Practitioner safety in the clinic

ARCHIVED POST N.B. This post is based on the 2012 Osteopathic Practice Standards and therefore may not reflect current legislation or current Mint procedures.

I was recently asked a question through the Mint Facebook page about guidelines for protecting staff from vulnerable adults, or practitioners feeling vulnerable during treatment of patients with for example Bipolar disorder.  This article outlines how to consider staff safety and good procedures and training to put in place.

A key fact to bear in mind from the Osteopathic Practice Standards is that:

D4 (4) You are not obliged to accept any individual as a patient, but if having done so you feel you cannot continue to give them the good quality care to which they are entitled, you may decline to continue treating them. In that case you should try to refer them to another osteopath. Good reasons for not accepting someone as a patient or declining to continue their care might arise where:

4.1. They are or become aggressive.

4.2. They seem to have no confidence in the care you are providing.

4.3. They appear to have become inappropriately dependent on you.

You always have the right to refuse to treat a patient, especially if they make you feel vulnerable.  Staff safety is part of complying with Health and Safety Law.   Procedures should be in place to protect staff and ensure safety of lone workers.

Risk Assessment

Carrying out a risk assessment will help to identify the issues and strategies to improve safety.  Whether you work alone or in a group practice, this is an important exercise to carry out.  You could discuss safety at a group or practice meeting or with a colleague working in a similar situation.  Every clinic will have different scenarios – make sure you consider all members of staff and also include all situations i.e. clinic and home-visits.

The questions to ask for the risk assessment are:

  • Who is at risk?
  • What are they at risk from?
  • When are they at risk? – are their higher and lower risk times of day/seasons etc. as well as situations
  • What is the likelihood of the risk?
  • What strategies can be put in place to reduce risks?

Reducing Risk

An important step in reducing risk is discussing the risk with others and identifying ways of reducing risk.  You need to put in place a clear protocol for staff safety which all members of staff are aware of and engaged in.

Reducing risk will involve considering:

  • Good visibility/accessibility in the clinic room and reception, avoiding trapping points
  • Make sure there are no potential weapons such as furniture or scissors or other weapons accessible to the patients
  • Train staff in identifying potential risk situations and response strategies – de-escalation strategies, alarm strategies, causes of violence, warning signs
  • Put in place suitable alarm systems – being able to alert reception staff, speed dial to help nearby, a panic alarm/button, personal safety alert alarms (Alarms can be purchased at less than £15), Make sure there is someone you can alert if you work alone – even if it is getting someone to call you when you raise an alarm.
  • Staff should be able to communicate risk but without compromising privacy, this may need the use of code words
  • Where possible there should be two members of staff on the premises at all times
  • You may wish to limit times when new patients book to when there are more staff are on site
  • A buddy system could be helpful with a local colleague – if you do home-visits someone should know where you are and that you have safely returned, or just knowing there is someone you can call on for help if a situation arises in your clinic
  • Identify escape routes and procedures should an emergency situation arise – how to get out, where to go, who to call for help etc.


If an incident arises you should have procedures in place for reporting the incident.  You must record the incident clearly in the patient record.  You should have procedures in the clinic for making sure all staff are alerted to high risk patients and the clinic approach to that patient.  For example, there may be a patient that you have decided not to treat, you need to make sure all staff are aware of this so that no-one makes a mistake and books that patient in if they contact the clinic.

You should also decide how to inform other people about the incident as appropriate. You may wish to inform the patient’s GP, the police, a key worker or others depending on the nature of the incident.  Be careful to work with consent though.

Who to contact

If you are concerned about personal safety it will often be most appropriate to call the police if a situation arises.  It may be appropriate to ask a patient to bring a chaperone with them.  You could ask patients to give you an emergency contact or key worker contact.  You may find it helpful to contact other health professionals working with the patient to seek their advice regarding the appropriateness of your treatment and the potential risks – this must be done with the patient’s consent.

Advice and Help

There are a number of sources of advice and free training information that could be helpful to you in your clinic:

Booklets available online:

Not Part of the Job – Part 1: A guide to reporting assaults and violent incidents at work.  NHS Protect, June 2015

Not Alone – A guide for better protection of lone workers in the NHS.  NHS Security Management Service, 2009, version 2

Helpful websites: NHS Protect, information service – a website with free information on de-escalation techniques and identifying risks HSE guidance on working alone

Supporting Staff after an Incident

Should an incident arise there should be strategies in place for supporting staff.  If you work alone you should get support from colleagues or support services such as those available through the IO.  Use the incident as a means of learning how to improve your procedures and skills – there are lots of reflective tools for incidents considering – what went well, what didn’t go well etc.  For example, Gibb’s Reflective Cycle.


Every clinic and lone worker should consider safety.  By undertaking a risk assessment you will be able to identify the issues and put in place safe procedures for working and strategies to follow should an incident arise.

Thanks for the question, if anyone else has any questions regarding clinic policies and procedures I am very happy to research and respond.

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