■ Safety of care:
Improving patient safety and reducing risks
The office safety plan
Published: March 2017
Revised: March 2023
The information in this article was correct at the time of publishing
If safety is at risk, contact police
Physicians should not hesitate to contact the police if they feel their safety or the safety of others is at risk due to a patient’s aggressive or threatening behaviour. If reporting to police, only give the information necessary for the police to address the threat, such as the threatening individual’s name and the nature of the incident. Avoid divulging any further patient medical information that could be considered a privacy breach.
When it comes to maintaining a safe office environment, physicians can take steps to protect everyone who enters—patients, visitors, staff, and themselves. Examples of steps that may help include:
- creating and posting a policy about what behaviour is considered inappropriate, aggressive, or threatening, and the potential consequences for anyone exhibiting such behaviour
- positioning the reception area so that it is visible to other staff1 and allows for a view from reception of everyone entering the office
- placing office furniture, such as chairs and desks, close to a door or exit to avoid anyone from being cornered1 and to allow a rapid exit
- using controlled access to certain areas within the office (e.g. having a code entry system)1
- securing medical records, computers, and medical equipment
- properly storing medications in designated areas and, if applicable, securing all opioids and other controlled substances in a locked area2
- having security alarms, including a system to summon assistance (e.g. panic button, personal alarm)
- having sufficient lighting near entrances and in the parking lots1
- establishing and documenting emergency response procedures, and ensuring employees are properly trained
Physicians who are employers should be aware of legislation regulating their responsibilities for health and safety in the workplace. In most provinces and territories, these responsibilities are set out in occupational health and safety legislation. Some of these statutes have specific requirements for managing workplace violence, such as the need to develop policies on workplace violence prevention and to provide safety training to staff. Physician-employers are encouraged to consult their employment lawyer to learn about their obligations regarding workplace safety.
In the context of a medical practice, policies, procedures, and interventions should also ensure that the confidentiality and privacy of patients and employees are protected.
Members are encouraged to contact the CMPA for case-specific advice. There are certain legal measures that can be taken to protect a physician and their staff if a particular patient’s behaviour is of significant concern for personal safety.
Video surveillance in offices
Some physicians might consider using video surveillance as part of their office safety plan. Physicians who do this need to be aware that video images of patients (at entrances or exits, in waiting rooms, or in other parts of an office or clinic) may be considered personal health information. As such, provincial/territorial privacy laws will likely apply to the collection, use, and storage of that information.
Advice relating to the use of surveillance in physicians’ offices is typically outside the scope of CMPA’s assistance. Physicians who intend to employ video surveillance in their offices should seek advice in advance from a lawyer on the business and privacy issues that may arise when using video surveillance.
If you are thinking of using video surveillance in an office, be aware that:
- Patient consent is needed for the use of cameras that capture images of patients.
- In most cases, consent can be implied by posting clearly visible signs ensuring that patients are aware of the existence of video cameras.
- It is generally encouraged that signs be posted at the entrance to the office or clinic, so that patients can make a decision about being video recorded before they enter.
- Consider developing a script that can be relied upon to explain to patients the rationale for the video surveillance and the limited use of the video recordings.
- If a patient expresses concern about being video recorded, the physician should consider offering alternatives to the patient, such as entering through a side entrance, waiting in a room where video surveillance is not being used, or offering an appointment time when the cameras can be temporarily turned off.
- Patients should be reassured that they will not be denied care if they refuse consent to being video recorded.
- Canadian Centre for Occupational Health and Safety [Internet]. Violence in the Workplace. Government of Canada, 2012 Jan 18 [cited 2016 Nov 10]. Available from: http://www.ccohs.ca/oshanswers/psychosocial/violence.html
- The College of Physicians and Surgeons of Ontario. Prescribing drugs [Internet]. Policy number 7-16, category: Drug/prescribing, 2012 December. [cited 2017 Jan 16], Available from: http://www.cpso.on.ca/Policies-Publications/Policy/Prescribing-Drugs