In 2002, North West Dialysis Service (NWDS) developed an Anger and Aggression program in response to management and staff concerns regarding renal health care worker exposure to negative clinical behaviours in the dialysis setting

Since the implementation of this program, NWDS staff have continued to complete an incident report for any behavioural incident of concern to them or patients that arises in the clinical setting. The NWDS Quality and Safety and Occupational Health and Safety Committees, which include representation from all dialysis sites, review all service incident reports monthly, with quarterly and annual trend reporting and analysis. Action plans are implemented as required with relevant support provided by management, social work and OH&S personnel.

In 2008, NWDS conducted a four year retrospective analysis of reports of negative clinical behaviours. Each report information was broken down into the categories of age, sex, site of incident, whether it was verbal or physical (non violent) abuse and reason for expression of anger. In the 10 months to 31st October 2008, NWDS has noted a 100% rise in reports of anger and aggression compared with the previous year.

In 2008, in response to our analysis and trends, a formal multidisciplinary review of the NWDS Anger and Aggression was undertaken. The review resulted in some modifications to the program and recognition that evolving factors, such as mental health issues, needed to be addressed. As waiting was highlighted as significant trigger, NWDS is actively pursuing methods to reduce the factors that contribute to this anxiety.