Royal United Hospitals Bath NHS Foundation Trust Annual Health and Safety Report 2014/15 Introduction and background This Annual Health and Safety Report covers the period from 1 April 2014 to 31 March 2015. The purpose of the report is to provide key information regarding the Trust s health and safety arrangements put in place to protect its employees, patients, contractors and members of the public. The Trust s Health and Safety Framework is based on the 1997 Health and Safety Executive s publication entitled: Successful Health and Safety Management (HSG 65). This is the over-arching guide on the essential philosophy of good health and safety: what it means; how to achieve it; and how to maintain it. The well-known POPIMAR model (Policy, Organising, Planning, Implementation, Measuring performance, Audit and Review) was replaced in 2013 with the Plan, Do, Check, Act cycle, which is similar to the Plan, Do, See, Act model introduced for patient safety. This has simplified the process, without losing the general points for good Health and Safety management. The Health and Safety Executive [HSE] set out key health and safety issues relating to healthcare provision. The Trust has measures in place to limit the impact of these on patients, employees and members of the public. Under safety topics are the following:- Slips and trips Falls from windows Moving and handling Safe use of Bed rails Scalding and Burning Workplace violence Under Health topics are the following:- Sharps injuries Legionella Skin care [Dermatitis & latex allergy] The status of these initiatives will be discussed in more detail later in the report. Management Responsibilities Responsibility for Health and Safety at Board level lies with the Director of Estates and Facilities. The Director of Estates and Facilities is supported by a dedicated Head of Security and Safety and a Health and Safety Service Manager, who line manages the members of the Health and Safety team. Managers and staff at all levels are encouraged to act within the Strategic Framework for Risk Management where risks are identified. Agenda Item: 15 Page 1 of 6
The Health and Safety Committee is currently chaired by the Director of Estates and Facilities, with representation from both staff side and management across a wide range of departments and meets quarterly. The chairmanship of this committee is being reviewed to ensure sufficient challenge exists in the reporting structure. Risks The Trust undertakes a broad range of activities, and so there are a wide variety of risks to manage. The list below represents only some of the most common of these. The Trust s Strategic Framework for Risk Management is well embedded and includes a risk assessment process for use by managers and staff that is underpinned by a suite of policies and procedures which can be found on the Trust s Intranet. The types of health and safety risks experienced within the trust are varied, but include: Slips, Trips and Falls Lone Working Security Violence and Aggression, including Managing Difficult Behaviour Manual Handling Infection Control, including waste management and needle stick injuries Work related ill health, and injuries, including work related stress Environmental, including structural and equipment Fire safety Performance 2013/14 and 2014/15 The table below shows the number of incidents recorded on the Trust s Incident Reporting System (Datix) for each of the two financial years. The increase in the number of RIDDOR reportable incidents is due in part to a significant number of late reports, which may not have previously been reported. Health and Safety training has been emphasising the need to report incidents, both as a legal duty and shared learning. Over the last year the number of employees has also increased, first with the transfer of maternity services from Great Western Hospitals NHS Foundation Trust in June 2014, then with the acquisition of the Royal National Hospital for Rheumatic Diseases (RNHRD). Category 2013/2014 2014/15 Environment 173 174 Fire 83 73 Ill Health 21 27 Personal Accident 347 436 Security 162 191 Vehicle 10 45 Violence, abuse, harassmen 241 328 RIDDOR 19 33 New Claims 6 6 Total 1037 1274 Agenda Item: 15 Page 2 of 6
Health and Safety Training Health and Safety training relates to Health and Safety, Fire, Resuscitation [First Aid], Conflict Resolution Training and Moving and Handling training (levels 1 {loads} & Level 2 {patient handling}), the target figure for H&S training is 90%. The final totals for 2013/14 are shown in brackets. The compliance figures on 31 March 2015 were CRT Fire H&S Moving and Handling (1) Moving and Handling (2) Resuscitation (adults) Resuscitation (paediatric) 67.1% (51.4) 78.8% (69.7) 90.6% (87.4) 87.6% (72.2) 80.5% (62.8) 88.2% (81.8) 84.8% (82.5) Over the last 12 months there has been a steady increase in compliance figures across all Health and Safety training subjects, with the largest rise being Moving and Handling level 2 ( patient handling). The resuscitation training is the only area to have moved into another category, moving up from red to amber. Health and Safety remains the only subject in the green category, due in part to it being embedded into the core skills 2 and 3 programme with no requirement for staff to undertake more frequent refresher /update training. Areas with a high incidence of violence and aggression incidents are targeted to receive Conflict Resolution Training. The Conflict Resolution Training faculty receive a quarterly report relating to all violence and aggression incidents reported on Datix so that action can be taken to ensure areas reporting incidents receive appropriate training. Contractors employed to undertake works on the RUH site have to complete an online induction training programme before they can be issued with an Identity Card and authority to carry out works. This procedure is well established within the Estates Department. Summary of work undertaken 2014/15 Safety risks Slips and trips and falls- During 2014/15 the number of staff related slips, trips and falls have decreased. A template risk assessment has been devised and distributed to wards and departments for completion, the H and Safety Advisor has spent time with wards reviewing this document and updating it during the latter part of 2014. The long awaited spill stations were installed in January 2015. As a result of the mild winter, there have not been any serious injuries reported as a result of slipping and falling due to ice and snow. Lone Working- Areas where lone working is carried out have submitted risk assessments and procedures. No adverse incidents have been reported. Those lone workers attending Agenda Item: 15 Page 3 of 6
Health and Safety training are able to outline the procedures they use. From these discussions, it has to be noted that although the systems are in place, they are not robustly adhered to. A lone worker device has been identified and was trialled on and off site during March 2015. The outcome of this work has not yet been finalised. Violence and Aggression, including Managing Difficult Behaviour The Security Operations Manager is responsible for overseeing the management of violence and aggression within the Trust. A document issued following the death of a Nursing Home resident, who had been restrained, identified that a clinical condition, such as Dementia or Learning Disability needed to be better understood as a cause of violence and aggression towards staff. This has led to a change in guidance regarding the use of control and restraint (restrictive practices) and has identified that the standard Conflict Resolution Training is not suitable for all staff. Work is ongoing to identify suitable training based on staff role, and how to deliver this training in the future. The current management of violence and aggression is focussing on identifying potential problems before they escalate and having the appropriate people in place. The Women and Children s Division has been leading on this initiative. Falls from windows- Falls from windows was one of the main reasons for prosecution within the Health and Social Care sector in the United Kingdom during 2012/13. The Trust has worked hard to reduce this risk to a level as low as is reasonably practicable Risk assessments have been completed for all areas, with additional risk assessments in place for windows fitted with single glazed units. In some staff only areas, window restriction has been reviewed, and where safe, removed to aid thermal comfort of staff. The main issue now associated with window restriction is the reduced level of ventilation achieved by opening windows. Heat-wave advice was sent to wards and departments regarding not opening windows during the hottest part of the day, but more needs to be done. Estates staff have researched the rental of air conditioning units to manage raised temperatures over the warmer months, but this has to be funded by the ward or department and in order to prevent legionella contamination maintained and serviced by the supplier. New windows are being fitted which are designed to offer better ventilation whilst complying with the need for restriction to 100mm eg. Waterhouse and Cardiac wards. Moving and handling- Training compliance continues to improve, and a number of new trainers were trained during 2014/15. The revised training programme now includes those attending and participating in a patient handling induction session so that teaching style and skills can be assessed. Once this is completed, trainees are deemed competent to train at ward /department level. This has proven to be successful, with trainees actively taking part in the induction session and using it to ensure that they deliver high quality standardised training across the Trust. All incidents relating to Moving and handling are investigated by the Manual Handling Advisor and where changes in practice are required, she works with the department in order to facilitate this change. Safe use of Bed rails All Trust beds are fitted with integral safety sides, except on the low level beds where their use would be contra-indicated. A risk assessment process is in place to ensure their correct deployment. The Trust s Falls Policy, incorporating bed rails use has recently been updated. Agenda Item: 15 Page 4 of 6
Scalding and Burning- This is a National Patient Safety Agency (NPSA) never event. Water temperatures have to be maintained above 50 o C for legionella management, therefore thermal mixing valves are fitted to all taps in areas used by patients. A review of the location and use of thermo mixing valves (TMV) is required to ensure their correct use and removal of those where they are not required. This will reduce the impact these devices have on the Trust s maintenance resources. There were no reported incidents of patients being burnt or scalded by the domestic hot water system during 2014/15. Fire Safety - The Fire Safety Advisor delivers a fire awareness session on the Induction Course and also on the two and three year Core Skills Courses. Classroom based fire awareness sessions are also provided, for consultant /medical staff, student nurses and staffing solutions staff. In addition to this, he has provided specific fire awareness training, to staff in their work areas. In January 2015, a Fire Safety craftsperson started working at the Trust to support the Fire Safety Advisor. He has taken on some of the fire awareness training here at the RUH and at the RNHRD plus many other fire safety related duties. The Fire Safety Advisor and Fire Safety craftsperson, continue to identify measures, to reduce the number of unwanted fire alarm activations and to improve the fire alarm system. Health Risks Sharps injuries- all reported incidents are dealt with in line with the Trust s Sharps Policy. During 2014, the number of reported sharps related injuries increased. A review of all incidents took place from June 2014 until December 2014, but no definitive cause for sharp injuries was Identified. Safer sharps devices have now been introduced, starting with insulin pen needles and syringes, and now including venepuncture needles and butterfly and subcutaneous fluid needles. Risk assessments have been completed for paediatrics as it is currently not possible to get safety devices in the small sizes that are used in practice. Work will continue during 2015/16 to ensure safer sharps are available where reasonably practicable Legionella The Trust has completed all the actions set out in the 2011 Health and Safety Executive action plan. The Trust is focusing on the action plan associated with the 2012 Legionella Risk Assessment. The requirement to also to test for, and manage Pseudomonas bacteria and this has led to an increase in the amount of water sampling completed. The Trust currently undertakes approximately. 600 water samples per year. The Water Safety Group manages and monitors all aspects of water safety and has recently agreed to the revision of the Legionella Risk Assessment. The Trust is currently progressing with work to replace the current chemical water disinfectant plant with a Copper /Silver ion system. Before this can be installed a separate water supply is required for Dialysis, as it is felt the Copper/Silver ions may impact on patients treatment. Skin care [Dermatitis & latex allergy] - An additional category was added to the Datix Incident Reporting system to capture incidents relating to skin /hand damage. To date there s Agenda Item: 15 Page 5 of 6
been only been one incident reported. Occupational health have amended their preemployment screening for skin damage and staff attending core skills and induction Health and Safety training are reminded of the conditions they need to look out for and the appropriate action to take. Royal National Hospital for Rheumatic Diseases With the acquisition of the RNHRD in February 2014, there has been a requirement to review the health and safety risks at the RNHRD site as outlined above. Prior to the acquisition, the Health and Safety Service Manager provided health and Safety support and advice to the RNHRD under a Service Level Agreement. This role has continued, with the focus being on aligning the health and safety systems and processes at the RNHRD site with those at the Trust. The change in management has resulted in a review of the RNHRD risks which were tolerated by the RNHRD being reassessed, such as the balconies and fire assessment for Bath Heights used for patients attending RNHRD residential programmes. Conclusion The Board of Directors is asked to take note of the contents of this report as a record of Health and Safety performance for 2014/15. Agenda Item: 15 Page 6 of 6