Safety

Safety for patients, families, and ourselves is a paramount priority, without which no other interventions can ensue. Below is the policy for safety incidents in outpatient clinics involving violent or near-violent behavioral escalations.

Definition of Violent or Near-Violent Incident: Any incident that involves a threat of or actual physical harm to someone, as perceived by the victim.

Prevention: All trainees and faculty in the outpatient clinics should participate in Professional Assault Crisis Training for the Outpatient Setting

During an incident: When a violent or near-violent incident involving a patient and a trainee (psychiatry resident, fellow, psychology intern, medical student, or other rotator in clinic) occurs in any outpatient clinic, the clinic director and other clinic attending supervisor(s) will be responsible for ensuring that the immediate and short-term needs of the involved patient and trainee are met in a timely manner.

Postvention: It is the responsibility of the director of the clinic, supervisors, and the training director to follow-up with the patient and family and with the affected trainee to ensure that post-incident procedures have been followed.

Procedure:

• Prevention:
  • All trainees in the outpatient setting should receive an assault crisis training specific to outpatient services.
  • All faculty in the outpatient setting (at UCLA Westwood campus, the VA, Harbor and other sites that trainees rotate) should be offered faculty development in procedures involving a violent incident.
  • Outpatient clinic environments should all be assessed for safety (functioning panic buttons) and should consider a safety drill annually.
• During an incident:
  • When an incident occurs, the clinic director (or other supervising faculty if the clinic director is not present or available) is notified and supervises the care of the patient, the trainee involved, and others in the clinic. These responsibilities include: mobilizing additional support staff, securing the involved patient in a room away from others, ensuring that others in clinic area are safe, and making sure that campus security (310-825-1491) is contacted, if needed.
  • If the incident occurs after hours or if the injury requires emergency room attention, the clinic director/faculty will send the trainee to the ER. If the incident occurs Monday-Friday 7:00AM -4:30pm the clinic faculty will send the trainee to the Occupational Health Facility (10833 Le Conte Avenue, Suite 17-240 CHS, 1^st Floor Main Lobby of CHS near Café Med).
  • With any Violent or Near-Violent incident, the clinic director/faculty should check-in with the trainee immediately after the incident, offer to have the trainee leave clinic (to go home or other location), and check in again at the end of the clinic day. Multiple follow-ups with the trainee should be considered, including the next day, the next week, and additional times as It is at the discretion of the direct supervisor/clinic director to determine if the trainee should be sent home, even if the trainee says that they can continue working.

Because it is not always possible to assess the effects of such an incident on oneself until some time has passed, some individuals may appear and report being “fine” immediately post incident but have residual posttraumatic stress and other psychological effects days or weeks later. Any incident, no matter how seemingly mild, may have significant deleterious effects on a trainee and/or others who witnessed the incident.

• •  The clinic director/faculty should also alert the appropriate program director (for General Residents contact Katrina Debonis, p26168; for Child Fellows contact Dr. Misty Richards, p29042; for Psychology Interns contact Dr. Patricia Walshaw, p24707; for Geriatric Fellows contact Dr. Denise Feil (dfeil@mednet.ucla.edu); and for Addiction Fellows contact Dr. Larissa Mooney, p24886 about the incident). The clinic director/faculty will confirm that an incident report has been completed by the trainee.
  • The trainee’s program director will assist the trainee in contacting, as necessary, the appropriate resources: UCPD (310-825-1491), Office of Legal Affairs (310-794-3138), Quality Management/Patient Relations (310-267-9092). The program director also confirms with the trainee that an incident report has been completed and submitted.
  • The program director confirms that all aspects of emergent care have been addressed and should facilitate the trainee obtaining legal information/services (which may include workers compensation). The program director should also facilitate communication with parties that the trainee indicates (e.g., the trainee’s significant other, other trainees, other faculty, etc.).

• Postvention:
  • The program director, along with the program coordinator, should also help facilitate appropriate follow up care for the trainee, as This may include medical or psychiatric referrals, arranging needed time off or leave of absence, and coordinating return-to-work issues.
  • Clinic director and supervising faculty should address the incident with the clinic team as needed, providing post crisis discussion, processing the incident, identifying if there are additional individuals who have been traumatized, planning for future prevention efforts, addressing future care for patient/family in the outpatient setting (consider change in trainee assignment for involved patient, as needed).
  • Follow-up of incident reports of violent or near violent incidents in the outpatient clinics should be assessed with continuous quality improvement efforts resulting from such tracking and assessment.