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Purpose
The implementation of a standardised response to incidents of violence and aggression (Code Grey) in
Victorian public hospitals is a recommendation from the Inquiry into Violence and Security Arrangements in
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Victorian Hospitals.
This document outlines the standards required for an organisational response to the prevention and
management of clinical aggression. These standards may also inform responses for the prevention and
management of non-clinical aggression, such as that associated with visitors.
Managing clinical aggression is a broader organisational response that begins with prevention and extends to
post-incident management. This document articulates the Department of Healths expectation that all public
health services:
have a policy or procedure that defines the organisational Code Grey response (whilst local arrangements
will vary, the policy is to align with the principles and minimum practice standards in this document)
have an emergency alert of Code Grey that is separate from Code Black.2
These standards recognise that responses to clinical aggression are different from those to an armed threat.
While this differentiation of emergency codes is a change for some health services, it is necessary to have
consistent critical emergency response codes across health services state-wide.
Background
Health services have overarching policies outlining their accountability for providing a safe workplace. These
policies are underpinned by the principles of occupational health and safety and risk management. Building on
that foundation, this document describes, for incorporation into health services policies and procedures, a set of
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evidence-based principles and minimum practice standards for managing incidents of clinical aggression.
Code Grey procedures that are based on the best available evidence:
ensure patients are treated safely, with dignity and with clinical needs met
reduce the risk of serious injury to patients and staff, and
ensure staff implement a standard escalation process to a potential threat.
Establishing Code Grey standards raises awareness of the issue while providing support for our valuable staff.
Increases in the use of Code Grey alerts are considered a measure of success, reflecting the implementation of
good practice and thus safer and more secure workplaces.
The Inquiry into Violence and Security Arrangements in Victorian Hospitals can be found at
http://www.parliament.vic.gov.au/component/content/article/307-inquiry-into-violence-and-security-arrangements-in-victorianhospitals/1528-report .
Code Black is defined under ASA 4083. Code Grey is not recognised under the current ASA Standard.
These principles are based on a review of the literature, an exploration of current practice in Victoria, consultation and expert opinion.
A full report of the research can be found under Standardising Code Grey responses across all health services at
http://health.vic.gov.au/emergency-care/hospital-safety.htm .
Department of Health
Definitions
Clinical aggression: Aggression arising from the health condition and which occurs between a health
professional and a patient (or visitor).
Code Black: A hospital-wide internal security response to actual or potential aggression involving a weapon
or a serious threat to personal safety (ASA 4083).
Code Grey: A hospital-wide coordinated clinical and security response to actual or potential aggression or
violence (unarmed threat). Code Grey activates an internal alert or emergency response.
1.1 All Victorian health services have an operational Code Grey response.
1.2 Local Code Grey responses align with the set of evidence-based principles and standards
outlined in this document.
1.3 The term Code Grey is used as the emergency code designated for unarmed, clinical
aggression across the Victorian health sector.
2.1 A Code Grey policy and procedure is in place and has executive sign-off and support.
2.2 Factors that support sustainable Code Grey policy are in place including ongoing training.
2.3 The organisational strategy includes a clear governance structure for:
data collection and monitoring
evaluating outcomes
a defined review period.
2.4 The organisational procedure for Code Grey:
includes triggers and mechanisms for activation
defines the roles of team members
prescribes mechanisms for escalation
outlines post-incident procedures
includes guidance for involving or engaging police.
2.5 Policies that complement an effective Code Grey response are in place, including policies
regarding the management of weapons, restraining or secluding patients and search
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criteria .
2.6 Environmental factors that may lead to aggression (such as environmental design, security
systems and risk assessment) and interventions focused on individuals (such as training)
are considered.
2.7 Staff are trained to prevent and manage clinical aggression.
2.8 Carers and consumers are consulted when developing clinical aggression policies and
communication plans, including those representing vulnerable groups such as children,
older people, patients with disabilities, persons experiencing an episode of acute mental
illness and patients from culturally and linguistically diverse backgrounds.
2.9 Policies outlining acceptable behaviour are clearly visible to patients and visitors, and
provided in a format that will increase and enable comprehension.
Department of Health
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Principle 3: Code Grey strategies consist of a dual clinical and security response that is clinically led.
Description
Principle 4: Code Grey responses maintain a patient focus while ensuring safety for staff and visitors.
Description
Department of Health
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