provincial violence prevention curriculum module 8 … · · 2014-11-10provincial violence...

P r o v i n c i a l V i o l e n c e P r e v e n t i o n

C u r r i c u l u m

M o d u l e 8 – B e h a v i o u r a l C a r e P l a n n i n g f o r V i o l e n c e P r e v e n t i o n

VE R S I O N 2.3

J A N U A R Y , 2011

V I O L E N C E P R E V E N T I O N

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T A B L E O F C O N T E N T S

Acknowledgements ............................................................................................................ iii

Course Overview ................................................................................................................. 1

Course introduction ............................................................................................................. 1

Course objectives ............................................................................................................... 1

Conducting a Patient Violence Risk Assessment (PVRA) ..................................................... 2

Introduction ....................................................................................................................... 2

PVRA defined ...................................................................................................................... 2

Why should I conduct a PVRA? ............................................................................................. 2

How do I conduct a PVRA? ................................................................................................... 3

When should I conduct a PVRA? ............................................................................................ 4

Components of a Detailed PVRA .......................................................................................... 5

Introduction ....................................................................................................................... 5

1. Mental and/or emotional state .......................................................................................... 5

2. Observed behaviours ....................................................................................................... 6

3. Communication ............................................................................................................... 7

4. Ability to inflict harm ....................................................................................................... 7

5. Stressors ....................................................................................................................... 8

Test Your Knowledge #1 ..................................................................................................... 9

Communicating Risk .......................................................................................................... 10

Introduction ..................................................................................................................... 10

How do I communicate risk? .............................................................................................. 10

How are violence alerts applied? ......................................................................................... 11

Why and how do I develop a behavioural violence prevention care plan? ................................. 11

Test Your Knowledge #2 ................................................................................................... 12

Step number .................................................................................................................... 12

Task ................................................................................................................................ 12

Developing Interventions .................................................................................................. 13

Introduction ..................................................................................................................... 13

Acute care – caution risks .................................................................................................. 13

Acute care – high risks ...................................................................................................... 13

Community care – caution risks .......................................................................................... 14

Community care – high risks .............................................................................................. 14

Residential care – caution risks ........................................................................................... 14

Residential care – high risks ............................................................................................... 15


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Why Charting is Important ................................................................................................ 16

Introduction ..................................................................................................................... 16

How can charting help me and my co-workers deal with violence? .......................................... 16

How can charting help me and my co-workers after a violent incident? .................................... 17

How can charting help the patient? ..................................................................................... 17

How can charting help the health care organization? ............................................................. 17

Charting Basics for Violence Prevention ............................................................................ 18

Introduction ..................................................................................................................... 18

Keep the information factual .............................................................................................. 18

What not to do ................................................................................................................. 18

Test Your Knowledge #3 ................................................................................................... 19

What You’ve Learned ........................................................................................................ 20

Module 8 Quiz .................................................................................................................... 21

Test Your Knowledge - Answer Keys ................................................................................. 24

Test Your Knowledge # 1 ................................................................................................... 24



Module 8 Quiz Answer Key ................................................................................................ 25

Notes ................................................................................................................................. 26


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A C K N O W L E D G E M E N T S

This Violence Prevention Curriculum was developed as a project of the Provincial

Violence Prevention Steering Committee (PVPSC) to fill a need for effective, recommended and provincially-recognized violence prevention training for all British Columbia healthcare workers across a range of care settings, including affiliate organizations. The Curriculum includes eight online and five classroom modules.

The PVPSC wishes to acknowledge the generous support and commitment of the

management and the subject matter experts representing the following health authorities and healthcare unions. Without their expertise the development of this curriculum would not have been possible.

British Columbia Nurses’ Union Union of Psychiatric Nurses of BC Hospital Employees’ Union Health Sciences Association of BC

Fraser Health Authority Interior Health Authority Vancouver Coastal Health Authority Northern Health Authority Vancouver Island Health Authority Providence Health Care Provincial Health Services Authority

WorkSafeBC Occupational Health and Safety Agency for Healthcare (OHSAH) in BC

The PVPSC would also like to acknowledge the British Columbia Ministry of Health funding received through the Joint Quality Worklife Committee and the financial support provided by OHSAH for the Provincial Violence Prevention Curriculum Project.

The copying, reproduction and distribution of this guide to promote effective Violence Prevention activities in the Healthcare Industry is encouraged; however, the current owner, the Provincial Health Services Authority (PHSA), should be acknowledged. Written permission must be received from PHSA if any part of this curriculum is used for any other publication. This curriculum, whether in whole or in part, must not be used or reproduced for profit.

This course has been developed by Andrea Lam, Ana Rahmat, Chris Back, Charles

Ballantyne, Dailaan Shaffer, Deb Niemi, Helen Coleman, Joe Divitt, Kathryn Wellington, Lara Acheson, Larry Bryan, Leslie Gamble, Lynn Vincent, Marg Dhillon, Marty Lovick, Michael Sagar, Peter Dunkley, Phil Goodis, Rob Senghera, Sheile Mercado-Mallari, Sherry Moller and Tara McDonnell. The information on the fight/flight/freeze response and self settling strategies was contributed by Shayna Hornstein.

Bringing a group of subject matter experts to the table to develop a curriculum

such as this takes vision, passion and a diversity of experience and practice. The creators of this curriculum drew on their skill in and knowledge of the following disciplines:


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o Mental Health and Addictions o Occupational Health and Safety o Social work

o Healthcare Violence Prevention programs o Geriatric care o Nursing o Psychiatry o Physical strategies and team response training

Course Materials Designed by Tanya Schecter and Brad Eastman.

Photographic contributions by fotografica studio ltd.

This curriculum was developed during 2010 by the Provincial Violence Prevention Curriculum Team at Vancouver, British Columbia, Canada.


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C O U R S E O V E R V I E W

C O U R S E I N T R O D U C T I O N

As a healthcare worker, conducting a patient violence risk assessment (PVRA) is

an important component in preventing violence. Essentially, it allows you to identify known risks, communicate them to others, and develop appropriate interventions.

In this module, you will learn about:

Conducting PVRAs

How to communicate risk

How to develop interventions

C O U R S E O B J E C T I V E S

By the end of this course, you will be able to:

Describe how to conduct a patient violence risk assessment (PVRA)

Identify the various components of a PVRA

Identify ways of communicating risk

Identify how to develop violence interventions

Identify how charting can help prevent violence

Identify how to chart more effectively

In order to complete this course, you need the following materials:

This participant guide

Optional: a computer with internet access to look up additional resources (e.g., glossary, references)


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C O N D U C T I N G A P A T I E N T V I O L E N C E R I S K

A S S E S S M E N T ( P V R A )

I N T R O D U C T I O N

Conducting a patient violence risk assessment (PVRA) is a key element in violence prevention.

P V R A D E F I N E D

A patient violence risk assessment (PVRA) is an assessment that deals specifically with a patient's potential for violence or observed violent behaviours. It is

conducted as part of a general patient assessment and is used by clinical staff to

help create a behavioural violence prevention care plan.

W H Y S H O U L D I C O N D U C T A P V R A ?

Completing a comprehensive PVRA is important since the results:

Are the basis for creating a violence prevention care plan

Help gather information to establish baseline behaviour and allow staff to track behavioural changes

Help to determine intervention options

Help to determine if a violence alert is needed

Allow for care to be provided in a way that ensures both staff and

patient safety


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H O W D O I C O N D U C T A P V R A ?

The standard practice for conducting a PVRA includes using:

A screening tool (e.g., found in nursing admission forms) to

identify:

Recently reported or demonstrated verbal or physical violence

A history of violence

Pre-existing violence alert(s)

Behaviours or conditions which indicate an increased risk of violent behaviour

A detailed violent behaviour assessment (e.g., form, assessment tool, multi-disciplinary consult, etc.) if the screening tool reveals the existence of any of the above

Some sectors also have additional specific risk assessment practices (e.g., pre-visit screening calls). Talk to your supervisor to learn more.


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W H E N S H O U L D I C O N D U C T A P V R A ?

You should conduct a screening whenever a patient is admitted, re-admitted, or transferred to another care service or care provider and before visiting a home

You should conduct a detailed PVRA assessment when:

Screening indicates a risk

A patient exhibits agitated or violent behaviours

A patient exhibits a change in physical, mental, or emotional condition that affects their behaviour

A patient has a history of violence


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C O M P O N E N T S O F A D E T A I L E D P V R A


A comprehensive patient violence risk assessment evaluates the patient in terms

of five specific areas. Once you have gathered information in each area, you make a determination about the patient based on their overall level of risk for violence. This determination then informs how interventions are developed.

Identifying, documenting, and treating the patient according to their assigned

risk status is the first step in violence prevention care planning. The next steps involve developing ways to address the risks in the care plan.

1 . M E N T A L A N D / O R E M O T I O N A L S T A T E

Treat a patient with caution if they:

Are disoriented

Describe intrusive and/or persistent thoughts

Cannot grasp the consequences of their actions

Exhibit paranoid behaviours

Are actively hallucinating

Have a change in medical condition

Exhibit or report substance misuse and/or withdrawal

Treat a patient as high risk if they exhibit and/or report:

Feelings of extreme anger

Wanting to inflict harm

Constantly feeling provoked

Drug/alcohol intoxication

That they are unable to calm themselves through discussion


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2 . O B S E R V E D B E H A V I O U R S

Based on the behaviours that you observe, treat a patient with caution if they demonstrate rising anxiety levels such as:

Fidgeting and/or pacing

Restlessness

Increasingly withdrawn

Difficulty/reluctance to follow the care plan

Irrational intent to leave against medical advice

Treat the patient as high risk if they demonstrate:

A lack of awareness of, or respect for personal space

Increased activity level (e.g., waving arms, throwing items, slamming doors, etc.)

Verbal or physical violence

Belligerent and/or threatening behaviour


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3 . C O M M U N I C A T I O N

Treat a patient with caution if they cannot make themselves understood as a result of a language barrier resulting from either:

Cognitive impairment

Aphasia

Lack of familiarity with the English language

Hearing difficulties

Treat a patient as a high risk if they are:

Unwilling to communicate appropriately (e.g., are challenging or

demanding)

Demonstrating verbal violence (e.g., swearing, yelling, etc.)

Unable or unwilling to communicate

4 . A B I L I T Y T O I N F L I C T H A R M

Treat a patient with caution if they have the ability to inflict harm even if

restricted in their mobility (e.g., confined to a bed or wheelchair).

Treat a patient as high risk if they have both the strength and mobility to inflict harm.


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5 . S T R E S S O R S

It is important that you uncover a patient's known stressors (e.g., noise, fear of needles, etc.) and the best way of addressing them so that these can be included in the care plan and communicated among workers.


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T E S T Y O U R K N O W L E D G E # 1

Select all statements that are TRUE. Once you’ve completed the quiz,

you can go to the end of this guide to check your answers.

1. A Patient Violence Risk Assessment is conducted as part of a general patient assessment.

2. A behavioural violence prevention care plan is based on PVRA results.

3. A PVRA is ONLY used as a screening tool.

4. You should ONLY conduct a PVRA upon patient admission or if the patient

demonstrates violent behaviour.

5. A comprehensive PVRA evaluates a patient in terms of five specific areas.

6. It is important to uncover all of a patient's stressors so that these can be included in the care plan and communicated among workers.


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C O M M U N I C A T I N G R I S K


If a risk for violence is identified through a Patient Violence Risk Assessment, you are responsible for communicating the risk.

H O W D O I C O M M U N I C A T E R I S K ?

You must communicate an identified risk for violence to all workers involved

in the patient’s care. This can include:

Manually or electronically entering it on the patient’s chart

Including it in the kardex

Verbally reporting it at shift change or break coverage

Reporting it to a physician and requesting medical assessment and guidance

Adding a violence alert

Please consult your supervisor to learn more about the procedure that you must follow.


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H O W A R E V I O L E N C E A L E R T S A P P L I E D ?

You can apply a violence alert symbol (e.g., purple dot):

On a chart

On a whiteboard

On the kardex

On a wristband

Above the patient's bed

Outside the patient's room

You can also apply a violence alert electronically.

W H Y A N D H O W D O I D E V E L O P A B E H A V I O U R A L V I O L E N C E

P R E V E N T I O N C A R E P L A N ?

You need to develop a behavioural violence prevention care plan in order to communicate to other workers about the risk for violence and interventions that address the risks.

In order to develop and maintain a care plan, you need to:

1. Gather information to create a baseline

2. Complete a PVRA and use the information to develop interventions

3. Create the care plan

4. Track changes in patient behaviour

5. Continually assess the care plan to determine whether or not it is effective

6. Modify the care plan if it is not effective

7. Communicate changes to the care plan


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Order each step for developing and maintaining a care plan in the correct order. Once you’ve completed the quiz, you can go to the end of this guide to check your answers.

S T E P

N U M B E R

T A S K

Continually assess the care plan to determine whether or not it is effective.

Track changes in patient behaviour.

Create the care plan.

Modify the care plan if it is not effective.

Communicate changes to the care plan.

Complete a PVRA and use the information to develop

interventions.

Gather information to create a baseline.


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D E V E L O P I N G I N T E R V E N T I O N S


Different care sectors use different interventions for providing care to potentially

violent patients. These are further divided into caution and high risk categories. Once interventions are developed, they are included in the care plan. When responding to a patient, you must always use the least restrictive and most appropriate response.

A C U T E C A R E – C A U T I O N R I S K S

Possible interventions for acute care patients who must be treated with

caution (in terms of violence prevention) include:

Identifying and documenting patient specific de-escalation or distraction techniques for staff to use

Relocating the patient to a quieter area without isolating yourself

Asking a family member, if available, to sit with the patient and help out, if safe to do so

Requesting clinical consults with a specialist (e.g., traumatic brain injury

program, mental health and addictions, geriatrician, psychiatrist)

Calling for preventative backup (e.g., co-worker, security, or Code White team)

A C U T E C A R E – H I G H R I S K S

Possible interventions for acute care patients who are identified as high risk include (in no particular order):

Developing a care contract with input and agreement from site administration

(talk to your supervisor to learn more)

Using restraints (e.g., ankle, wrists, chemical, etc.) or seclusion as ordered by the doctor and in keeping with legislation, local policies, and procedures

Using two-person care at all times

Using appropriate observation levels

Removing all items that can potentially be used as weapons from a room

(e.g., cutlery, sharps, etc.)

Searching and securing a patient's belongings (talk to your supervisor to learn

more)

Calling Code White, for a team response, security, or the police

Initiating the process for transferring the patient to a tertiary or regional hospital that has better resources for managing violence (talk to your supervisor to learn more)


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C O M M U N I T Y C A R E – C A U T I O N R I S K S

Possible interventions for community care clients who must be treated with caution (in terms of violence prevention) include:

Identifying and documenting patient specific de-escalation or distraction techniques for staff to use

Making pre-visit phone calls to check for the presence of specific risks (e.g.,

client and/or family/friend sobriety)

Scheduling home visits during daylight hours only

Asking the client’s family to assist, if safe to do so

Scheduling alternate means of care (e.g., meeting a client in a public space or in the office instead of their home)

Developing a care contract with the client

Requesting clinical consults with a specialist (e.g., traumatic brain injury

program, mental health and addictions, geriatrician, psychiatrist)

C O M M U N I T Y C A R E – H I G H R I S K S

Possible interventions for community care clients who are identified as high risk include (in no particular order):

Assigning/scheduling two person care at all times

Ensuring that the client or client’s family remove all items that can be used as weapons (e.g., rifles, knives, etc.)

Arranging for care to be provided in more secure areas

Having the police accompany the worker on visits to the home

Following working alone policies and procedures

R E S I D E N T I A L C A R E – C A U T I O N R I S K S

Possible interventions for residents who must be treated with caution (in terms of violence prevention) include:

Identifying and documentation resident specific de-escalation or distraction techniques for staff to use

Relocating the resident to a quieter area without isolating yourself

Asking the resident's family, if available, to sit with the resident and help out, if safe to do so

Requesting clinical consults with specialists (e.g., traumatic brain injury program, mental health and addictions, geriatrician, psychiatrist, etc.)

Identifying resident-specific stressors and care needs and the best way of addressing them (e.g., bathing, toileting, fear of dark, etc.)

Searching for and removing or securing all items from a room that may, potentially, be used as a weapon (e.g., unsecured furniture, etc.) as per organizational policy


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R E S I D E N T I A L C A R E – H I G H R I S K S

Possible interventions for residents who are identified as high risk include (in no particular order):

Calling Code White, for a team response, security, or the police

Using two person care at all times

Using appropriate observation levels

Searching for and removing or securing all items from a room that may, potentially, be used as a weapon (e.g., unsecured furniture, etc.) as per organizational policy

Initiating the process for transferring the resident to a tertiary or regional

hospital or psychiatric center that has more resources for managing violence (talk to your supervisor to learn more)


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W H Y C H A R T I N G I S I M P O R T A N T


Charting is an important violence prevention tool.

H O W C A N C H A R T I N G H E L P M E A N D M Y C O - W O R K E R S D E A L W I T H

V I O L E N C E ?

Charting may help you and your co-workers deal with violence since:

Communicating using the chart helps prevent further violence once

an incident has occurred

It helps verify why care could not be provided or had to be altered (this can help you when discussing the situation with a manager or a patient's family)

It helps your unit to get required resources (i.e., if it is not charted,

the organization will not recognize this need as quickly)

It helps you and your co-workers communicate successes and lessons learned about the most effective care approaches

Documenting patterns of behaviour may alert others to identified risks


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H O W C A N C H A R T I N G H E L P M E A N D M Y C O - W O R K E R S A F T E R A

V I O L E N T I N C I D E N T ?

Charting can support:

A WorkSafeBC claim if you or a co-worker are physically or emotionally injured while caring for a patient

A legal claim since the legal system treats the chart as the most reliable source of information to determine what happened in:

Lawsuits

Coroners' inquests

H O W C A N C H A R T I N G H E L P T H E P A T I E N T ?

Charting can help the patient by:

Allowing workers to communicate successes or lessons learned

about the most effective care approaches among themselves

Allowing workers to develop optimal treatment plans for the patient

Making sure that workers provide a consistent care approach (to prevent further violent episodes)

H O W C A N C H A R T I N G H E L P T H E H E A L T H C A R E O R G A N I Z A T I O N ?

Charting can help your healthcare organization by:

Identifying needs for more effective and defined violence prevention

procedures, policies, and resources

Providing your employer with information to better support you if legal implications arise as a result of a violent incident


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C H A R T I N G B A S I C S F O R V I O L E N C E P R E V E N T I O N


Documenting specific types of information consistently will help make charting a more effective violence prevention tool.

K E E P T H E I N F O R M A T I O N F A C T U A L

This means only recording:

The physical behaviours that you observed

The exact verbal outbursts or language you heard, even if it is vulgar

Any interventions/safety precautions you took and the patient’s response(s)

How the patient's treatment and/or care was affected

Attempts to contact the physician in the event that this behaviour was uncommon for the patient

W H A T N O T T O D O

Do NOT:

Use subjective terms (e.g., aggressive +++ or violent +++ or "was violent for no apparent reason") since these do not define the

situation and can be interpreted in a variety of ways. They also do

not meet legal charting requirements.

Use medical jargon or abbreviations (e.g., OT instead of occupational therapist).

Express your feelings in the chart.

Chart anything that you have not observed yourself (i.e., incidents relayed to you by others) unless you document the source (e.g., information reported from a care aide along with the care

aide's name).

Label the patient or include inflammatory comments (e.g., homeless bum, patient reacted as a psycho, etc.).


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Select all statements that are TRUE. Once you’ve completed the quiz,

you can go to the end of this guide to check your answers.

1. A chart is not a legal document.

2. Charting can support your WorkSafeBC claim if you are injured while

caring for the patient.

3. Charting can help the patient by allowing workers to create optimal treatment plans for the patient and make sure that workers provide a consistent care approach.

4. You can use subjective terms (e.g., violent +++) when charting.

5. You must record physical behaviours that you observed when charting.


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W H A T Y O U ’ V E L E A R N E D

In this module, you've learned the following key points:

A PVRA is an assessment that deals specifically with a patient's potential for violence or observed violent behaviours. You can use PVRAs as a screening tool and as a detailed assessment tool whenever 1) screening indicates a risk, 2) a patient indicates agitated or violent behaviours, 3) a patient exhibits a

change in physical, mental, or emotional condition that affects their behaviour, and 4) a patient has a history of violence.

A PVRA evaluates a patient in terms of 1) mental and emotional state, 2)

observed behaviours, 3) communication, 4) ability to inflict harm, and 5) stressors.

PVRA results: 1) are the basis for creating a behavioural violence prevention

care plan, 2) allow staff to track behavioural changes, 3) help determine intervention options and whether a violence alert is needed, and 4) allow care to be provided in a way that ensures staff and patient safety.

You must communicate identified risks for violence to other workers. You can communicate risk verbally, electronically, and in writing. You can also use a violence alert symbol.

Different care sectors use different violence prevention interventions for

dealing with potentially violent patients. These interventions are further divided into caution and high risk categories.

Charting is a violence prevention tool that can help protect you, your co-

workers, and the patient. When charting you must keep information factual and avoid subjective terms (e.g., violent +++).


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M O D U L E 8 Q U I Z

Please complete the following quiz once you have finished this module. Circle the correct

answer(s) for each question.

1) A PVRA is: A. Short for Patient Violence Risk Appraisal

B. An assessment that deals specifically with a patient’s potential for violence or observed violent behaviours

C. Conducted as part of a general patient assessment D. Used by clinical staff to help create a behavioural intervention schedule E. All of the above

2) Conducting a PVRA allows you to identify known risks, ________ them, and develop appropriate interventions. A. Prevent

B. Communicate C. Isolate

3) The benefits of conducting a PVRA include:

A. Helping to gather information to establish baseline behaviour B. Helping to determine if a violence alert is needed C. Providing a basis for creating a behavioural violence prevention care plan

D. Allowing for care to be provided in a way that ensures staff and patient safety E. All of the above

4) You should conduct a PVRA when: A. Screening indicates a stressor B. A patient exhibits agitated or violent behaviours

C. A patient exhibits a change in physical, mental, or emotional condition that affects their behaviour

D. A patient has a history of violence E. All of the above

5) How a PVRA is conducted will depend on your organization/sector’s risk assessment practices. o True

o False


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6) A comprehensive PVRA evaluates the patient based on their: A. Mental and/or emotional state B. Observed behaviours C. Ability to communicate D. Ability to prevent harm

E. Stressors F. All of the above

7) Identifying and __________ __________ and treating the patient according to their assigned risk status is the first step in behavioural violence prevention care planning. The next steps involve developing ways to address the risks in the care plan.

A. Managing risks

B. Documenting risks C. Preventing stressors D. Evaluating stressors

8) If you identify the risk for violence through a PVRA, you are responsible for communicating the risk by: A. Entering it on the patient’s chart

B. Verbally reporting it at shift change C. Reporting it to a physician D. Removing a violence alert E. All of the above

9) Different care sectors use __________ interventions for providing care to potentially violent

patients. Once interventions are developed, they are included in the care plan. A. Multiple B. Different C. Violence D. Complex

10) Charting can help prevent violence by:

A. Communicating the risk of violence to visitors B. Verifying why care could not be provided or had to be altered C. Helping your department/organization get the required violence prevention resources D. Communicating the successes and lessons learned about effective care approaches E. Documenting patterns of behaviour to help identify risks F. All of the above

11) Charting can help you and your co-workers after a violent incident by supporting a WorkSafeBC claim or legal claim if you or a co-worker are injured while caring for a patient.

o True o False


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12) Charting can help the patient by helping workers develop the best treatment plans and provide consistent care.

o True o False

13) Documenting the following specific types of information consistently will help make charting a more effective violence prevention tool: A. Physical behaviours other people observed B. Exactly what was said (i.e., quoting what your heard), even if it is vulgar

C. The interventions or safety precautions that were taken and the patient’s response(s) D. How the patient’s treatment or care was affected

E. Attempts that were made to contact a physician for help F. All of the above

14) Charting can help healthcare organizations by: A. Identifying needs for more effective violence prevention procedures, policies and resources

B. Providing information about potential biological hazards C. Providing information that can be used to support you if legal actions occur as a result of a

violent incident D. Identifying complex working conditions E. All of the above

15) When you are charting, you should: A. Use subjective terms

B. Use medical jargon and abbreviations C. Label the patient and include inflammatory comments D. Describe in detail what you observed and heard E. Include your personal opinion


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T E S T Y O U R K N O W L E D G E - A N S W E R K E Y S


1. True - A PVRA is conducted as part of a general patient assessment.

2. True - A behavioural violence prevention care plan is based on PVRA results.

3. False - A PVRA is used as a screening and assessment tool.

4. False - You should conduct a PVRA when: screening indicates a risk; a patient

exhibits agitated/violent behaviours or a change in physical, mental, or emotional condition that affects their behaviour; or a patient has a history of violence.

5. True - A comprehensive PVRA evaluates a patient in terms of five specific areas.

6. True - It's important to uncover all of a patient's stressors so they can be included in the care plan and communicated among workers.


1. Gather information to create a baseline.

2. Complete a PVRA and use the information to develop interventions.

3. Create the care plan.

4. Track changes in patient behaviour.

5. Continually assess the care plan to determine whether or not it is effective.

6. Modify the care plan if it is not effective.

7. Communicate changes to the care plan.


1. False - A chart is a legal document. The legal system treats the chart as the most reliable source of information to determine what happened in lawsuits and coroner inquests.

2. True - Charting can support your WorkSafeBC claim if you are injured while caring for the patient.

3. True - Charting can help the patient by allowing workers to create optimal treatment plans for the patient and make sure that workers provide

consistent a care approach.

4. False - Do not use subjective terms (e.g., aggressive +++ or violent +++)

since these do not define the situation and can be interpreted in a variety of ways. They also do not meet legal charting requirements.

5. True - You must record physical behaviours that you observed when charting.


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M O D U L E 8 Q U I Z A N S W E R K E Y

1) B, C 2) B 3) E 4) B, C, D 5) True

6) A, B, C, E

7) B 8) A. B. C 9) B 10) B, C, D, E 11) True 12) True 13) B, C, D, E

14) A, C 15) D

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N O T E S

provincial violence prevention curriculum module 8 … · · 2014-11-10provincial violence...

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