On: 23 January 2012 Review Date: January 2015 Distribution: Essential Reading for: Information for:

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1 CONTROLLED DOCUMENT Withholding Treatment Procedure (procedure for managing patients/public who are violent and/or abusive) - Yellow and Red Card Procedures CATEGORY: CLASSIFICATION: PURPOSE Controlled Document Number: Controlled Document Version: Controlled Document Sponsor: Controlled Document Lead: Approved By: Procedure Governance To set out the procedure for the management of patients who are violent or abusive in their behaviour towards staff, other patients or members of the public and includes the possible withholding of treatment New Hospitals Project Director Head of Governance New Hospitals Project Director On: 23 January 2012 Review Date: January 2015 Distribution: Essential Reading for: Information for: All staff Withholding Treatment Procedure (procedure for managing patients/public who are violent and/or abusive) - Yellow and Red Card Procedures Issued: 30/01/2012 No: 650 Version: 2

2 Paragraph Contents 1 Purpose 1 2 Procedure For Invoking Yellow card status 1 Page 3 Exclusion from Treatment/Alternative Care Arrangements 5 4 Return onto Trust Premises 5 5 Implication of Red Card Status 5 6 Appeals Against Yellow/Red Card Status 6 7 Implementation and Monitoring 6 8 Associated Documents 6 Appendices Appendix 1 Yellow /Red card process flow chart 7 Appendix 2 Confirmation of Understanding of Formal Written Warning to Patients who are Violent or Abusive Appendix 3 Implementation of Yellow Card Status Checklist 9 Appendix 4 Yellow Card Status letter to GP 11 Appendix 5 Yellow Card Status letter to patient 12 8 Appendix 6 Red Card Status Exclusion Procedure - Implementation Checklist 13 Appendix 7 Red Card Status letter to GP 15 Appendix 8 Red Card Status letter to patient 16 Appendix 9 Yellow and Red Cards 17 Withholding Treatment Procedure (procedure for managing patients/public who are violent and/or abusive) - Yellow and Red Card Procedures Issued: 30/01/2012 No: 650 Version: 2 0

3 1 Purpose 1.1 The purpose of this procedure is to support the Security Policy by setting out the procedure for the management of patients and visitors who are violent or abusive in their behaviour towards staff, other patients or members of the public. 1.2 It explains the circumstances in which staff can invoke a Yellow or Red Card to sanction patients showing inappropriate/unacceptable behaviour/ abuse, up to and including the sanction of excluding patients/public who present an unacceptable risk. 2 Scope 2.1 This procedure may be used to deal with both patients and visitors whose behaviour is unacceptable. Persons who are on the premises other than as patients may be asked to leave the premises immediately. Where such persons are also patients of the Trust it may be necessary to consider the use of this procedure, in which case references to patients shall include such persons and appropriate records of any actions taken should be kept. 2.2 This procedure has three stages (Formal Warning, Yellow Card, Red Card), which are normally intended to be followed progressively. However, where the behaviour so warrants, the procedure may be commenced at any one of the three stages. 2.3 This procedure may also be followed where a patient/visitor is known to present a risk towards staff, other patients or members of the public, irrespective of the source of the information regarding such risks, for example, a patient with a history of violence towards staff at another healthcare provider. In such cases, the procedure may be commenced at any one of the three stages. 3 Procedure 3.1 Immediate management of incidents of violence and aggression must be dealt with in accordance with the Security Policy (including The Prevention and Control of Violence & Aggression) and the Security Procedure. 3.2 Consideration should be given to reporting incidents of assault/violence to the police where there is no lawful justification or excuse for the behaviour, with the default position being that a report should be made. However, consideration should be given to the wishes of the victim, although the Trust may report an incident to the police even if the victim does not wish such a report to be made. Stage 1 - Formal Warning 3.3 In the event of inappropriate behaviour by a patient/visitor, the nurse or department manager in charge of the relevant area should explain to the patient/visitor that his/her behaviour is unacceptable and the expected standards that must be Withholding Treatment Procedure (procedure for managing patients/public who are violent and/or abusive) - Yellow and Red Card Procedures Issued: 30/01/2012 No: 650 Version: 2 1

4 observed in the future. This explanation should, wherever possible, be carried out in front of a witness and must be documented in the patient s healthcare records with the details of the incident that triggered the warning. The entry must also be signed by the witness and the patient s Consultant must be informed. An incident report form should also be completed using the Datix online incident reporting system. 3.4 A careful review of the patient s condition must be made by a senior member of the individual s clinical team to ascertain whether the behaviour is excused by the patient s mental state at the time, taking into account their medical condition and their medication. This must be at Registrar or Consultant level, including staff of the on call team, and should preferably be the Consultant responsible for the patient; Where the Consultant responsible for the patient was not involved in the review, they must be informed. The review must be documented fully in the patient s healthcare records. 3.5 Where, following the aforementioned review, it has been established that there is no lawful justification or excuse for the patient s behaviour, the following process should be applied: 3.6 Within working hours, a member of the Divisional Management Team must be informed, and nominated to issue a written warning about the possible consequences of any further repetition. Out of hours, the on-call manager must be informed and should perform the same duty. 3.7 Details of the warning must be recorded in the patient s healthcare records. The patient must be advised that he/she is receiving a formal written warning; the patient s Consultant should also be informed of the written warning. The patient should receive an explanation of the expected standards that they must observe in the future and warned about any failure to comply. At this point the patient will be required to sign the document Confirmation of Understanding of Formal Written Warning to Patients who are Violent or Abusive (Appendix 2). 3.8 Where a patient refuses to sign the document this should be recorded in the patient s healthcare records. It should be explained to the patient that the document will be valid with or without the patient s agreement/signature. A copy must be filed in the patient s healthcare records and the patient informed. An incident report form should be completed promptly and submitted. Stage 2 - Issue of a Yellow Card 3.9 Failure to subsequently desist from inappropriate/unacceptable behaviour following the written warning may result in the issue of a Yellow Card A yellow card should be implemented by an appropriate senior member of the Trust management team. These include: Withholding Treatment Procedure (procedure for managing patients/public who are violent and/or abusive) - Yellow and Red Card Procedures Issued: 30/01/2012 No: 650 Version: 2 2

5 Site Manager/ Night Sister/ Senior Nurse; Consultant/ Clinical Service Lead; Divisional Director; Associate Director of Nursing; Divisional Director of Operations; Risk Management Advisor; Head of Governance; Group Manager or On Call Manager; Patient s Consultant; or Executive Team Member/Manager on the Executive Team on call rota When a decision has been made to implement a Yellow Card, it is the responsibility of the person issuing the card to undertake the following: Document staff member s concerns; Decide whether action under this procedure is required. Further consultation with the patient s medical team may be appropriate; and Complete the implementation checklist and letters to GP and patient (Appendix 3, 4, 5). Copies of all the paperwork must be sent to the Risk Management Department to provide a central record of the event The patient will be advised that any further incident of unacceptable behaviour within that 12 month period may result in escalation to Red Card Status, i.e. their exclusion from treatment within the Trust 3.13 The patient must be advised that the implementation of the Yellow card can be appealed through the Trust Complaints process A yellow slip will be attached to the inside of the front of the patient s healthcare record and an electronic Flag will be inserted on the Lorenzo system, the Emergency Department s Symphony System and the Clinical Portal to alert staff to the patient s Yellow Card status. This will be initiated by the person implementing the Yellow card. Risk management must be informed 3.15 When a patient warrants a Yellow Card, the status will remain in effect for a 12 month period. If the patient has not had any further episodes of unacceptable behaviour, the Yellow card status will be removed by agreement at the trust s Clinical Ethics Group The Clinical Ethics Group will review all yellow cards that are due to be rescinded. If the patient has not displayed any episodes of unacceptable behaviour the Chief Withholding Treatment Procedure (procedure for managing patients/public who are violent and/or abusive) - Yellow and Red Card Procedures Issued: 30/01/2012 No: 650 Version: 2 3

6 Operating Officer will nominate an appropriate member of the Divisional team to take the manual and electronic flags from the patient s information. The Risk Management Team must also be informed 3.17 If a patient complies with the terms of the Procedure at the Yellow Card Status stage, they can expect that: Their clinical care will not be affected in any way; Where substance abuse has been identified, appropriate medical assistance will be provided if they require it; The Trust will fully investigate all valid concerns about the process raised by the patient; and Any formal warning issued under the Procedure will cease after one year. STAGE 3 - Invoking Red Card Status 3.18 The Red Card Status may be invoked, where the patient has failed to comply with the terms of the procedure during Yellow card status and in situations where the patient s behaviour has been of an extreme or serious nature The issuing of a Red card and subsequent exclusion from treatment within the Trust will be implemented by an appropriate senior member of the Trust management team, who must be different from the member who invoked yellow card status The case for implementation of a Red card must be presented to the Clinical Ethics Group, before any formal action is taken The Clinical Ethics Group will discuss the case and either endorse or deny Red card implementation In the event of a case that is deemed as extreme or of such a serious nature that may require implementation of an immediate Red card the Medical Director can review the case and endorse implementation. However, this decision can only be made following full medical review by the appropriate medical staff caring for that patient The Clinical Ethics Group will discuss the case at its next meeting to formally record the decision The same process applies as per the Yellow card i.e. a formal written warning must be issued to the patient and a copy filed in the patient s healthcare records, and an incident report form be completed and submitted. Withholding Treatment Procedure (procedure for managing patients/public who are violent and/or abusive) - Yellow and Red Card Procedures Issued: 30/01/2012 No: 650 Version: 2 4

7 3.25 A checklist for implementation of a Red Card Status should also be completed and sent to the Risk Management Team to provide a central record of the event. (Appendix 6) The patient must be advised that the implementation of the Yellow card can be appealed through the Complaints process. The patient will be sent a letter from the Chief Executive informing them of the implementation of the Red card. (Appendix 8) 3.27 A red slip will be attached to the inside of the front of the patient s files and an electronic Flag will be inserted on the Lorenzo system, the Emergency Department s Oceano System and the Clinical Portal to alert staff to the patient s Red Card status. This will be initiated by the person implementing the Red card. The Risk Management Team must also be informed. 4 Exclusion From Treatment/Alternative Care Arrangements 4.1 A patient who has received a Red card should be advised that they can appeal to the Trust against any decision to exclude them from treatment through the Trust Complaints process. Such exclusion will last for a period of 12 months, subject to alternative care arrangements being made. The Trust (including the Consultant responsible for the patient s care) will discuss such arrangements with the patients General Practitioner (Letter Appendix 7) and relevant Commissioning body to ensure appropriate alternative arrangements are commissioned. 4.2 Where immediate alternative care arrangements are required, but cannot be made, there should be security staff in attendance to support the clinical team if necessary. 4.3 In the event of an excluded individual presenting at the Trust s Emergency Department for emergency treatment, that individual will be treated and stabilised with, if necessary, security staff in attendance. Where possible, the patient should then be treated and discharged as soon as clinically safe to do so. However, if admission is deemed necessary, the patient should be admitted and support given to the medical/nursing staff through attendance of security and possible isolation of the patient in a side room. 5 Return Onto Trust Premises If an excluded individual returns to the Trust in circumstances other than a medical emergency, security staff should be called immediately. If necessary, the police will be asked to attend. The Trust will subsequently seek legal redress to prevent the individual from returning to Trust property. 6 Implication Of Red Card Status Withholding Treatment Procedure (procedure for managing patients/public who are violent and/or abusive) - Yellow and Red Card Procedures Issued: 30/01/2012 No: 650 Version: 2 5

8 If a patient complies with the terms of the Procedure at the Red Card Status stage, they can expect that: 6.1 The patient will be excluded from clinical care, except when presenting at the Emergency Department; 6.2 The Trust will fully investigate all valid concerns about the process raised by the patient; and 6.3 Any formal warning issued under the Procedure will cease after one year. 7 Appeals Against Yellow/Red Card Status 7.1 Should the patient wish to challenge the decision, they may do so through the Trust s Complaints process. 7.2 Patient Services should liaise with the relevant division to ensure that a full investigation of the Yellow/Red card implementation process has taken place which will then be referred to Clinical Ethics Group for discussion and final approval or refusal. 8 Implementation And Monitoring 8.1 This procedure will be available on the Trust intranet and implementation of this procedure will be monitored by the Health, Safety and Environment Committee and Clinical Ethics Group. Monitoring 8.2 The Health, Safety and Environment Committee receives a quarterly report regarding the numbers of Yellow/Red status issued within the Trust. 8.3 The Clinical Ethics group will review the process for the issuing of all Yellow/Red cards. 8.4 The Director of Corporate Affairs will provide an update on the process for issuing Yellow and Red cards to the Audit Committee through the Health and Safety report, who will provide assurance to the Board of Directors. 9 Associated Documents 9.1 Security Policy (including The Prevention and Control of Violence & Aggression) 9.2 Security Procedure Withholding Treatment Procedure (procedure for managing patients/public who are violent and/or abusive) - Yellow and Red Card Procedures Issued: 30/01/2012 No: 650 Version: 2 6

9 APPENDIX 1 Yellow/Red Card Process Implementation of Card Warning to patient behaviour not tolerated. (Documented in patients notes) Nurse or Departmental manager Formal warning o Review of patient o Explain policy o Document o Ensure pt understands o Pt signs Conformation of understanding Appendix 2 Consultant or Registrar to review patient Member of DMT or On Call manager to proceed to issue warning if appropriate Yellow Card o Complete incident form o Patient receives letter Appendix 5 o Patients GP informed by letter Appendix 3 o Yellow card documented in patients notes. Member of DMT or On call manager to issue warning and complete paperwork If patient persists with behaviour consider escalation to Red card status Red Card o Patient receives letter from CEO Appendix 8 o Patients GP informed by letter Appendix7 o Red card documented in patients notes Appendix 9 Ethics Committee to consider all applications for the issuing of Red Card Status Withholding Treatment Procedure (procedure for managing patients/public who are violent and/or abusive) - Yellow and Red Card Procedures Issued: 30/01/2012 No: 650 Version: 2 7

10 APPENDIX 2 UNIVERSITY HOSPITALS BIRMINGHAM NHS FOUNDATION TRUST Confirmation of Understanding of Formal Written Warning to Patients who are Violent or Abusive PATIENT DETAILS Ward/Dept QE/SOH Surname Forename(s) Registration Number Home Address Home Phone Number Next of Kin Contact Name Next of Kin Address GP Name GP Contact Number The consequences of a failure to comply with the Yellow and Red Card Policy have been fully explained. I understand my GP will be informed if I continue to behave in an unacceptable manner. *I agree to comply with the expected behaviours, set out in the Yellow and Red Card Policy, under which care will be provided at University Hospital Birmingham NHS Trust. Patient Signature Date *Delete if refused Witnesses for the Trust Date Name Position Signature Withholding Treatment Procedure (procedure for managing patients/public who are violent and/or abusive) - Yellow and Red Card Procedures Issued: 30/01/2012 No: 650 Version: 2 8

11 APPENDIX 3 UNIVERSITY HOSPITALS BIRMINGHAM NHS FOUNDATION TRUST IMPLEMENTATION OF YELLOW CARD STATUS To be completed by an Appropriate Person as detailed in Appendix 2. Yellow Card Status - Implementation Checklist This procedure should not be followed where the Consultant responsible for the patient believes the behaviour of the patient is attributed solely to his/her medical condition. Inform and seek advice from the patient s Consultant or Specialist Registrar, on call team (out of hours), and their GP if necessary. Consideration must be given to the need for a referral for a Mental Health Assessment to be undertaken. All medical reviews must be documented in the patient records. Ensure that the behaviour which triggered the Policy is documented in full, and signed by the member of staff and any witnesses. Inform the patient of the ward/department staff s concerns. Fully explain the Policy and the formal warning issued ensuring there is no confusion as to the standard of behaviour required or the possible consequences of failure to comply. Complete all details on the Confirmation of Formal Written Warning for Patients who are Violent or Abusive (Appendix 2). Ask the patient to sign the confirmation of the formal warning. If the patient refuses to sign, this should be documented. It should be explained to the patient that the document will be valid with or without the patient s agreement/signature. A copy will be filed in the patient s healthcare records. Ensure that a suitable member of staff (any registered doctor, or registered nurse, preferably known to the patient) witnesses the explanation to the Withholding Treatment Procedure (procedure for managing patients/public who are violent and/or abusive) - Yellow and Red Card Procedures Issued: 30/01/2012 No: 650 Version: 2 9

12 patient and signs the confirmation of the formal written warning. Inform the Trust Security Management Specialist, site security staff, and the Risk Management Team providing them with a copy of appropriate documentation including the relevant incident form. Provide the Risk management Team with a copy of appropriate documentation, complete an incident form. Give the patient a copy of the formal written warning and a copy of the procedure. The procedure can be downloaded from the Trust Intranet. Prepare a copy of The Standard Letter (Appendix 4), for issue to the patient s GP. This letter should be signed by the relevant Divisional Director of Operations. A copy of the Procedure should be attached to the letter to be sent to their GP. Prepare (type) a copy of The Standard Letter (Appendix 5), for issue to the patient. This letter is to be given to the Divisional Director of Operations with the letter to the GP for checking, to ensure that both the letter and the procedure have been applied appropriately before the correspondence is sent to the patient and their GP. The behaviour that initiated the implementation of the policy and full process of actions must be documented in the patient s healthcare records. A copy of the Formal Written Warning (Appendix 2) should be sent to; the Risk Management Advisor, the relevant Senior Nurse and the Trust Security Management Specialist. A copy of the Formal Written Warning (Appendix 2) must be kept in the patients healthcare records along with a detailed record of the reasons for implementation of the Yellow Card Status. Place a flag in medical notes. Ensure that an electronic flag is placed on the Emergency Department system, patient administration system and clinical Portal to alert staff to their Yellow Card Status. Insert a Yellow Card in to the front of the patient record to alert staff to the fact that the patient has Yellow Card Status Insert a electronic flag on the Lorenzo system, the Emergency Department s Symphony System and the Clinical Portal to alert staff to the patient s Red Card status. Withholding Treatment Procedure (procedure for managing patients/public who are violent and/or abusive) - Yellow and Red Card Procedures Issued: 30/01/2012 No: 650 Version: 2 10

13 APPENDIX 4: YELLOW CARD STATUS LETTER TO GP Date GP s name and address Dear Dr Re: Patient s name Patient s address Patient s date of birth Patient s hospital registration number The above individual is currently an inpatient on ward... or receiving outpatient care at the University Hospitals Birmingham NHS Foundation Trust. In order to protect the ward environment for other patients and members of staff, it has been necessary to instigate the first stage of the Trust s Yellow and Red Card Procedure. The Procedure is to support staff in the management of patients who are violent or abusive, including the possible withholding of treatment, a copy of which is enclosed for your information. At this stage the patient has been issued with a formal written warning regarding their unacceptable behaviour and classified as Yellow Card Status. If you have any queries regarding the implementation of this procedure, please do not hesitate to contact:...(name and tel. no. of patient s Consultant), or...(name and tel. no. of Senior Nurse/ Associate Director of Nursing). Yours sincerely Divisional Director (of Operations) ENC: Copy of the Yellow and Red Card Procedure; to support staff in the management of patients who are violent or abusive including the possible withholding of treatment. Withholding Treatment Procedure (procedure for managing patients/public who are violent and/or abusive) - Yellow and Red Card Procedures Issued: 30/01/2012 No: 650 Version: 2 11

14 APPENDIX 5: YELLOW CARD STATUS LETTER TO PATIENT-must be sent Registered Mail Date: Patient s name Patient s address Patients Hospital Registration Number Dear This letter is to formally advise you that due to your unacceptable behaviour on...at..., you are now subject to the conditions outlined in the Trust s Yellow and Red Card Procedure; to support staff in the management of patients who are violent or abusive including the possible withholding of treatment. The first stage of the Policy has been applied to you and you have been given a Yellow Card Status. You should have received an explanation as to why you are subject to this Procedure and a copy of the Procedure to read. A copy of the Procedure is also included with this letter. Should you, on any occasion in the future, fail to comply with the expected standards of behaviour explained to you by...and outlined in the Procedure, you will become subject to the next stage of the Procedure. This is a Red Card Status and may involve your immediate exclusion from the Trust premises by our security staff/police. Such an exclusion from Trust premises would not mean that you would not receive care. Arrangements will be made by the medical staff responsible for your care for you to receive appropriate treatment at an alternative hospital. Yours sincerely Divisional Director (of Operations) ENC: Copy of the Red Card Procedure; to support staff in the management of patients who are violent or abusive including the possible withholding of treatment. Withholding Treatment Procedure (procedure for managing patients/public who are violent and/or abusive) - Yellow and Red Card Procedures Issued: 30/01/2012 No: 650 Version: 2 12

15 APPENDIX 6 UNIVERSITY HOSPITAL BIRMINGHAM NHS FOUNDATION TRUST Red Card Status Exclusion Procedure - Implementation Checklist This procedure should not be followed where the Consultant responsible for the patient believes the behaviour of the patient is attributed solely to his/her medical condition. Once it is agreed that the patient s behaviour is unacceptable, and that exclusion is the only option, alternative arrangements for the patient s medical care will be made. These will be made in consultation with the responsible Consultant and the relevant Primary Care Trust. The Consultant with responsibility for the patient s care must be informed and write to the patient s GP to notify them of the exclusion, detailing the reasons that such measures were necessary. The patient must be informed that they are being excluded, verbally when possible and by letter from the Chief Executive (see Appendix 9). The patient must be given a copy of the Procedure and be advised that they may challenge the decision via the established NHS Complaints Procedure. The relevant Divisional Director of Operations should prepare a copy of the standard letters (Appendix 8) for the patients G.P. and for the patient (Appendix 9). The relevant Divisional Director of Operations should check that the Procedure has been applied appropriately and forward the letters on to the Chief Executive s office for signature. The Trust Headquarters Executive Office Manager (Personal Assistant to the Chief Executive) must be informed and they will facilitate the dispatch of a written confirmation from the Chief Executive to the patient s home. A copy of the letter must be returned to the Risk Management Advisor who will maintain a central file in the Risk Management Department. Withholding Treatment Procedure (procedure for managing patients/public who are violent and/or abusive) - Yellow and Red Card Procedures Issued: 30/01/2012 No: 650 Version: 2 13

16 Copies of the exclusion documentation should be sent to the, Risk Management Advisor, relevant Senior Nurse for the area, Complaints Department and the Trust Security Management Specialist. A detailed record of the rationale for exclusion and of the alternate arrangements for care should be kept in the patient s healthcare records. Copy of all documentation relating to the implementation of this Policy should be kept in the patient s healthcare records. A red warning card should be attached to the inside of the patient s healthcare records folder. If an excluded individual returns in any circumstances other than a medical emergency, security staff should be called immediately. If necessary the police will be asked to attend. The Trust will subsequently seek legal redress to prevent the individual from returning to Trust property. Insert a electronic flag on the Lorenzo system, the Emergency Department s Symphony System and the Clinical Portal to alert staff to the patient s Red Card status. Withholding Treatment Procedure (procedure for managing patients/public who are violent and/or abusive) - Yellow and Red Card Procedures Issued: 30/01/2012 No: 650 Version: 2 14

17 APPENDIX 7 UNIVERSITY HOSPITAL BIRMINGHAM NHS FOUNDATION TRUST Date LETTER TO GP RE EXCLUSION AT THE RED CARD STAGE GP s name and address Dear Re: Patient s name Patient s address Patient s date of birth Patient s hospital health records number The above individual has attended... Ward/Department at the University Hospitals Birmingham NHS Trust. Following episodes of unacceptable behaviour, it has been decided in line with Trust Procedure that must be excluded from this Trust for the following reasons: *Arrangements have been made for follow-up care at. with *No arrangements for follow up care are necessary (*please delete as appropriate) The patient has/has not been informed verbally. A letter has been sent to the patient informing them and a copy of this letter has been placed in the patient s inpatient notes. This exclusion will last for one year from the date of this letter. Yours Sincerely Chief Executive ENC: Copy of the Yellow and Red Card Procedure; to support staff in the management of patients who are violent or abusive including the possible withholding of treatment. Withholding Treatment Procedure (procedure for managing patients/public who are violent and/or abusive) - Yellow and Red Card Procedures Issued: 30/01/2012 No: 650 Version: 2 15

18 APPENDIX 8 UNIVERSITY HOSPITAL BIRMINGHAM NHS FOUNDATION TRUST RED CARD STATUS LETTER TO PATIENT-must be sent Registered Mail Date: Patient s name Patient s address Hospital Number Dear This letter is to formally advise you that due to your unacceptable behaviour on...at..., you are now subject to the conditions outlined in the Trust s Yellow and Red Card Procedure; to support staff in the management of patients who are violent or abusive including the possible withholding of treatment. The first stage of the Procedure,Yellow Card Status, has already been applied to you and you have now been given been given a Red Card Status. This means as a result of your unacceptable behaviour it has been decided that you will be excluded from the care of University Hospital Birmingham NHS Foundation Trust. You should have received an explanation as to why you are subject to this Procedure and a copy of the Procedure to read. A copy of the Procedure is also included with this letter. Such an exclusion from the Trust requires the Consultant in charge of your care to make alternative arrangements for you to receive treatment elsewhere. Follow up treatment has been arranged for you at with This exclusion will last for one year from the date of this letter. Should you wish to challenge the decision, you may do so through the Trust s complaint procedure, a copy of which is attached. Yours sincerely Chief Executive ENC: Copy of the Yellow and Red Card Procedure; to support staff in the management of patients who are violent or abusive including the possible withholding of treatment. Withholding Treatment Procedure (procedure for managing patients/public who are violent and/or abusive) - Yellow and Red Card Procedures Issued: 30/01/2012 No: 650 Version: 2 16

19 APPENDIX 9 YELLOW AND RED CARDS (for printing and placing in the front of patient notes) YELLOW CARD STATUS PATIENT NAME AND HOSPITAL NUMBER THIS PATIENT HAS RECEIVED A FORMAL WARNING THAT ANY FURTHER BEHAVIOUR THEY EXHIBIT WHICH CONTRAVENES THE WITHHOLDING TREATMENT FROM PATIENTS WHO ARE VIOLENT AND AGGRESSIVE WILL RESULT IN THE ISSUING OF A RED CARD THE PERIOD IS FROM UNTIL RED CARD STATUS PATIENT NAME AND HOSPITAL NUMBER THIS PATIENT HAS BEEN EXCLUDED FROM TREATMENT WITHIN THE UNIVERSITY HOSPITAL BIRMINGHAM FOUNDATION NHS TRUST THE EXCLUSION PERIOD IS FROM UNTIL Withholding Treatment Procedure (procedure for managing patients/public who are violent and/or abusive) - Yellow and Red Card Procedures Issued: 30/01/2012 No: 650 Version: 2 17