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Lone Ranger: Maintaining Staff Safety

The Children's Hospital at Westmead
Project Added:
21 February 2011
Last updated:
21 October 2016

By The Children's Hospital at Westmead


Hospital staff who work on their own outside the Hospital environment are always at some risk of harm. If they have an accident or fall victim to violence while out in the community, co-workers may be unaware for some time.

In 2009, the operating hours of the Children's Hospital at Westmead (CHW) Community Acute / Post Acute Care (CAPAC) service were extended so that more patients can be cared for at home and to further relieve the demand on hospital beds. This meant CAPAC staff were now travelling alone in the community and visiting homes out of daylight hours and on weekends when there are fewer checks from supervisory staff and a higher potential for danger.

To address staff safety concerns, CAPAC began using the Lone Worker Service. The service allows the lone worker to receive regular calls from an automated control centre to which they must respond. If there is no response, the Lone Worker Service automatically calls the Manager on duty who may try to contact the worker themselves. If the manager is concerned, they will speak with someone in the Lone Worker Service about what action to take in response.

The system reduces the risk of harm to staff by having early notification of potentially risky situations and promotes a safer environment for staff 24 hours a day.

No other 'Hospital in the Home' service is currently using such a facility to improve the safety of staff, making the introduction of this facility at CHW the first of its kind.


To have a system that can help protect staff working alone outside the hospital, especially after dark or on weekends.

Nature of the problem

The safety of staff previously depended on the individual’s reporting or ability to contact the relevant Manager – reporting or monitoring of staff location was not required under Hospital policy. If the staff member did try and contact the Manager, their message was not always received. If staff did not arrive back at CHW when they were supposed to, it may be some time before the Manager would know they had not arrived and were potentially at risk.

The issue of staff safety has been a hot topic in the CAPAC Department since the increase in operating hours, with staff on shifts out in the community until 8.30pm, seven days a week.

Staff reported feeling unsafe going out into the community into potentially risky situations out-of-hours without a system in place, which could closely monitor their safety.

Planning and implementing solutions

There were a number of steps in the planning and implementation stage:

  1. Mapping ideas, risks and current issues with procedure (see Diagram 1)
    • Policy allows for no supervision
    • Some suburbs more unsafe than others
    • CAPAC extending hours
    • Difficulty in contacting hospital
    • Uniforms identifying us as hospital staff
    • Seen sitting in car with light on
    • Entering homes at night
    • CHW managers busy
    • First visit after dark
    • More family members in homes
    • Delays in getting help if in a potential risk
  2. Review hospital policy on home visiting
  3. Survey staff pre and post implementation
  4. Seek alternative solutions to monitor staff safety
  5. Network with other community services to discuss management of staff safety
  6. Educate staff on new system
  7. Trial new system
  8. Evaluate changes

Risk factors identified by staff
Diagram 1 Staff identified risks

Several options for safety monitoring systems were investigated before it was agreed by staff to trial the Lone Worker Monitoring System. All members of staff were fully in-serviced on its application, which was adapted to meet our needs. A trial commenced on 9 November 2009 and was conducted over two weeks. The mobile phone which CAPAC nurses carry on all visits was set up with the Lone Worker options logged into the speed dial selection.

Each CAPAC staff member can set up their individual preference for frequency of monitoring calls received. It is easy for staff to respond to calls to indicate either they are safe or they feel concerned for their safety.

Although the After Hours Nurse Manager is no longer being informed of the movement between clients as they were in the past, they are still given an activity statement at the commencement of shifts so they know planned visits for that shift and they are paged when staff safely return to the Hospital.

Outcomes and Evaluation

The name of the Home Visiting Policy was changed to Risk Management Policy as a direct result of this project.

Details project plan, implementation and evaluation as a timeline
Diagram 2 Plan and evaluation

The obvious outcome from the Lone Worker Monitoring System is a reduced risk of harm and increased sense of safety for all CAPAC workers. With clients located in all suburbs, some quite isolated, and with visits out of daylight hours, the safety of staff is imperative.

Staff have given positive feedback to the CAPAC Nurse Unit Manager (NUM) that they feel a greater sense of security since the introduction of the Lone Worker System.

The Lone Worker System was trialled and evaluated. Staff were surveyed pre and post introduction to identify areas of safety concerns.

The system is simple and user-friendly whilst being an effective tool in providing staff safety.

Financially, the one-off set up cost was $1,000. After this, it costs $1 per day per phone monitored. At present there is one phone, which means an annual cost of $365. The system works with any mobile phone as it is web-based, not phone-based. No extra equipment is required.

Sustaining change

Staff are all conscious of the need for safety, especially as they go into homes alone at all times of the day and evening.

Staff have been using the Lone Worker Service for all shifts since November 2009.

The guidelines for using the speed dial feature are in the folder taken out on home visits and the response centre procedure is very user-friendly.

The Lone Worker Service has now been incorporated into the CAPAC orientation program and all new staff are appropriately educated before using the system for the first time.

Transferability and future scope

Staff safety has been greatly increased in the CAPAC environment. It is now part of our normal practice to use the Lone Worker Service whenever staff leave the Hospital.

This program could be implemented to promote staff safety in other hospital departments and services where staff leave the hospital during their working hours.


Nursing Unit Manager - CAPAC
The Children's Hospital at Westmead
Phone: 02 9845 3856

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