
Does the practice have a designated health and
safety representative?
Does the practice have a security process in place
to deal with situations e.g. how to approach
unknown visitors?
Does the practice have a policy that all verbal
aggression and threats by patients or others must
be documented in patients‟ notes and that any
ongoing risk for the future is flagged?
Have local police and security providers been
provided with after hours contacts for the
practice?
If the practice is one of a number of tenants within
a building, does practice management liaise with
building management and other tenants about
security issues?
Have local police and security providers been
provided with after hours contacts for the
practice?
Does the practice have a Victim Support Policy
established?
Does the practice policy provide for post-incident
responses for any victim of a serious incident such
as: debriefing and counseling or referral to support
services?




_________________________________________________________________________________
                                              Nov-1999, Feb-2001, Dec-2001,
                                              Feb-2002, Feb-2003, Feb-2004,
                                   Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                    Section Three



               3.      Information and Education of Patients & Visitors

Question                                                  Yes     No    N     What will
                                                                        A     you do
                                                                              about
                                                                              this?
Does the practice display any information/posters
that emphasises violence will not be tolerated?
Does the practice provide patient information sheets
and utilise patient behaviour contracts, if available?



        4.      Training and Education for Practice Management and Teams
Question                                               Yes   No NA       What
                                                                         will you
                                                                         do about
                                                                         this?
Does the practice provide OHS training for all
practice team members, in practice time that
includes occupational violence prevention?
Is OHS training provided as part of induction to all
new practice staff members, including contractors,
agency staff and locums?
Does the practice provide information on risk factors
relevant to practice team member‟s work?
Does the practice provide training and/or
information when relevant:
 How a situation of patient-initiated aggression
  will be managed?
 Employer and employee obligation and rights
  under the OHS legislation?
 Awareness of Work Safe Guidance Note on
  Prevention of Bullying and Violence at Work and
  other guidelines, codes of practice, and
  standards?
 Occupational violence?
 Legal context of occupational violence?
 Workplace policy and procedures to prevent and
  manage occupational violence?


_________________________________________________________________________________
                                              Nov-1999, Feb-2001, Dec-2001,
                                              Feb-2002, Feb-2003, Feb-2004,
                                   Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                     Section Three


 When and how to call for assistance?
 Whom to contact?
 Hazard identification?
 Risk assessment, including recognition of
  potential risk groups and causes of violence?
 Risk control?
 Defusing aggressive situations?
 Post incident management, including procedures
  for incident reporting, investigation and follow-
  up, critical incident debriefing and counseling?
 Legal duty of care and the use of reasonable
  force?
 Making police statements, reports?


   5.       Incident Reporting
Question                                                   Yes     No    NA    What will
                                                                               you do
                                                                               about this?
Does the practice have an incident register and
encourage written reporting of all incidents, whether
resulting in injury or not?
Does the practice have a policy of acting
immediately following an incident to ensure the
safety of all practice team members and others?
Does the practice have policy/procedures for the
investigation of all incidents in consultation with
practice team members and/or the practice‟s OHS
representative?
Does the practice have policy/procedures that any
ongoing risk with regard to patient aggression or
threat for the future is flagged in the patient record?
Does the practice have a policy that practice team
members should not place copies of incident forms
into patients‟ records?
Are all potential or actual incidents reported to the
designated person within the practice?
Does the practice have a policy that following

_________________________________________________________________________________
                                               Nov-1999, Feb-2001, Dec-2001,
                                               Feb-2002, Feb-2003, Feb-2004,
                                    Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                     Section Three


investigation of serious incidents, it will review
measures to prevent risks to team members and
others?
Does the practice have a policy stating that it will
regularly liaise with police following serious
incidents?
Does the practice have a policy that it will inform
police when serious incidents occur?
Does the practice have a policy that it will support
staff in making police statements and laying
charges?
Does the practice assist police prosecutions when
appropriate?
Has the practice assessed the need for on-site
trained security personnel?
Does the practice have a policy that professional
counseling will be offered for those who require
ongoing assistance in dealing with the incident?




_________________________________________________________________________________
                                               Nov-1999, Feb-2001, Dec-2001,
                                               Feb-2002, Feb-2003, Feb-2004,
                                    Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
     (Practice Name) Policy & Procedure Manual                                     Section Three



                                    6.        Physical Security

Outside the building
Question                                                         Yes   No    NA   What will you do
                                                                                  about this?
Practice Identification
  Is the street number clearly visible to the street?
  Is the Practice‟s business name clearly displayed?
  Is the Practice identifiable from the rear?
Landscaping
  Is landscaping around the practice free from potential
  hiding places?
  Are obstacles and rubbish that can otherwise be used
  by offenders to gain access to the premises removed?
  Does the practice keep trees and shrubs trimmed to
  reduce concealment opportunities and increase visibility
  to and from practice access points?
  Are ladders, bins and loose items such as tools and
  heavy garden stakes locked away or inaccessible which
  could assist offenders gaining access?
  Have bollards, heavy planters or large rocks been
  installed to act as ram raid barriers?
Lighting
  Is lighting provided to all entrances, recesses,
  movement routes and car parks around the practice?
  Can recesses and doorways be painted in light colors to
  improve visibility?
  Is there overnight security lighting installed around the
  practice?
  Is the security lighting operating?
  Is the practice well lit internally?
Fences and Gates
  Does the practice maintain well built and adequately
  secured boundary gates and fences?
  Are gates fitted?
  Are the gates in good condition
  Are the boundary fences in good condition?
  Are the fences and gates of appropriate material?
  Does the practice fully secure all external doors and
  windows with good quality locking devices that are
  regularly checked?




     _________________________________________________________________________________
                                                    Nov-1999, Feb-2001, Dec-2001,
                                                    Feb-2002, Feb-2003, Feb-2004,
                                         Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
      (Practice Name) Policy & Procedure Manual                                   Section Three




Inside the building

Question                                                      Yes No NA What will you
                                                                        do about this?
Telephones
            Are all practice telephones pre-programmed
            with emergency contact numbers?
            Can the telephone line be easily tampered
            with?
Restricted Areas
            Does the practice restrict access by
            patients/visitors to practice team members
            and some practice areas?
            Are patients prevented from accessing the
            area behind reception?
Signs
            Does the practice have effective directional
            signage to facilitate work and patient flow
            e.g. reception areas, toilets and consulting
            rooms?
            Does the practice have interior and exterior
            warning signs to deter potential offenders
            (does the practice has monitored alarm,
            CCTV etc)?
            Are restricted areas appropriately signed?
            Are the entry/exit points clearly identified?
Furniture/ Fixtures
            Are furniture and fixtures placed in ways to
            minimise the potential for aggression?
            Is the reception/waiting room area:
             Well lit?
             Comfortable and spacious?
             Decorated in muted colours?
             With adequate seating for the numbers
               of people likely to be waiting?
             Provides patients with sufficient personal
               space?
             Provided with furniture and décor that is
               comfortable, and designed to minimize
               stress and noise?
             Provided with a television (securely fixed
               to a wall) and/or reading materials, play
               areas for children) to reduce boredom?
General Security
             Is the building of solid enough
               construction to restrict unauthorized
               access?
             Is there adequate protection against
               entry via the roof?
             Are the manholes secured and skylights

      _________________________________________________________________________________
                                                   Nov-1999, Feb-2001, Dec-2001,
                                                   Feb-2002, Feb-2003, Feb-2004,
                                        Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
      (Practice Name) Policy & Procedure Manual                                    Section Three


                covered with grills?

Communication Systems
           Is there an effective patient and practice staff
           communication system?
Doors
           Does the practice have appropriate, strong
           secure strengtheners attached to
           doorframes?
           Are the practice‟s external doors of solid
           (not „hollow core‟) construction?
           Are external doors fitted with quality lock
           sets to restrict access?
           Are all fire doors self-closing?
           Are at-risk doors appropriately locked at all
           times?
           Are external door hinges mounted so they
           cannot be removed?
           Can patients/visitors be seen before access
           is allowed?
           Does the practice have procedures that
           document exit routes?
           Are all practice team members aware of
           egress and escape routes within the
           practice?
           Are exit routes within the practice well
           marked and clear of obstructions?
           Does the practice take steps to ensure all
           practice team members understand and
           follow lock-up procedures?
Windows
           Are these windows fitted with quality lock
           sets?
           Are windows free of unnecessary posters or
           other material which can impede vision?
           In high risk areas are windows protected by
           grills or laminated glass?
           Are any manholes secured and/or alarmed
           and skylights covered with grills?
Key, Valuables and Drug Control
           Do practice team members have a safe
           location to store their personal belongings
           (e.g. bags)?
           Does this location have restricted access?
           Does the practice maintain a key register?
           Are all spare keys secured?
           Does the practice have a procedure to
           ensure that keys (physical or electronic) to
           storage areas can be accounted for at all
           times?
           Does the practice keep drugs on the
           premises?
           If yes: are drugs such as S4 & S8 drugs
      _________________________________________________________________________________
                                                    Nov-1999, Feb-2001, Dec-2001,
                                                    Feb-2002, Feb-2003, Feb-2004,
                                         Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
        (Practice Name) Policy & Procedure Manual                                   Section Three


               securely stored?
               If padlocks are required to secure
               equipment or drugs, has the practice
               confirmed that selected locks are
               appropriate for their intended use?
Safes
            Does the practice have a safe installed?
            Is the safe securely anchored?
            Is the safe in an appropriate position?
            Does the safe have a drop-chute facility?
            Is the safe kept locked?
            Are keys to the safe adequately secured?
Surveillance/Security Equipment/Systems
            Does the practice have surveillance
            equipment installed?
            Is video footage recorded on tape or
            computer?
            Are video feeds monitored?
            Is there a system to manage the tapes or
            computer video data?
            Are security systems installed?
            Is the security system monitored?
            Does the practice have procedures in place
            to ensure that any surveillance and security
            systems installed are routinely checked to
            be functioning correctly?
            Does the practice prominently display any
            signs indicating the presence of a security
            system, the continual surveillance of the
            premises and any other security measures
            present?
            Are one or more security systems e.g.
            Duress alarms; mobile phones available and
            operational at all times?
            Does staff have access to security systems
            when attending to a person or moving
            between work locations?
            Does the practice have hard-wiring security,
            including panic alarms? If yes, is there a
            routine for checking the battery back up
            and the detector batteries if not hard wired.
            If the area warrants it, consider installing
            CCTV.
            If CCTV is used, is there appropriate
            signage to inform patients that they are
            being filmed?
            Consider having a monitor for every
            consulting room.
            Consider installing duress buttons at each
            counter in the practice.
            Does the practice have electronic sensors to
            advise GPs and practice staff when patients
            are entering and leaving the premises?
        _________________________________________________________________________________
                                                     Nov-1999, Feb-2001, Dec-2001,
                                                     Feb-2002, Feb-2003, Feb-2004,
                                          Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
    (Practice Name) Policy & Procedure Manual                                     Section Three


            Is the practice fitted with security bars,
            screens, grills or roller shutters to
            vulnerable doors, windows and skylights?
            Note: deadlocks and security restrictions on
            exit doors are subject to Fire Regulations
            and may require appropriate approvals.


              7.      New Building or Renovations (skip this section if not applicable)

Furniture /Fixtures reception and waiting areas
               Are counters wide enough to prevent a patient
               or the visitor reaching across them easily?
               Does the practice have counters fitted with
               vertical glass partition or be high enough to
               deter an adult climbing over them easily?
               Is the waiting room set up to ensure that a
               practice team member is located close to an
               exit?
               Is there a good view from the reception desk
               of the entry, waiting room and main corridor?
Lighting
               Is lightning mounted at a height that allows
               best spread of light, without shadows and
               reduces vulnerability to intrusion?
               Does the practice have appropriate design and
               lighting to minimise stress and fatigue
               and maximize feelings of relaxation in
               appropriate areas?
               Does the practice have adequate lighting
               especially at the entrance and in car parks to
               help prevent incident?
Communication Systems
               Is there an effective patient and practice staff
               communication system? (For example, a
               speaker phone and a single dial to reception
               which allow someone to press one button and
               have the activity in the consultation room
               heard in reception).
Consulting Rooms
               Do the consulting rooms have 2 doors for
               egress and entry with the doctor being
               positioned close to one of them, not blocked by
               the patient?
Car Park
               Does the practice have an adequately lit car
               park located within close proximity?




    _________________________________________________________________________________
                                                   Nov-1999, Feb-2001, Dec-2001,
                                                   Feb-2002, Feb-2003, Feb-2004,
                                        Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                    Section Three




FACT SHEET 1
Security of Practice
This fact sheet provides important security advice and information for the practice.
Privately contracted security advice can also be obtained. Additional advice about
security firms as well as key/access card control and CCTV (Closed Circuit
Television) is located further along.


PREVENTION
Basic Security Tips
1. Make sure laneways and other external areas and doorways are well lit. Lighting
should be regularly inspected to see that it is all working and that time clocks if
used are functioning correctly.
2. Prune all trees and shrubs around your practice to enable clear visibility and
minimize their use to conceal. Ensure that this landscaping is maintained.
3. Clear all building perimeters including fences of rubbish and potential climbing
aids.
4. Maintain well built and adequately secured boundary gates and fences.
5. Fully secure all external doors and windows with good quality locking devices.
Make sure they are regularly maintained. All doors should be of solid construction
and well fitted.
6. Fasten steel door jamb strengtheners to wooden doorframes.
7. If padlocks are required to secure fixtures or items, confirm that they are
appropriate for their intended use.
8. Consider installation of security bars, screens, grills or roller shutters to
vulnerable windows, doors and / or skylights, subject to Fire Brigade approvals.
9. Consider installation of bollards, heavy planters or large rocks to act as ram raid
barriers.
10. Consider installation of a monitored security alarm system.
11. Prominently display any sign indicating the presence of a security system, the
continual CCTV surveillance of the premises and any other security measures
present.
12. Consider installing electronic sensors to advise practice team members when
visitors/patients are entering and leaving the practice.



_________________________________________________________________________________
                                              Nov-1999, Feb-2001, Dec-2001,
                                              Feb-2002, Feb-2003, Feb-2004,
                                   Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                    Section Three


13. Consider installation of surveillance cameras with continuous recording of the
video output which will act not only as a deterrent but will assist police in
identifying offenders. (Refer to CCTV section over)
14. Minimise posters and curtains on windows (where possible) to ensure visibility
to and from the street is maintained.
16. Consider layout of consultation rooms and arrange furniture and remove
obstacles which would come between the practice team member and the exit door
and minimize the risk the risk of the practice team members from becoming
trapped or cornered.
17. Duress buttons should be installed.
18. Secure and register all property of value including details of make, model,
serial number, description etc.
19. Clearly and permanently mark all property with your Australian Business
Number (ABN), practice name or a drivers‟ licence number, preceded by the letter
V if the licence is Victorian, NSW for New South Wales etc.
20. Minimise or do not store addictive drugs on premises and minimize drug
storage in general.
21. If a safe is present on site, ensure that it is located in a secure position and
affixed to the wall or floor.
22. Ensure all relevant staff/practice team members understand and obey lock-up
procedures.
23. Advise local police and any security provider of emergency after hour‟s
contacts for the practice.
24. Keep TV‟s, monitors and computers away from windows.


CLOSED CIRCUIT TELEVISION (CCTV)
Where to use
• After hours surveillance of areas which have little or no natural surveillance such
as passing motorists, pedestrians or employees
• Areas at risk to vandalism, graffiti or other criminal offences
• High-risk areas such as computer rooms or drug handling areas that are not
adequately protected by staff surveillance
• Entrances, exits, reception areas etc.


Equipment consideration
• Cameras – quality high resolution cameras provide quality images

_________________________________________________________________________________
                                              Nov-1999, Feb-2001, Dec-2001,
                                              Feb-2002, Feb-2003, Feb-2004,
                                   Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                     Section Three


• Video recorders/computer hard drives – connected to camera/s, continually
recording
• Copying facilities – to provide police with a copy of recorded footage
• Signage - clearly displayed reminding customers that all activity is being
recorded
• Monitors - placed in a prominent position easily observable by staff
It is important that staff know how to operate security equipment and that it is
tested and checked regularly.


Positioning of cameras
• At places where the offender/s is most likely to have to pass to gain access, such
as building entry/exit points, or areas where high value items are kept
• Clearly visible if seeking to deter potential offenders
• Placed at a height that captures a full view of the offenders face whilst not being
obscured by other interferences
• In areas where image capture will not be compromised by insufficient lighting.


For CCTV to be useful for police purposes, the largest possible facial image of an
offender is required. The usefulness of facial images captured is largely dependant
upon the quality of the camera used, lighting and the placement of cameras. Do
not position cameras at heights that only provide vision of the top of a persons
head.


KEY/ACCESS CARD CONTROL
• Must be maintained at all times after hours to ensure internal security
• Utilise security keys/cards that cannot be copied without authorisation
• Maintain a formal key/card register, ensuring that their issue and return is
monitored
• Utilise a lockable key/card storage cabinet which provides controlled and
restricted access
• When not in use keys/cards should be kept in a lockable steel cabinet located in
a secure area
• Maintain strict control of all keys/cards
• Keys/cards should be restricted to a minimum number of people and retrieved
from ex-employees.



_________________________________________________________________________________
                                               Nov-1999, Feb-2001, Dec-2001,
                                               Feb-2002, Feb-2003, Feb-2004,
                                    Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                   Section Three


PRIVATE SECURITY
When selecting a security provider, ensure that the provider is registered with the
Victoria Police Licencing Services Division. To check whether a security provider is
registered,   refer   to    the   Licencing     Services      Division     website     at
www.police.vic.gov.au. It is advisable to select a provider that has an established
reputation for quality service. To further check you can enquire with them about
their professional accreditations and associations with peak body regulatory
agencies such as the Australian Security Industry Association Ltd (ASIAL) that
offer complaint resolution processes for concerns about unsatisfactory or defective
work.


Source: Adapted with permission from Victorian Police Business Security Kit 2007.




_________________________________________________________________________________
                                             Nov-1999, Feb-2001, Dec-2001,
                                             Feb-2002, Feb-2003, Feb-2004,
                                  Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                   Section Three



FACT SHEET 2
AGGRESSIVE PEOPLE

Whilst the vast majority of patients are polite and friendly to deal with, violent
outbursts that occur inside a practice can result in physical or psychological injury
to practice team members, patients, the offender and/or damage to equipment or
fixture.


It may be useful to keep photocopies of the Description Form in a predetermined,
convenient location within the practice for quick and easy reference and use by
practice team members. Make sure that all practice team members are familiar
with its location and use.


PREVENTION
Educating your practice team members about the causes of violence can be a
useful investment in avoiding (patient complaints and) potential risks such as
those outlined above. Practice team members should be skilled to differentiate
between assertive, aggressive and potentially violent customers.


In all instances of dealing with aggressive people, the main priority is to ensure
the safety of yourself, your practice team members and your patients. Every
situation is different and as such there is no one, absolute set of procedures in
dealing with aggressive people. Following some basic steps however, may assist
practice team members to respond to such situations.


General Security Tips
1. Assess the situation and remain calm at all times.
2. If security officers are employed, ensure practice team members are aware of
when and how to contact them.
3. If it appears that the safety of practice team members or patients is at risk, the
police should be immediately telephoned on 000.


Aggressive Offenders
      Do not respond to the person‟s bad behaviour in the same manner.



_________________________________________________________________________________
                                             Nov-1999, Feb-2001, Dec-2001,
                                             Feb-2002, Feb-2003, Feb-2004,
                                  Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                    Section Three


      Remain respectful. Try to restore a sense of justice for the person. Explain
       what options are available and encourage them to try one of these.
      Patience is usually a good strategy and this can be achieved by not only
       listening to the person but by acknowledging their problem or situation.
      Practice team members should not take insults personally – they are being
       delivered by a person who appears unreasonable and may relate to practice
       policies and procedures as opposed to the employee personally.
      Listening can be useful to allow the person to „let off steam‟.
      Remember that over a period of time anger can diminish.
      Other team members not involved in the incident should not become an
       audience; however they should monitor the situation for any possible
       escalation.
      If the person is not able to be calmed and they continue to be offensive or
       obnoxious, politely request the person to leave the practice.
      If having been politely requested to leave a practice, a person refuses,
       contact the police and await their arrival. Do not engage in any further
       unnecessary dialogue.
      Provide a means of escape that does not involve crossing the path of the
       patient.
      Consult with another team member if conflict is anticipated.
      Call the police if an abusive situation seems likely to become violent.
      If the Practice cannot provide a safe environment, or staff with the relevant
       skills, a patient should not be retained on the patient list.


Violent Offenders
1. Do not enter the person‟s physical space as this can escalate the situation.
2. Discretely remove any items that could potentially be used as weapons.
3. Counter areas or display stands can be discreetly used to create natural barriers
and distance between staff members and the other person.
4. Practice team members are entitled to remove themselves from violent
situations and protect themselves from violence. The amount of force used
however to repel the violence, must be reasonable and proportionate to the harm
that is being sought to be avoided. Excessive force is not justified and can result in
a counter claim of criminal assault or civil litigation. Keeping weapons such as
baseball and cricket bats and guns on the premises is not advisable.



_________________________________________________________________________________
                                              Nov-1999, Feb-2001, Dec-2001,
                                              Feb-2002, Feb-2003, Feb-2004,
                                   Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                   Section Three


Source: Adapted with permission from Victorian Police Business Security Kit 2007.




_________________________________________________________________________________
                                             Nov-1999, Feb-2001, Dec-2001,
                                             Feb-2002, Feb-2003, Feb-2004,
                                  Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
(Practice Name) Policy & Procedure Manual                                     Section Three



FACT SHEET 3
PATIENT ALERT SYSTEMS - FILE
FLAGGING

Employers and practice team members have a responsibility to provide any
information with regards to a client‟s behaviour to all other practice team
members who may have contact with this patient. Patient alert systems or „File
flagging‟ may be a useful violence risk control strategy.


File flagging policies and protocols need to comply with relevant legislation and
must not be discriminatory. Victoria‟s Equal Opportunity Act 1995 (refer to Section
2.5) does not prohibit the flagging of files to identify patients presenting a risk to
the health and safety of patient team members and other patients. File flagging
systems must meet privacy requirements and are subject to freedom of
information requirements. Flagging information must be kept relevant, accurate
and up to date.


Retention of a flag that is no longer accurate will have implications under privacy
legislation and possibly the Anti-Discrimination Act. Thus an active flag should not
remain on a file once the risk is no longer current.


Issues to be covered in local “File Flagging” policies include:
      Clearly defined purpose for the flag
      Who is to be covered by the flag
      Ensure that your practice has a readily accessible patient management
       advice that supports the flag e.g. how to manage the patient so that
       violence is prevented.
      Define who has access to the information
      Ensure there is a criteria for the particular flag
      Ensure there is a process to review and remove flags as appropriate is
       critical to any flagging system.
      File flagging system needs to be supported by related management plans.
      Regular review of the management plan for continued appropriateness.
      Delegated responsibility for initiating, reviewing and removing flags; and

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        Delegated         responsibility        for     reviewing        and       updating        associated
         management plans.


Source: Adapted with permission from Tuschke H, Laver S, (2006) Preparing a
resource ToolKit Manual for Health workplaces in Victoria. Non-Tolerance of Violence.
Prevention and Management of client initiated aggression in Victoria‟s Health
Services. Unpublished.




Template Patient Alert

This should be placed prominently in the front of the patient’s paper file or could
be adapted to appear on the computer when the record is opened to inform
practice team members of potential risks to their health and safety or be
incorporated into your practice’s own file flagging policies and procedures. The
development and implementation of local file flagging policies and procedures
need to be done with due consideration to relevant legal requirements including
ant-discrimination and privacy legislation.




PATIENT ALERT
Based either on assessment or past behaviour the following potential areas or
risks to practice team members have been identified:
 …………………………………………………………..

Practice team members are advised to check the patient record and incident
register to familiarise themselves with these risks before contact, and are advised
to always use safe work practices for themselves and others.

SIGNED ……………………………………………. Designation

LAST UPDATED ……/……/…


Source: Australian Nursing Federation (Victorian Branch) Zero Tolerance (Occupational Violence and Aggression)
Policy and Toolkit 2002.




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FACT SHEET 4
PERSONAL SAFETY
Under the Occupational Health and Safety 2004 Act, (S2 and S4) all people have
the right to work in a safe environment in which risk to their health and safety is
minimised. Employers have an obligation to provide a safe working environment.


The tips below may assist practice team members to be safe. Additional factors
may need to be considered depending upon individual circumstances.


WITHIN THE PRACTICE


Employer Actions


          Ensure practice teams are familiar with emergency procedures and
           policies on how to deal with aggressive/difficult people.
          Consider establishing code words to alert practice principal/manager if
           practice team member is in a threatening situation or under duress.
          Duress alarms provided with appropriate coverage and appropriate
           response system in place.
          Practice employees authorised to contact emergency services directly if
           required.
          Restrict access to all areas of the practice other than the
           reception/waiting rooms and toilet facilities.
          Ensure valuables such as personal possessions belonging to staff
           remain locked away at all times. Never leave items such as mobile
           phones, handbags and wallets unattended.
          Don‟t leave cash or valuables at the practice.
          Do not remove cash or valuable when leaving alone.
          Alter banking routine frequently.


(NO AMOUNT OF PROPERTY IS WORTH RISKING YOUR SAFETY)


Working alone, after hours and weekends

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Employer Actions


   Put a system in place to ensure practice team members can leave and return
    safely, including when working alone, after hours and weekends, if
    appropriate.
   Ensure that there is adequate external lighting for practice team members
    when leaving the practice.
   Consider not allowing practice team members to work alone.
   If working alone, ensure policies and procedures are in place for working alone
    or at night.
   Install audible door announcers to identify when patients/visitors enter the
    practice.
   Ensure duress alarms are provided with appropriate coverage and appropriate
    there is a response system in place.
   Ensure torch and batteries are provided for use by practice team members.


Practice Team Actions


   Pre-program important numbers such as 000 into your business telephones
    and the mobile telephones.
   If you work alone or before/after normal practice hours, keep the practice door
    locked.
   Conduct a situational risk assessment and end a consultation if concerned that
    a risk of violence exists.
   If you work late, try to find another practice team member or a security guard
    to walk out with you to your car.
   Keep doors and windows locked if working late.
   When temporarily leaving the practice, notify a second party and advise that
    person of the practice team members‟ likely movements, expected time of
    return or arrival at next location.
   Position vehicles as close to your practice or premises as allowed.
   Report all suspicious persons/circumstances to the proper authorities: practice
    principal/manager, building security and/or the police.
   Be aware of all escape routes for emergencies and have police and security
    numbers displayed prominently.


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Travelling outside the practice


Employer Actions


   Ensure there are procedures in place for practice team members traveling to
    and from home visits.
   Procedures are in place to ensure practice team members advise Practice
    Principal and/or Manager of the patient‟s phone number, address and their
    expected arrival and return times.
   Ensure that a GP is not sent to a patient requesting pain relief for a chronic
    pain syndrome unless a pain management plan is in place
   Ensure   that      practice   team   members     are   provided     with   appropriate
    communications equipment.
   Ensure procedures are in place and training is provided to practice team
    members on what to do in the event of a vehicle breakdown.
   Consider ensuring practice team members use vehicles with automotive
    breakdown assistance.
   Consider ensuring that practice team members who are visiting a patient with
    an aggressive history or identifiable risk go in pairs or be provided with a
    security escort.
   Ensure that police are requested to attend patients threatening suicide, or who
    appear to be violent or abusive.




Practice Team Actions


   If a second person has been notified of a practice team members‟ departure
    from the practice, ensure that the same person is contacted and advised that
    the practice member has reached their intended destination safely.
   Avoid walking alone at night unless absolutely necessary, stay on lit paths and
    wear visible clothing.
   Wear comfortable clothes and footwear that allow for freedom of movement.
   Avoid shortcuts and dark, isolated areas.
   Walk purposefully and know where you are going.
   Walk on the footpath facing the oncoming traffic.

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   If you feel threatened, cross the road, locate a telephone, or enter a store or
    place of business even if you have just left it.
   If using a public telephone, stand with your back to the phone after dialing –
    maintaining a view of the surrounding area and persons approaching.
   Carry purses and handbags close to your body.




Home Visits


Employer Actions


       Ensure the practice has policies in place for traveling to and from home
        visits.
       Provide training to practice team members regarding policies, procedures
        and what to do in the event of a vehicle breakdown.
       Ensure practice team members have a system to document their location
        time of departure and return. The system must be actively monitored and
        supported by Management.
       Consider ensuring that a person is available (i.e. practice staffed) to
        respond appropriately if the practice team member does not return or
        make contact at the end of their visit.
       Consider contacting practice team members performing home visits within
        30 minutes of them arriving at a patient‟s home, using „yes/no‟ questions
        to determine if any issues exist.
       Where there is a known history or identified risk of violence and
        aggression, consider staff working in pairs or being provided with a security
        escort.
       Provide mobile phones with appropriate coverage and programmed with
        emergency numbers (including automotive breakdown assistance) and
        provided and taken on visits.
       Ensure practice team members are able to conduct a situational risk
        assessment and end a visit if they consider a risk of occupational violence
        exists.
       Be mindful of situations where a practice team member has attended a
        patient for a longer period than seems necessary and details of each team


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       member‟s vehicle type and registration number should be available to
       inform police if contact with the practice team member is lost.
      Establish   relationships   with   local   services   and   consult   with   other
       organisations working with the same patient.
      Ensure procedures established with police regarding best methods of
       contacting them in an emergency.


Practice Teams Actions


      Consider asking patients to restrain dogs, to turn on an outside light at night
       and provide guidance on identifying the residence (for example, nearest
       intersection).
      Carry a mobile telephone and a personal duress alarm for security linked to
       security personnel or police.
      Assess suitable and if possible, well lit areas to park vehicle and suitable
       access/egress points from the property to be visited.
      Park in an accessible position on the street (not in the driveway) where you
       can easily drive out in an emergency.
      When leaving the car, always close the windows and any glass vents,
       remove the ignition key and lock the doors.
      Consider not entering enclosed properties with a dog in the front yard, until
       the pet is secured by owner.
      Listen for any conflict that may be occurring at a premise before entering.
      Have car keys in hand ready for use. Do not search for them in a handbag
       along the way or when standing at the car door.
      Check inside the car by looking through the windows before getting in.
      Consider driving with all of the doors locked and the windows wound up.
      Do not leave valuable items visible inside the car.


Source: Adapted with permission from Victorian Police Business Security Kit 2007.




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                                   Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
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FACT SHEET 5
Robbery and Drug Related Incidents


A small amount of planning may assist in reducing the risks of robbery and drug
related incidents at the practice thereby maximizing the safety of practice team
members and patients.


It may be useful to keep photocopies of the Description form (see Appendix x) in a
predetermined, convenient place within the practice for quick and easy reference
and use by practice team members. Ensure all practice team members are familiar
with its location and use.


PREVENTION
   1. Do not discuss drug holdings or storage of drugs in public.
   2. Consider not keeping cash drugs such as S8 drugs or other drugs with
       addictive properties stored on site.
   3. Ensure procedures in place regarding handling of drugs and valuable
       equipment
   4. Ensure sharps containers are anchor bolted to prevent easy removal of
       container.
   5. If padlocks are required to secure drugs, ensure that the selected locks are
       appropriate for their intended use.
   6. Predetermine and designate escape routes and safe areas for practice team
       members to move to when required.
   7. Ensure all practice team members are aware of security and drug robbery
       procedures and what to do in the case of such an event. This routine
       should be regularly practiced as with any other type of emergency drill.
   8. Make use of signage and stickers (e.g. No drugs are held on these
       premises).
   9. Consider installation of additional security devices such as duress/panic
       buttons and quality Closed Circuit Television (CCTV).




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IN THE EVENT OF A DRUG RELATED INCIDENT


Employers
      Try to remain calm, assess the situation and do exactly as the offender
       says. Remember the number one priority is your safety, the safety of other
       practice team members and patients.
      Activate alarm devices as soon as possible but only if it is safe to do so.
      Avoid sudden actions and calmly explain any necessary movements to the
       offender. These could pose an unintended threat to the offender, who may
       already be anxious and tense.
      Speak only when spoken to as any conversation with the offender will
       prolong the incident.
      Observe and take not of any weapons that are being used.
      If safe to do so, observe the direction of travel taken by the offender/s
       when they leave the premises.
      Never take drastic action and do not chase the offender.




Practice Team members


If practice team members feel threatened by a patient or individual, especially
someone who is affected by drugs and seeking a prescription or needles:
      Consider giving the patient what they want and getting them out of the
       consulting room or practice as quickly as possible.
      Or leave the offender alone and vacate the practice.
      Then call the police.
      Don‟t confront them.




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AFTER THE INCIDENT


Employers
      Immediately telephone the police on 000, even if you have activated a hold
       up or duress alarm. Provide the police telephone operator with:
             Exact location – practice name/address of where the crime occurred
              including the closest intersecting street
             Your name
             Details of persons injured and whether medical assistance is
              required
             Date/Time/Nature of the offence
             Number and description of offender/s including any vehicles used
             Direction of travel
             Only hang up the telephone when told to do so and stay off the
              phone until police arrive unless you remember additional
              information that may be important.
             Close the practice to the public and keep unauthorized persons out.
             Make sure that no person touches or moves any items where the
              offender/s was/were present.
             Consider arranging someone to meet police outside.
             Request that witnesses, practice team members and/or patients
              remain until the police arrive – failing that, request their names,
              addresses and telephone numbers and pass them onto police when
              they arrive.
             Supply to police all details no matter how insignificant they appear
              to you. This could include earlier suspicious patients/visitors, rude,
              drunk or drug affected patients or simply details of certain cars
              constantly driving past.
             Crime affects different people in different ways and the impact may
              not be felt immediately. Consideration should be given to organising
              professional trauma counseling for employees affected by crime.




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Description Form




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Source: Adapted with permission from Victorian Police Business Security Kit 2007.



FURTHER INFORMATION/CONTACTS
For urgent police, fire brigade or ambulance attendance, dial 000

For further crime prevention information contact your nearest police station and
request contact details for the Divisional Crime Prevention Officer in your area

You can also visit the Victoria Police website at www.police.vic.gov.au or
Crimestoppers
1800 333 000 or www.vic.crimestoppers.com.au

For further information and support for victims of crime contact Victims of Crime
Helpline
1800 819 817 or www.justice.vic.gov.au

For further safety and prevention information contact WorkSafe
www.worksafe.vic.gov.au or 03 9641 1444 or 1800 136 089 (toll free)

Victorian Police Victorian Police Business Security Kit 2007 available from the Victoria
Police website www.police.vic.gov.au


It is not possible to provide an exhaustive list of specialist general practice and other
health professional advisory and regulatory bodies however the list below will provide
a good starting point.

Australian Nursing Federation (Victoria Branch) www.anfvic.asn.au or 03 9275 9333
or 1800 133 353 (regional toll free)

Australian Medical Association, 03 9280 8722 or 1800 810 451 (Australia toll free) or
www.amavic.com.au

General Practice Victoria http://www.gpv.org.au or 03 9341 5200 has a
Division Directory and provides a range of services to divisions of general
practice.

Royal Australian College of General Practice (Victoria) vic.faculty@racgp.org.au
or 03 8699 0488




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REFERENCES

Australian Nursing Federation-Victorian Branch (2002). Zero Tolerance (occupational
violence and aggression) Policy. ANF, Melbourne.

Delaney J (2001), Prevention and Management of Workplace Aggression: Guidelines
and Case Studies from the NSW Health Industry, Central Sydney Area Health
Service.

Royal Australian General Practitioners. Safety for general practitioners and their
practice teams: position statement of the Royal Australian College of General
Practitioners. Melbourne: RACGP, 2007. http://www.racgp.org.au/gpissues/safety
(accessed Dec 2007).

Royal Australian General Practitioners (2006). Difficult patient information sheet.
Melbourne: RACGP. 2006.
http://www.racgp.org.au/Content/NavigationMenu/Advocacy/IssuesinGeneralPractice/
GPsafetyissues/Difficult_Patients_Defence_Update_Winter06.pdf (accessed Dec
2007).

Royal Australian General Practitioners. Safety for general practitioners and their
practice teams. Fact Sheet. Melbourne RACCGP 2007.

Magin PJ, Adams J, Sibbritt DW et al. Experiences of occupational violence in
Australian urban general practice: a cross-sectional study of GPs. MJA 2005; 183 (7):
352-356.


Mayhew C, Chappel D. Violence in the workplace. Med J Aust 2005: 183:346-347.

NHMRC. When it‟s right in front of you – assisting health care workers to manager the
effects of violence in rural and remote Australia. Commonwealth of Australia. 2002.
Accessed from: http://www.nhmrc.gov.au/publications/synopses/_files/hp16.pdf.
19/5/07.

NSW Department of Health. Zero Tolerance. Policy and Framework Guidelines. 2003.
Accessed from http://www.health.nsw.gov.au/pubs/z/pdf/zero_tol_guide.pdf. 20/5/07.


Nurse Policy Branch, Victorian Government Department of Human Services. Victorian
taskforce on violence in nursing. Final report. Melbourne: Nurse Policy Branch, 2005.

Tolhurst H, Murray G, Bell P, et al. Rural general practitioner experience of work-
related violence in Australia Aust Journal of Rural Health 2003 Oct; 11(5): 231-6.


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                                               Nov-1999, Feb-2001, Dec-2001,
                                               Feb-2002, Feb-2003, Feb-2004,
                                    Feb-2005, Feb-2006, Feb 2008, Aug 2010, March 2011
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Tuschke H, Laver S, (2006) Preparing a resource ToolKit Manual for Health
workplaces in Victoria. Non-Tolerance of Violence. Prevention and Management of
client initiated aggression in Victoria‟s Health Services. Unpublished.

Victorian Police (2006). Victorian Police Business Security Kit 2007 (accessed Aug
07) www.police.vic.gov.au

WorkSafe Victoria (2006). Employee Representation. A comprehensive guide to Part
7 of the Occupational Health and Safety Act 2004.
WorkSafe Victoria (2005) Designing Safer Buildings and Structures. 1st Edition. A
guide to section 28 of the Occupational Health and Safety Act 2004.

WorkSafe Victoria ((2003) Prevention of Bully and Violence at Work. Guidance Note.

WorkSafe Victoria (2005). Summary of the occupational health and safety act 2004.
2nd Edition.

WorkSafe Victoria (2005) Guide to the OHS Act 2004. A guide to your responsibilities
under the Occupational Health and Safety Act 2004. . 1st Edition.

WorkSafe Victoria (2003), Workplace Violence and Bullying: Your Rights, What to Do,
and Where to Go for Help WorkSafe Victoria. Melbourne.




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