Emerging Idea: Violence Prevention Program in Manitoba Hospitals

Rationale / Objectives

A recent survey by the Manitoba Nurses Union, found that 30 percent of nurses had been assaulted and 50 percent had been intimidated by patients while on the job. In 2011, Manitoba introduced a Provincial Healthcare Violence Prevention Program via a Provincial Advisory Committee on Violence Prevention. The program was researched and developed for province-wide implementation based on evidence suggesting that almost one-quarter of all incidents of workplace violence occurred at health services organizations. Part of this program includes the two purple ring symbols which are put on the doors of potentially violent patients to warn healthcare professionals of possible danger.           

Project/Program Description & Major Achievements

Manitoba’s health care violence prevention program involves a variety of elements including provincial Policy and Operational procedures on violence prevention, measures and procedures for summoning Immediate Assistance when an incident of violence occurs or is likely to occur, and referral to a healthcare provider for treatment or for post-incident counseling where appropriate. The incident reporting, investigation and follow-up includes the implementation of control measures and a provincial orientation and training curriculum for violence prevention.The purple ring symbol initiative to prevent violence uses patient screening to identify the risks of violence and measures to reduce these risks. Staff rely on the two purple rings to warn them of potential danger. The rings are placed on a patient’s door or in their room to notify workers that the patient may have been violent in the past. This ensures more effective, respectful communication regarding the potential for and actual violent behaviour of a patient. 

Lessons Learned

The safety of nurses and other healthcare professionals is important to maintain a stable and healthy healthcare organization. It is necessary to have strategies and programs to address workplace violence.

Further Description

The provincial healthcare violence prevention program is working diligently to implement a number of important elements. The Manitoba health policy has been adopted, environmental assessments of all sites have begun and are scheduled, the provincial screening tool for use in facilities has been adopted and a person of interest program for those not seeking care has been developed.Manitoba Health Care is committed to providing a safe and respectful environment for patients, staff and visitors. To do so, all patients are screened for possible aggression and violence.  The types of violence that can occur include type 1 (criminal intent), type II (customer/client), type III (worker-on-worker) and/or type IV (personal relationship). It is hoped that the ring symbol can help violence prevention and response. Before the initiative can be introduced, the staff must be trained on four modules which include strategies such as diffusing difficult behaviour, dealing with conflict and summoning assistance when it's needed. Some patients are not able to control their outbursts, but the purple rings will not impact their right to privacy. There are numerous symbols throughout hospitals on patients' doors and in their rooms already, so the use of this new visual system is not anticipated to cause disrutpion. Anecdotally, no complaints have been heard about the strategy.

Major Achievements

The achievements of the program to date include: 13,600 staff members have completed the first module of training, and 9,500 have completed both the first and second models as of February 1, 2017. Nurses are speaking favourably about the purple rings and the perception is that patients are receiving better health care as a result. This case study will be updated once more data becomes available.