Hospital's assessment tool not meant as long-term indicator of violence, agency admits

The violence assessment tool the London Health Sciences Centre uses to indefinitely flag patients as potentially violent was only meant to be a "short term predictor" of behaviour, CBC News has learned.

The Public Services Health and Safety Association developed the tool as a short-term predictor

The entrance to Victoria Hospital at the London Health Sciences Centre. (Dave Chidley/CBC)

The violence assessment tool the London Health Sciences Centre uses to indefinitely flag patients as potentially violent was only meant to be a "short term predictor" of behaviour, CBC News has learned. 

London Health Sciences Centre began using a violence assessment tool, developed by the Public Services Health and Safety Association (PSHSA) in May, after it agreed to a settlement with the Ontario Nurses Association. 

If a person has a history of violence or displays one or more "observed behaviours," such as being agitated, boisterous, or confused, he or she must wear a purple armband on each subsequent visit to the hospital. If the armband is refused, the patient has a large exclamation mark hung outside his or her door. 

Patients can get their bracelets removed if they go through an appeal process.

Proponents, including the Ontario Nurses Association, say it's an important tool to keep all hospital workers safe. 

But now there's evidence the tool was never meant to be an indefinite indicator of violent behaviour. 
An exclamation mark outside of a patients' room at the London Health Sciences Centre denotes that someone inside could potentially be violent or aggressive. (Supplied)

"The tool is meant to be (a) short-term predictor, based on the behaviours a health care worker observes," Henrietta Van Hulle, PSHSA's executive director of health and community services, wrote the CBC News in an email. 

"The behaviours listed in the tool have been identified in several research studies and a systematic review as predictors of violence."

Van Hulle declined to speak to CBC News because PSHSA is discussing the issues raised about the violence assessment tool with the LHSC. 

Since the beginning of November, CBC News has requested at least five interviews with the hospital. Staff refer questions to a written statement

"Once a patient has been flagged for a risk of violence, LHSC is required to communicate the risk to others," the LHSC said in a statement released Nov. 13. 

Van hulle said in an email "the assessment is meant to provide a first step so a person-centred and individualized care plan can be developed to prevent violent events." 

"The toolkit assesses behaviours that are present at the time of the assessment and identified a wide variety of factors that may contribute to the risk of violence in a health care setting."

An employer has an obligation under the Occupational Health and Safety Act to warn workers if there is a possibility of violence in the workplace. 

Psychiatrists and those in the mental health sector say the LHSC policy unfairly targets mentally ill patients. 

Although the hospital says every patient is screened for a history or potential for violence, there are special screeners set up in the psychiatric outpatient areas of the hospital. Mobile users: View the document
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