1:1 Nursing Care Policy (Specialling)

Transcription

1 1:1 Nursing Care Policy (Specialling) Name of Policy Author & Title: Jenny Watkins, Safeguarding Adult Nurse Lead; Alison Lambert, Falls Specialist Nurse; Fay Wright, Dementia Nurse Specialist; Name of Review / Development Body: Professional Nursing and Midwifery Steering Group Ratification Body: Professional Nursing & Midwifery Committee Date of Ratification/ effective from April 2017 Review Date: April 2020 Reviewing Officer: Jenny Watkins If this document is required in an alternative language or format, such as Braille, cd, audio, please contact the author. 1:1 Nursing Care Policy (Specialling) Version 1 Page 1 of 15

2 Version Control Date Minor amendment Review Type (please tick) April 2017 New Policy 1 Page Line Details of change Version Date Ratification Numbers Numbers Author of Review Title of Author No. Ratified Body (where (where 1 Full Review amended) amended) Inserted Deleted Jenny Watkins, Safeguarding Adult Nurse Lead; Alison Lambert, Falls Specialist Nurse; Fay Wright, Dementia Nurse Specialist; Lauren Bowler, Learning Disability Liaison Nurse Clinical Quality Governance Committee N/A 1:1 Nursing Care Policy (Specialling) Version 1. Page 2 of 15

3 Table of Contacts 1. INTRODUCTION / BACKGROUND SCOPE OF POLICY DUTIES & RESPONSIBILITIES Directors Heads of Nursing, Matrons, Clinical Site Managers & Site Nurse Practitioners Ward Manager, Sisters & Nurse In Charge of the Shift Staff SUBJECT MATTER OF POLICY TRAINING IMPLEMENTATION MONITORING COMPLIANCE WITH & EFFECTIVENESS OF THIS POLICY REVIEW, RATIFICATION AND ARCHIVING DISSEMINATION AND PUBLICATION EQUALITY IMPACT ANALYSIS ASSOCIATED DOCUMENTS REFERENCES APPENDICES..11 APPENDIX 1 RECORD OF 1:1 CARE (SPECIALLING) PROVIDED APPENDIX 2 1:1 (SPECIALLING) NURSING CARE PLAN APPENDIX 3 SPECIALLING DECISION MAKING TOOL/PROTOCOL :1 Nursing Care Policy (Specialling) Version 1 Page 3 of 15

4 1. INTRODUCTION / BACKGROUND This policy is based on national guidance for patient observation issued by NICE For the purpose of this policy, special, specialling and 1:1 are interchangeable. This policy aims to help & support patients to stay independent, maximising their well-being and improving their health outcomes while reducing the risk & incidence of harm to patient. It is intended to be a therapeutic intervention. To ensure patient safety and maintain the appropriate level of supervision and observation, patients may require 1:1 care in a number of circumstances. These circumstances may include: The nature of the treatment or procedure the patient is undergoing The patient is acutely physically ill/requires frequent observations The patient is acutely mentally ill The patient may be likely to become lost and/or abscond The patient has a level of disability that requires a specialist level of support to provide care or facilitate communication The patient may be confused, at risk of falls or at risk of self-harm The patient is exhibiting behaviour that may put them or others at risk. This list is not exhaustive and each case must be considered on an individual basis. This care may be provided by a Patient Sitter, Healthcare Assistant, Associate Practitioner, RN or RMN. For any patient who is requiring specialling and who lacks capacity to consent to this, there must be consideration as to whether the level of supervision they are receiving amounts to a deprivation of their liberty (DOLS). There should also be a clearly documented capacity assessment and there may need to be a best interest decision made following discussion or meeting with relevant others and this should be documented Any potential DOLS issue must be discussed with the matron and medical staff (see DOLS flowchart appendix 2). If appropriate the necessary DOLS applications should then be completed & submitted to the relevant Local Authority. 2. SCOPE OF POLICY The Policy applies to all clinical staff working in the organisation, whether they are substantive, bank or agency staff, where 1:1 care may need to be considered. It applies to all patients that may require 1:1 Care within the Trust regardless of the Specialty or their age. 3. DUTIES & RESPONSIBILITIES Duties within the Trust 3.1. Directors Directors have overall accountability for all aspects of patient safety within the Trust and to ensure appropriate care is delivered. Trust Directors are responsible for the implementation of all relevant policies and arrangements within their areas of control and to lead their managers and staff in proactive and effective risk management. 1:1 Nursing Care Policy (Specialling) Version 1 Page 4 of 15

5 3.2. Deputy Director of Nursing (DDON) The DDON is responsible for ensuring there are appropriate systems and processes in place for the safe observation and supervision of patients whilst improving their care & wellbeing, as far as reasonably practicable Divisional Heads of Nursing, Matrons, Site Nurse Practitioners and Lead Nurses Have responsibility for supporting clinical staff to identify patients who may need additional support and supervision whilst in the hospital. They should support staff to review risk assessment documents (e.g. falls, NEWS, learning disability and mental health concerns) to inform appropriate decision making around those people who may require additional care and supervision and signpost for additional support e.g. LD Liaison, Psychiatric Liaison. Support the ward teams to ensure patient safety and maintain the appropriate level of supervision and observation for patients who do require 1:1 care in a number of circumstances. Support teams when reviewing staffing levels to ensure that appropriate levels of supervision can be provided based of the outcomes of the risk assessments, and where necessary to authorise movement of staff from other areas or authorise additional staffing. Support line managers to release staff for training when required. To ensure all staff are aware of and comply with this policy 3.4. Ward Manager/ Sister or Nurse in Charge of shift To ensure staff are using appropriate risk assessment documents (e.g. falls, NEWS, learning disability and mental health) when assessing patients to enable the identification of those people who will require additional care or observation/support. Identify and review if the enhanced level of care can be provided for the first special from within the clinical teams own numbers where possible. Including consideration of team members skill set and wards acuity. Must consider use of own staff for the Special role for consistency where possible, even if this requires backfill with a temporary member of staff. Also may need to consider other factors e.g. patient response to male versus female providing their care. When using a Patient Sitter the skill set of the Patient Sitter role must be considered to ensure it matches the needs & acuity of the patient. To escalate to Matron in hours or SNP out of hours if it is felt that the additional level of supervision cannot be met from within the team. Must retain overall responsibility for the patient s care where the special is either a Healthcare Assistant, Patient Sitter or a member of staff who is less experienced. This should include ensuring that the special receives an initial appropriate handover of information and any up-dates as required. Must also 1:1 Nursing Care Policy (Specialling) Version 1 Page 5 of 15

6 ensure the special knows who to communicate with regarding any changes in condition or concerns regarding the patient. Must ensure the special is relieved for regular breaks. In certain circumstances (rare) it may be necessary to consider rotating staff who are specialling during a shift. This should be considered where the intensity of the special role means that to perform it for an extended period is likely to place an undue pressure on that special. Must identify knowledge and skills deficits within the team and arrange training for staff accordingly To review the level of care daily or more frequently if there is change in the patient s condition Staff All staff are responsible & accountable for complying with the policy. They should identify patients who may be at additional risk and use the appropriate risk assessments and other associated documents e.g. This is Me, My Care Passport to ensure that safe care is delivered. If there are concerns about the ability to deliver the level of care required, either due to ward acuity or individual s skills, this should be escalated to the Nurse in Charge of that area. Staff are also responsible for reviewing their training needs as part of their PDR and attending any training identified. 4. SUBJECT MATTER OF POLICY All members of the MDT, nursing, medical or therapy staff should be proactive in identifying that a patient may require 1:1 care or they have a history of behaviour that would merit 1:1 care. Other clinical interventions should be considered prior to a decision about 1:1 care including involvement of specialist teams e.g. Outreach, Dementia Nurse Specialist, Psychiatric Liaison Nurse Specialists. Use of sensor mats on seats or beds, caring for the individual in a dementia bay where there may be better overall observation and supervision should also be considered where appropriate. The type and level of specialling should be reviewed at least daily and is dependent on the individual s needs. It is preferable that patients (especially those who are confused or who have a learning disability) should not be moved unless it is clinically indicated. Providing care for the patient. When taking over the 1:1 care of a patient please ensure you receive a handover that encompasses the patients specific needs e.g. level of supervision/observation required, any cognitive or sensory deficits, dietary requirements, communication needs etc. In cases where you feel the patient may require more assistance than you can provide, do seek the help of another nurse either as a chaperone, or to assist in the provision of care. Ensure all care and observations are recorded as instructed. If the patient s condition changes and/or requirements change ensure you inform the nurse in charge. 1:1 Nursing Care Policy (Specialling) Version 1 Page 6 of 15

7 If observations or intervention are required that you are not competent to perform, inform the nurse in charge, so they can organise a relevant person with the necessary skills to perform the observations or interventions. 1:1 Care/Observation of the patient. Observe the patient even if you think that they are resting/asleep. If the patient s condition or behaviour is such that you feel concerned that you are unable to care for them safely, please inform the nurse in charge. If there is significant change (deterioration) in the patient s condition or behaviour at any time it is vital that you inform the nurse in charge and document the changes. Depending on why the patient requires 1:1 care, you may need to consider supporting patient with short periods of purposeful activity (e.g. utilising activity boxes, available on all wards) this is particularly pertinent to patients with dementia / delirium / confusion. Things to consider if the patient is agitated or distressed: Getting the patient to read the newspaper (or reading it to them) and discussing items in the paper with them. If there is a day room on the ward, sitting there quietly with the patient; there may be fewer distractions than in a bay area, which may have a calming effect on the patient, as well as giving other patients some respite. Watching the TV or listening to the radio. Depending on the patient s ability & any safety concerns (e.g. the risk of patient trying to leave the hospital where they lack capacity for that decision), consider taking them for a walk. Engage with the patient by utilising an assortment of reminiscence items, games or puzzles on the ward e.g. playing cards, scrabble, dominos or puzzles. If the patient has a learning disability or dementia use the invaluable information held in the This is Me, My Care Passport to gain an in-depth understanding about the patients likes, dislikes and hobbies. If they do not have a This is Me, My Care Passport document you could start one by gathering the information. They may be hungry or thirsty please encourage eating & drinking, snacks etc. between meals. Please ensure consideration is given to such things as non-verbal communication, expression of pain (Bolton pain scale assessment). NB. The nurse in charge will decide whether it is safe or appropriate for the patient to leave the ward and / or whether another member of staff should accompany you. It is important that you must never leave the ward with the patient without gaining permission from the Nurse in Charge and it is imperative that the nurse in charge knows where you are going. The Nurse-in-Charge may ask the person providing 1:1 care to assist another patient or to perform other duties within their scope of practice, if patients family are visiting or if the patient they are providing care for is discharged during their shift Avoid any situation which jeopardises your own or patients safety. 1:1 Nursing Care Policy (Specialling) Version 1 Page 7 of 15

8 In an emergency dial 2222, state clearly what you need e.g. Adult/Paediatric Resuscitation Team/ Security etc. and clearly state exact location. The input of carer / relatives For some patients depending on the reason they require specialling, it may be possible for the carer/relative (if they agree to it) to provide the patient observation required. This could apply to patients who are confused or wandering. The nurse in charge should liaise with the family regarding these arrangements if appropriate. Only leave the patient if the nurse in charge has authorised the carer/relatives to provide observation of the patient. Even if the carer / relative is providing the observation the allocated special should still check regularly on the patient (as agreed with nurse in charge, dependent on individual need). Handing over to the next special. At the end of each shift, you should await someone to take over the care of the patient do not leave the patient unattended. Give the person taking over from you a handover of the person s condition and what has occurred during your shift including any activities or distraction techniques that have proved effective. Ensure you have written up the care plan for your shift. If you are an unregistered nurse, you must ensure your entry is countersigned by a registered nurse. Review/Termination of 1:1 care. Review of the patient s condition and the need to continue 1:1 care should be undertaken on each shift by the Sister/Charge Nurse or the shift leader and with the Matron at least daily. The feedback on the patient and how they have been on the shift should feed into this assessment. 5. TRAINING Awareness of dementia & learning disability training is provided on the Trust Clinical Induction program & Health Care Assistant Induction. In addition the Trust provides ad hoc Dementia, Delirium & LD study days. Falls Prevention & Consent & Capacity Training which includes DOLS is provided on Induction and Statutory & Mandatory update training within the Trust. 1:1 Nursing Care Policy (Specialling) Version 1 Page 8 of 15

9 6. IMPLEMENTATION This is a new Policy replacing previous guideline document. There will be notification via Trust Communications and it will be part of training sessions. 7. MONITORING COMPLIANCE WITH & EFFECTIVENESS OF THIS POLICY All issues/concerns relating to patients that require 1:2:1 care will be discussed at a local level with the clinical teams and escalated to relevant Matron & Divisional Head of Nursing where appropriate. All relevant issues will also be discussed within the Safeguarding Adults Committee. Any emerging themes or concerns regarding 1:2:1 care should be reported via Datix reporting and discussed at the Safeguarding Adults Committee. 8. REVIEW, RATIFICATION AND ARCHIVING The policy will be reviewed every three years or earlier if national guidance changes. The review will then be subject to review & re-ratification. The Local Policy Officer is responsible for ensuring that archive copies of superseded working documents are retained in accordance with the Records Management: NHS Code of Practice, 2015 refer to Policy Development and Management: including policies, procedures, protocols, guidelines, pathways and other procedural documents 9. DISSEMINATION AND PUBLICATION Dissemination of the final policy is the responsibility of the author. They must ensure the policy is uploaded on Trust Net via the Central Policy Officer. The Central Policy Officer is responsible for informing the Communications team to issue a trust-wide notification of the existence of the Policy. Clinical Directors, DMDs, DDOs Speciality Business Unit (SBU) or supporting services management teams, ward managers and heads of department are responsible for ensuring that all relevant staff under their management (including bank, agency, contracted, locum and volunteers) are made aware of the Policy. 10. EQUALITY IMPACT ANALYSIS The author of this policy has undertaken an Equality Impact Analysis and has concluded there is no impact identified. The analysis is available via the Central Policy Officer. 11. ASSOCIATED DOCUMENTS All existing Trust policies, procedures & plans will be adhered to, including: Learning Disabilities Policy Safeguarding Adults Policy Mental Capacity Act & Deprivation of Liberty Safeguards Policy 1:1 Nursing Care Policy (Specialling) Version 1 Page 9 of 15

10 Mental Capacity Act (2005) Code of Practice Missing Person s Procedure Cardiopulmonary Resuscitation Policy Falls Policy REFERENCES Mental Capacity Act (2005) 1:1 Nursing Care Policy (Specialling) Version 1 Page 10 of 15

11 Appendix 1 Record of 1:1 Care (Specialling) provided Ward.. Room Date Affix patient label Name Date of birth Hospital number Time 0700 Nursing interventions/ care provided during the specialling period Activities / therapeutic engagement provided during the hour Did the individual enjoy the activities Print name, designation and signature of special md :1 Nursing Care Policy (Specialling) Version 1 Page 11 of 15

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13 Appendix 2 1:1 Nursing Care (Specialling) Plan. Ward... Room / Bed number Date. Affix patient label Name Date of birth Hospital number Patient condition and diagnosis Rationale for specialling e.g. regular vital signs monitoring, risk of self-harm, falls risk, confusion Specific requirements, for example:- Do not leave ward area Male / female carer Date and time of entry Current level of observation being provided, e.g. 1:1, arm s length, bay nursing Changes in the patient s condition during the specialling period. Level of observation required after review. Rationale for new level of observation if applicable Next review date and time Print name designation and signature 1:1 Nursing Care Policy (Specialling) Version 1 Page 13 of 15

14 Date and time of entry Current level of observation being provided. Changes in the patient s condition during the specialling period. Level of observation required after review. Rationale for new level of observation if applicable Next review date and time Print name designation and signature 1:1 Nursing Care Policy (Specialling) Version 1 Page 14 of 15

15 Appendix 3 Does the Patient require 1:1 care for an acute episode of illness that necessitates a Trained Nurse e.g. close monitoring of vital signs, output, conscious level, RMN support for significant mental health issues or management of risk, e.g.? If Yes If No Specialling Decision Making Tool/Protocol Will this Trained Nurse require specialist skills e.g. Registered Mental Health Nurse, ICU skills, Cardiac monitoring etc.? If Yes If No Discuss with Matron to ascertain if there is potential for this nurse to be provided from within the Ward Team or another ward or Dept. If not them agreement sort for this to go out to Staff Bank/Agency Does the Patient require 1:1 Care due to significant risk to themselves or others as a result of behaviours that are challenging to manage on the Ward/Dept.? If Yes Discuss with Matron to assess if there is potential for the required Healthcare Assistant to be provided from within the Ward Team or another Ward or Dept. If not them agreement is sort for this shift to go out to Staff Bank If No Does the Patient require general supervision to manage risk & to receive some stimulation or distraction? Please note: All Decisions regarding Patients who require a Special 1:1 should be reviewed & discussed daily with the Matron or out of hours with the Clinical Site Manager/Site Nurse Practitioner Consider the use of a Patient Sitter 1:1 Nursing Care Policy (Specialling) Version 1 Page 15 of 15