When practicing in the psychiatric outpatient setting, it is important that the office environment remain as safe as possible to minimize risk of harm to the psychiatrist, other patients and office personnel. The following guidelines have been provided according to a review of multiple resources and are designed to guide the psychiatrist to identify and implement office security measures that are cost-effective and consider the limited resources that may be available. These strategies are not all-inclusive and are not meant to guarantee that violent acts, thefts and other crimes will not occur on the premises. Consider the following:
- Develop an office violence prevention plan. In general, the plan should involve, at least:
- Worksite analysis – determine the potential risks at your office. This includes identifying new potential threats and communicating those threats and the plan with office staff members. Issues to consider include having emergency exits and two exits from your office.
- Hazard prevention and control – identify what security measures may be implemented to minimize the risk of violence. These include: securing prescription pads in a locked location and having a lock on the door between the waiting area and your treatment area. If e-prescribing, ensure that your computer is secure, that passwords are protected and that you comply with all applicable federal and state specific e-prescribing guidelines.
- Safety and health training – discuss with non-clinical staff how to identify escalating behavior, what to do if a situation becomes escalated, and how to respond and identify a plan. Create a post – incident response plan – depending on the event, response may include whether to contact the police, contacting your risk management professional at your professional liability carrier to obtain advice on next steps, where applicable reporting staff member injuries to OSHA, and identifying future measures to implement in order to strengthen office security.
- Develop an emergency response plan that describes what to do if a violent individual poses an imminent threat of harm to you and/or your staff. For example, where the individual should go, how to alert others in the office, and what to tell police (office address, description of the perpetrator, name of the perpetrator-if known, address of the perpetrator-if known, and other descriptive factors that will help police identify the perpetrator. If under the HIPAA purview, you should not provide to the police information about the patient’s diagnosis or other treatment-related information. Contact your risk management professional or attorney before providing information about a patient’s diagnosis or treatment to anyone.
- Reception staff should sit in an area that is facing the public entrance to the office, and not with his/her back to the public entrance to the reception area. If the reception staff is at a desk in the reception/waiting area, place the desk so that his/her back is to the door to the clinical area and the desk is close to the door to the clinical area so that he/she may easily escape to the clinical area, if needed. Ensure that a security mechanism is on the door between the waiting area and clinical area (e.g., a lock on the door). When possible, create a barrier between the waiting area and the receptionist’s area.
- Train staff on the prevention and techniques to diffuse violent behaviors until clinical staff are able to assist.
- If an emergency arises, there may be situations where the police should be contacted. If possible, when there is a threat or incident, contact your risk management professional to obtain advice prior to doing so.
- Escort patients from the waiting area to the treatment area, and vice versa, as a measure to ensure that no one is wandering around the office.
- Where indicated, consider installing security cameras outside of the office. Limit the locations of cameras to entrances and exits only. The rules related to patient privacy may not support the use of cameras in the reception/waiting area or in clinical areas.
- For patients who have a history or propensity for violence, at the outset of treatment, clearly establish with the patient that violence is not permitted or tolerated. Consider utilizing “behavior contracts” or establish an office-wide code of conduct that employees/office staff members and patients agree in writing to abide by.
Additional Office Safety Measures include:
- Keep prescription pads in a locked drawer at all times. Do not pre-print and/or sign post-dated prescriptions. If prescription pads are lost or stolen, contact your risk management professional to determine next steps including whether to alert area pharmacies, the police and the Drug Enforcement Agency (DEA).
- Maintain medical records in a locked, secure area with limited access and do not leave medical records scattered around the office.
- Empty trash receptacles often and maintain the office in a neat and orderly fashion. This will help you to notice when something is out of place and will create the appearance that nothing of value is readily available.
USDA Office of Procurement and Property Management, Physical Security Program, “Security in the Workplace – Informational Material,” http://www.dm.usda.gov/physicalsecurity/workplace.htm
ASHRM Pearls for Physician Offices, p. 61.
Unites States Department of Labor, Occupational Safety & Health Administration (OSHA), “Workplace Violence,” https://www.osha.gov/SLTC/workplaceviolence/index.html