On children's wards, restraint appears to be used often, rather than as a last resort, to assist the delivery of clinical procedures. The difference between restrictive physical intervention and therapeutic holding seems to depend on the degree of force used and whether the child gives consent. Restraint can have a negative emotional and psychological effect on children, parents or carers, and nurses. Healthcare staff need to examine their daily practice and always employ a range of interventions to seek a child's co-operation with procedures. Restraint should only be used when there is no alternative in a life-threatening situation. It is essential that all hospitals providing care for children have an explicit restraint policy and provide education, training and guidance for all healthcare staff.

Introduction Violence in hospitals is a serious occupational health and safety (OHS) issue affecting the physical and mental health of front line staff, as well as, the quality of patient care. In 2010, the province of Ontario (Canada) introduced legislation that directs hospitals to put into place violence prevention and management systems. Our study examined how five Ontario hospitals have developed and implemented their violence prevention programs. Methods Semi structured interviews were conducted with eight key informants external to hospitals (legislators, union leaders, hospital associations), management and occupational health and safety specialists in hospitals (n=40), 21 focus groups (n=115) and interviews (n=6) with front line workers. Five hospitals participated in the study. Interview and focus group questions focused on the effect of the legislation on the development of violence prevention programs and how these were implemented across departments. Once data were collected, a code list was developed by the research team by reviewing the transcripts. Each transcript was coded by two researchers and then a thematic, inductive analysis was carried out. The constant comparative method was used to identify differences and similarities across hospitals and to understand factors that shape hospital policies and practices in the area of violence prevention and management. Findings Our study findings suggest that while legislation sets parameters for the development of policies, serious violencerelated events and the presence of a violence prevention 'champion' bolster long-term commitment to violence prevention in hospitals and the development of sustainable programs. We discuss four key components related to the prevention and management of violence in hospitals, namely; security systems, patient 'flagging', codes and alarms and incident reporting. Discussion Our findings detail how management commitment, workplace culture and broader structural factors can shape the implementation of hospital policies around violence prevention and reporting. Study recommendations focus on the long-term sustainability of violence prevention practices in the acute care sector and the implications this can have on worker health. Introduction This presentation provides an overview of the Occupational Audiometric Refresher Programme as field-tested in Gauteng province, South Africa. Despite growth in occupational health, audiometric surveillance is fragmented with poor record quality in RSA as similarly reported in USA and UK. Limited training opportunities perpetuate in Africa with no legal requirement for audiometrists to attend refresher programmes. The study thus developed and tested an intervention that would improve audiogram quality and cohesive result management. Method Mixed methods enriched the structured modularised blended learning refresher programme that evolved. A one group pre-test, post-test field-test with 49 purposively sampled registered audiometrists. Quality of the pre-intervention biological calibrati...