Escorting Vulnerable and at Risk Service Users

Transcription

1 Escorting Vulnerable and at Risk Service Users Target Audience Who Should Read This Policy All clinical staff n/a Version 1.0 January 2015

2 Escorting Vulnerable and at Risk Service Users CONTENTS PAGE NUMBER 1.0 Introduction Purpose Objectives General Principles Escorts Procedures Service users detained under the MHA Transport Accountability and responsibility Assessment of risk Policy compliance and monitoring Links to other policies, strategies and references 8 Appendix 1 Risk Assessment pro-forma 10. Version 1.0 January

3 1. Introduction This policy has been developed to support and guide clinical staff when considering transportation of vulnerable and/or at risk service users. The guidance links to the NHS Litigation Authority Risk Management standards. 2. Purpose This policy provides guidance for all staff involved in the planning and implementation of escorted activities of in-patients who require an escort as a consequence of their: Individual risk management plan Observation level Leave status Mental Health Act status. 3. Objectives Primarily this policy refers to hospital in-patients who may: Abscond Harm themselves Neglect themselves or disregard their own personal safety Harm others. However, this guidance may also be relevant to individuals living in community facilities, especially where the residence is designated as an in-patient service. In practice, the appropriateness of, and the requirement for, escorted activity of this sort may vary according to the nature and purpose of the service. For example escorted visits may be more frequent within inpatient areas rather than residential/rehabilitation services. Clearly, the emphasis for escorted transport needs to be on the degree of risk or vulnerability, and not the nature of the activity. Therefore, when considering transportation for service users always consider how the escort or travel planning arrangements may impact or limit the social, recreational, educational or rehabilitative aspects for service users. Consequently, this policy does not apply to those situations where staff simply accompany an individual, or individuals, in order to support and facilitate such activities. In other words, this policy is not intended to interfere with social care approaches that emphasise the service users personal responsibility and individual autonomy. 4. General Principles All risk assessments must be recorded in care records. Risk can be variable, depending on circumstances. Risk assessments should have short-term perspectives and be frequently reviewed in the patients/service users care plan: a maximum review period should be clearly identified. Interventions can increase as well as decrease risk. Good relationships between the nurse and the service user make risk assessment and management easier, more accurate and may reduce risk. Version 1.0 January

4 If the service user is to be transported and escorted by an unqualified member of staff, it is the qualified clinician s responsibility to assess the risk involved in the transportation. A risk re-assessment should be carried out at each time of transportation. Consideration as to whether two staff is required will always be needed. Service users who present as a risk to others are also likely to be vulnerable to other forms of risk. e.g. self-harm, self-neglect or abuse by others. Risk cannot be eliminated entirely but all actions need to demonstrate measures that aim to reduce identified risks. Assessment of risk should be documented in the care records and form part of the service users care plan. When undertaking an escort within the grounds of a hospital or other residential establishment, the escort must be aware of the physical boundary identified for that unit. Throughout the escorted activity, the escort maintains their duty of care to the service user. The service user must not be placed in a vulnerable position where their safety or welfare could be jeopardised e.g the escort and service use separate and meet up later. If a service user leaves the unit or service with an escort, they must return to the unit or service together. This is particularly significant in cases where the off site activity unexpectedly runs over the escort s shift hours the duty of care remains in place until the service user is returned safely to the unit. In these cases the manager/team leader may need to consider time owing arrangements. The escort must be mindful of any purchases or acquisitions made by the patient during an escorted activity. Patients should be advised against acquiring items that may jeopardise their own health or safety or that of others. If such purchases are made, or cannot be deferred, they must be brought to the attention of the Person-in-Charge upon return to the unit/service. The escort must be able to contact and communicate with their base e.g. the ward, service, unit. If the off site activity runs over anticipated times of return the escort must make an update/ safe and well' call to the unit. Version 1.0 January

5 5. Escorts Where possible, escorted activities should be planned in advance. Escorted activity provides a valuable opportunity for therapeutic engagement and affords the patient normalising, safe and therapeutic time away from the hospital or unit. Wherever possible, the patient or patients should be involved in the planning of escorted activities e.g. in relation to date, time, nature and purpose of the activity etc. Where this is not possible or practical, the patient(s) should be informed of the arrangements at an early stage and given as much advanced notice as is possible. All professions can appropriately fulfil the role of escort. Wherever possible, decisions about the appropriate professional to act as the escort, and the required level of competence, should form part of the forward planning process. In certain circumstances e.g. escorting a patient to court, the escort must be a registered/qualified practitioner. In such circumstances, unregistered or unqualified staff can be used to supplement the registered or other suitably qualified escort. Unless the care plan specifies otherwise, e.g. in relation to planned therapeutic risk taking, the escort must, at all times, be in the company of the patient. The escort must not let the patient out of their view unless it is fitting to do so e.g. for comfort breaks (use of toilet facilities) or within sports centre changing facilities. Patients are entitled to request an escort of the same sex and, where possible, every effort should be made to meet their request. However, there may be situations where this will not be possible or practical. 5.1: Students Students must not escort patients outside the boundary of the hospital or residential unit on their own. However, they may accompany the identified escort as part of their learning experience Unaccompanied students may escort patients within the boundary of the hospital or unit if they are considered to be competent and if it is appropriate to the activity and the assessed needs of the patient. The risks to the patient and the student must be taken into consideration; if there is any uncertainty, the student should accompany another identified escort. Responsibility for this decision rests with the nurse-in charge who maintains responsibility for the safety and welfare of the patient. Wherever possible, student learning objectives related to the activity should be identified. Further guidance on student learning objectives in relation to escort duties can be obtained from Clinical Student Placements. 6. Procedure A detailed record must be made, prior to escorted activities and include: The patients physical description upon leaving. Clothes worn for the activity upon leaving. The destination. The expected duration of the activity. The anticipated time of return. Vehicle registration number (or mode of transportation) Name(s) of escorts(s). Mobile phone contact number. Version 1.0 January

6 7. Service users detained under the Mental Health Act For those who are formally detained under the Mental Health Act, the patient's Consultant must authorise the appropriate leave of absence and arrangements prior to the escorted activity. In the absence of the consultant, this permission must be granted by the doctor who is temporarily in charge of the patient s treatment e.g. another consultant, a locum consultant or an appropriately approved specialist registrar (Department of Health 1999) For restricted patients detained under section 37/41 of the Act, authorisation for leave has to be approved by the Home Secretary. 8. Transport When considering transport requirements related to an escorted activity, staffs own personal transport should be used judiciously. However, personal transport may be appropriate where: It is more suitable in terms of normalisation It is not possible to obtain or use other means of transportation and the activity cannot be rescheduled It is warranted because of the urgency of the situation. If personal transport is used, the vehicle s owner must have the correct insurance cover authorising them to use the vehicle for such purposes. Check with your own insurance car company for more details about passengers in the course of work duties. Where a staff member is the driver of the vehicle, the number of escorts required must be reassessed and an additional escort or escorts arranged. Damage to personal vehicles incurred as a result of the escort e.g. cigarette burns, stained or soiled seats, broken fixtures remain the responsibility of the driver under their insurance arrangements. 9. Accountability and Responsibilities Team leaders and line managers have a responsibility to check that staff who drive as part of their professional role are appropriately insured, are not disbarred from driving or taking passengers on health grounds. Individual staff have a responsibility to ensure they are appropriately covered by insurance and be aware that should they drive whilst undertaking duties but are disbarred on legal or health grounds then they do so at their own risk. 10. Assessment of risk The aim of the assessment is to identify any factors that may impact on the safety of the service user or the employee during transportation. A pro-forma for risk assessment is attached to this policy for guidance and use e.g. it aims to act as a prompt or provide a useful format for services to retain evidence that a risk assessment has been undertaken. Identification of risk should consider the following: - How serious is the risk? - Is the risk general or specific? - Is the risk immediate? - Is the risk volatile? - Can the risk be reduced by any treatment or management plan identified? Version 1.0 January

7 Assessment of risk in relation to transportation will usually include:- (i) HISTORY Are these following risk factors stable or have any of them changed recently? - Previous violence and / or suicidal behaviour. - Poor compliance with medication. - Presence of substance use. - Any identified precipitants and / or mental state changes or behaviour that precipitated violence and / or relapse. - Any recent severe stress, particularly loss or threat of loss situations. - History of jumping from moving cars, disrupting driver, unable to follow simple safety requests. (ii) ENVIRONMENTAL/VEHICLE SAFETY The employee is responsible for ensuring that the vehicle being used is safe for the transportation of service users. The vehicle should meet all the statutory requirements of road safety. Insurance, MOT certificates and vehicle licence should be inspected annually to ensure ongoing patient safety. The vehicle should be appropriately insured for the transportation of clients. (iii) MENTAL STATE - The service user is agreeable to being transported. - Any specific threats made by the service user. - Evidence of emotions related to violence, for example irritability, anger, hostility and suspiciousness. (iv) MEDICAL ISSUES - Any medical condition that may affect mental state. For example epilepsy, diabetes, heart problems. - Physical limitations that affect usage of a car or walking to or from a car. If the qualified staff member has made a risk assessment that the service user is safe to be transported, then transportation and escort can proceed. If the qualified staff member identifies a risk, has concerns or is unwilling to transport in their own cars the service user should not be transported or escorted and alternative arrangements considered. All risk assessments must be retained/recorded in care records and easily accessible for escorts prior to leaving the unit or service. 11. Policy Compliance and monitoring. Consultants, service managers, team leaders and nurse-in charge will ensure that the policy is in place within their sphere of responsibility and that staff are aware of its contents. Examples of evidence to demonstrate compliance of this policy includes: Clinical risk assessments. Trip/transport/visit risk assessment. CPA documentation Notes from MDT meetings/ward reviews. Version 1.0 January

8 Care plans. Monitoring performance against this policy includes: An annual audit of risk assessments. Audit findings to be reported to the relevant Directorate Governance and Care Group and Clinical Audit. 12. LINKS TO OTHER POLICIES/STRATEGIES/REFERENCES Lone Worker Policy Mental Capacity Act Policy Mental health Act Section 132/133: Patients rights under the mental health act Consent to treatment Care Programme Approach (CPA) Risk Management strategy. Clinical Risk Assessment. Royal College of Psychiatrists London. Assessment and Clinical Management of risk of harm to other people. Council Report CR53 April Risk, choice and Independence, DoH 2007 NHS Litigation Risk Management standards for mental health (visit the NPSA website for updates on patient safety) Version 1.0 January

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10 TRIP/TRANSPORT/VISIT RISK ASSESSMENT The following pro-forma has been prepared to assist staff involved in trips or visits in completing their risk assessment as required by the Trusts policy. This pro-forma acts as a prompt to focus the mind on areas where risks can arise. Please feel free to modify the pro-forma to suit your circumstances. The completed form must be discussed with and approved by the Nurse-in-charge prior to the trip/visit. In addition the Staff escort must keep a copy of the document with them at all times during the visit/trip. A copy of the completed form should be retained in the client s records as part of your records retention strategy. Part A: To be completed by /trip/visit/ co-ordinator/named nurse Description of visit/trip Name/Unit No. of Client Coordinator Participating Staff (list) Mode of transport to/from area and within area (if applicable) Full address of where event takes place. Date of risk Assessment Risk Assessor Risk reviewed by Nurse in Charge (name) Date: Version 1.0 January

11 Part B: Risk Assessment form - to be completed by staff in charge of visit or trip. Risk description Means of transport presenting a risk to staff or client shealth and safety Staff/client numbers/ratio making it difficult to supervise activities Trip/ visit includes disabled personnel resulting in the need for special arrangements. Control Measures in place Risk Aggregate - Likelihood x Severity Risk classification (Low, Medium High) Prior checks made on vehicle suitability. Avoidance of driver fatigue by taking appropriate breaks during the journey. Check valid insurance documents Ratio of xx clients to 1 member of staff adopted to ensure proper supervision. Prior instructions/ training of client and staff e.g. Briefing for client & staff re health and safety information for general awareness. Planning of event to include checks if disabled personnel involved. Manage event as far as is reasonably practicable taking cognisance of DDA. Availability of equipment e.g wheelchair, walking aids etc. Availability of suitable toilet facilities etc. Version 1.0 January

12 Risk description Control Measures in place Risk Aggregate Likelihood x Severity Risk classification (Low, Medium High) Emergency situation arises putting the lives of client/staff at risk Briefing for all participants at start of event on how to respond to emergency situations. First aid/medical arrangements pre-arranged in case of need. Extremes of weather adversely affecting the health and safety of staff and/or client All staff are adequately prepared with proper clothing (including high visibility apparel if needed) Suitable lines of communication always available. Client/ member of staff gets lost during trip / visit Staff allocated to client asked to stay in contact at all times. Security issued with contact details including mobile phone numbers where possible. Staff to familiarise with local surroundings. Details of local emergency services always available whenever possible. Version 1.0 January

13 Risk description Unacceptable behaviour by client or staff leading to severe event disruption and possible loss of reputation Control Measures in place Event organiser/leader briefs staff/client on expected behaviour/rules and regulations at the start of event. Staff on hand to enforce good behaviour. Staff/client encouraged to immediately report unacceptable behaviour to members of staff. Risk Aggregate Likelihood x Severity Risk classification (Low, Medium High) Allergies resulting in client staff suffering an allergic reaction Co-ordinators to check if anyone suffers from allergies before event takes place if condition known, prior arrangements are made to manage the risk (i.e. appropriate medication, care taken not to expose individual to risk). Lone Working resulting in personal health and safety risks Security risks to staff and client Avoid lone working at all cost. Follow Trust s Lone Working Policy Contact information for local police available Version 1.0 January

14 Policy Details Title of Policy Unique Identifier for this policy State if policy is New or Revised Escorting Vulnerable and at Risk Service Users BCPFT-CLIN-POL-08 New Previous Policy Title where applicable Policy Category Clinical, HR, H&S, Infection Control etc. Executive Director whose portfolio this policy comes under Policy Lead/Author Job titles only Committee/Group responsible for the approval of this policy Month/year consultation process completed * n/a Clinical General Month/year policy approved January 2015 Month/year policy ratified and issued January 2015 Next review date March 2016 Executive Director of Nursing, AHPs and Governance Service Manager Adult/ Older Adult Professional Advisory Group Implementation Plan completed * Equality Impact Assessment completed * Previous version(s) archived * Disclosure status Yes Yes Yes B Key Words for this policy * For more information on the consultation process, implementation plan, equality impact assessment, or archiving arrangements, please contact Corporate Governance Review and Amendment History Version Date 1.0 January 2015 Details of Change Reformatted to meet new Trust policy template Version 1.0 January