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UWMF SAFETY POLICIES AND PROCEDURES
Subject: Responding to Angry Patients Policy
Effective Date: 11/18/13 Approved: Dr. Richard Welnick, Medical Dir
Supersedes Policy Date: 12/30/10 Revision #5
Distribution: All UWMF Locations
Defuser is the first health care worker to intervene with the angry patient and attempt to
“defuse” the controlled or expressed anger situation.
Mediator is the second health care worker who responds to support the defuser. This person
may standby to show support or intervene as necessary. If intervening, the initial defuser will
then fulfill the role of mediator.
Guardian is the third health care worker who responds to safeguard nearby occupants from
expressed or irrational anger situations and call police/security if needed. In guardian’s absence,
the mediator will call police/security if necessary and safeguard patients.
NOTE: If above roles cannot be filled, the affected health care worker may need to remove self,
notify site supervisor and/or call police for potentially aggressive situations.
Security Guard Response (if guard is not onsite, call 911):
At 1 S. Park, call 238-9295 for urgent security response. Be sure to clarify your
expectations for guard arrival to manage the situation. 1 S. Park Medical Imaging can
call security at 516-6233 for response during after hour patient visits.
At 20 S. Park, call 335-7318 for security guard response
At East Towne Urgent Care, call 333-1885 for guard response.
At West Towne Urgent Care, call 577-3607 for guard response.
Staff and providers will collectively work to recognize the different levels of anger and respond
appropriately to defuse the situation. If a difficult patient visit is expected, the provider and staff
will discuss measures to ensure safety and quick notification of police so that affected
occupants can be directed to safe areas away from the escalating patient. These measures may
include, but are not limited to:
Reviewing patient record prior to visit to discern any sensitivities such as mental health
issues, drug dependency, etc.
Talking with Patient Resources, Safety and/ or Legal about appropriate security
measures and communication plan for patient visit. In most circumstances, the provider
will be the main point of contact with patient. Additionally, this may include having a
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witness present in the exam room with provider, prepping the room so that sharps/
potential weapons are removed, provider is closest to the exit door, leaving door slightly
ajar for nearby staff to monitor the visit, etc.
Having police or security guard present to provide quick support if needed.
Identifying “safe areas” and communication plan should the need arise to evacuate
occupants. Also clarify how arriving patients and phone calls will be managed.
A Patient Safety Net report will be completed by the site for the following events:
Expressed and irrational anger situations.
Threatening comments and/ or actions. NOTE: If patient threatens physical harm, staff
will work to defuse situation and immediately notify site supervisor, Patient Resources
and Safety Manager. Police will also be notified and asked to intervene as needed.
Anytime police and/ or security are asked to intervene.
CONTROLLED ANGER: Patient begins to experience and exhibit tension, but they are still in
control of themselves.
THE PATIENT’S… THE DEFUSER SHOULD…
Facial expression appears tense
Eye contact is very direct or is avoided
Ability to concentrate is decreased
Voice is tense
Increase attention to the patient by:
Making eye contact
Giving them your undivided attention
Give the patient space by:
Keeping things non-threatening
Getting to their level (stand or sit with patient)
EXPRESSED ANGER: Patient becomes emotionally distressed. It is becoming increasingly difficult
for them to control their behaviors or to understand what is being explained to or asked of them.
THE PATIENT’S… THE DEFUSER SHOULD…
Swearing, and being verbally abusive
Is threatening verbally or physically
Pacing, swaying or shaking
Increased / exaggerated movements, pounding
fists, slamming hands
Unable to think rationally
1. Decrease or stop talking, giving the patient time to
2. Engage supervisor or mediator
THE MEDIATOR SHOULD…
1. Support defuser and intervene as necessary
2. May need to call police/safeguard nearby
occupants if guardian is not present
THE GUARDIAN SHOULD…
1. Remove nearby occupants from immediate area
and call police and/or security
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IRRATIONAL ANGER: Patient is in physical and mental distress. This person is going to be very
difficult if not impossible for you to de-escalate without outside intervention such as the police or
THE PATIENT’S… STAFF SHOULD…
Yelling or screaming uncontrollably
Making serious threats of harm
Attempting to strike or subdue
Out of control
1. Remove self and others to safety
2. Call police/security and notify supervisor or team
3. Warn others and stay away from patient
4. If patient has a weapon, follow “Weapons