Children presenting to Acute Healthcare Services at the Royal Cornwall Hospital who Leave Without Being Seen (LWBS) V1.0 July 2015
Policy for Children presenting to the Emergency Department, Minor Injury Units or Paediatric observation unit who Leave Without Being Seen (LWBS)
Summary. This Policy provides instruction and guidance for clinical staff when Children and Young People (under 18years) presenting to Acute Health Care Services in Cornwall including the Emergency Department and Paediatric observation unit at the Royal Cornwall Hospital who Leave Without Being Seen (LWBS). It is anticipated that this policy will also be used by countywide minor injury units. Staff working in the Emergency Department, Minor Injury Unit or the Paediatric Observation Unit may be the first point at which children who have been subject to maltreatment, abuse or neglect come into contact with health professionals who are able to act for their protection. Healthcare professionals have a duty to safeguard and protect children and young people and to act in the child s best interests. Individuals with parental responsibility have a duty to ensure that a child or young person s medical needs are not neglected and that they are protected from harm. Page 2 of 14
Contents Summary....2 1. Introduction...4 2. Purpose of this Policy/Procedure...4 3. Scope...4 4. Definitions / Glossary...4 5. Ownership and Responsibilities...4 5.1 Role of the Managers...5 5.3 Role of Individual Staff Members...5 6. Standards and Practice...6 6.1 Principles:...6 6.2 Policy...6 This section of the document along with appendi 1 and 2 form the main body of the policy....6 6.3... Error! Bookmark not defined. 7. Dissemination and Implementation...7 8. Monitoring compliance and effectiveness...7 9. Updating and Review...8 10. Equality and Diversity...8 APPENDIX 1...9 APPENDIX 2 (Sample)...10 Leave Without Being Seen- Discharge Form...10 Appendi 3. Governance Information...11 Appendi 4. Initial Equality Impact Assessment Form...13 Page 3 of 14
1. Introduction This Policy provides instruction and guidance for clinical staff when Children and Young People (under 18years) presenting to the Emergency Department, Minor Injury Units or Paediatric observation unit who Leave Without Being Seen (LWBS). All health professionals in the NHS play an essential role in ensuring that children and families receive the care, support and services they need in order to promote children s health and development (HMGov, 2015). Healthcare professionals have a duty to safeguard and protect children and young people and to act in the child s best interests (HMGov, 2015). Staff working in the Emergency Department, Minor Injury Unit or the Paediatric Observation Unit,may be the first point at which children who have been subject to maltreatment, abuse or neglect come into contact with health professionals who are able to act for their protection. Individuals with parental responsibility have a duty to ensure that a child or young person s medical needs are not neglected and that they are protected from harm. This version supersedes any previous versions of this document. 2. Purpose of this Policy/Procedure This policy has been developed to provide instruction and guidance for clinical staff when Children and Young People (under 18years) presenting to the Emergency Department, Minor Injury Units or Paediatric observation unit who Leave Without Being Seen (LWBS). (Previous discharge against medical advice) 3. Scope All Managers, Clinical Directors and Divisional/Departmental Managers throughout the Trust are required to instigate action to ensure the appropriate implementation of the Policy within their area(s) of control. 4. Definitions / Glossary Child: For the purpose of this policy a child is defined as a person under the age of 18 years at the time of their attendance (Children Act, 1989). MARU: Multi Agency Referral Unit (MARU) the central referral unit for children deemed at risk of harm or in need of support. Also known as the Local Authority 5. Ownership and Responsibilities Page 4 of 14
This process should be followed by clinical staff when Children and Young People (under 18years) presenting to the Emergency Department, Minor Injury Units or Paediatric observation unit who Leave Without Being Seen (LWBS). It is essential therefore that staff in the Emergency Department and Paediatric Observation Unit are familiar with child protection procedures (available via the intranet page) and are up to date with safeguarding children training requirements. These can be accessed via: http://intracornwall.nhs.uk/intranet/azservices/c/childprotection Or directly via the South west Child Protection Procedures: http://www.online.procedures.co.uk/swcpp Please be aware of the flow chart overleaf for managing these difficult cases. Keep the child at the centre of all decision making. Try not to allow your feelings on why the family want to leave from affecting your plan to keep the child safe. Staff should make themselves familiar with the NICE Guidelines When to suspect child maltreatment (2009). As far as possible the clinician should complete the safeguarding questions on the attending records which will highlight any safeguarding concerns. 5.1 Role of the Managers Line managers are responsible for: Ensuring that all staff, particularly newly appointed staff, are aware of the policy and its application. Overseeing Audit of compliance 5.2 Role of Safeguarding Children Operational Group (SCOG) Ensure that this policy is maintained and updated whenever necessary to reflect current best practice and National guidance, and that updated policy is uploaded to the document library. Overseeing Audit of compliance 5.3 Role of Individual Staff Members All Staff members are responsible for: Page 5 of 14
Understanding and applying the Policy in their everyday practice Ensure they follow the guidance provided on the flow chart (Appendi 1) 6. Standards and Practice 6.1 Principles: To ensure that the welfare of all children and young people presenting to the Emergency Department, Minor Injury Units or Paediatric observation unit who Leave Without Being Seen (LWBS) and make appropriate referrals if safeguairng concerns are identified. To keep the child at the centre of all decision making. To ensure that all children and young people presenting to the Emergency Department, Minor Injury Units or Paediatric observation unit who Leave Without Being Seen (LWBS) are followed up to ascertain their welfare. 6.2 Policy This section of the document along with appendi 1 and 2 form the main body of the policy. Maintaining accurate records of the Childs attendance and any safeguarding risk. Ensuring that the referral process is undertaken and recorded as per this protocol and in line with the SWCP Protocols. Inform Senior ED Doctor/Emergency Nurse Practitioner or Paediatric Middle Grade for advice regarding further management Offer advice and support to family and attempt to de-escalate Ensure any relevant health information is given including open access documents Document all conversations and safety net advice in the notes Parents/guardian should sign Leave Without Being Seen (LWBS) form Complete a DATIX form Health team to telephone parents/guardian to enquire about child s health and offer further review if required within 24 hour period and document this conversation in notes Keep the child at the centre of all decision making. Try not to allow your feelings on why the family want to leave from affecting your plan to keep the child safe. Staff should make themselves familiar with the NICE Guidelines When to suspect child maltreatment (2009). As far as possible the clinician should complete the safeguarding questions on the attending records which will highlight any safeguarding concerns. Appendi 1: provides a flow chart for the management when children and young people presenting to the Emergency Department, Minor Injury Units or Paediatric observation unit who Leave Without Being Seen Appendi 2: provides a copy of the Leave Without Being Seen- Discharge Form to be completed by Parents/Guardians or Young People that Leave without being seen by a Medical Practitioner Page 6 of 14
7. Dissemination and Implementation 7.1. The policy will be disseminated across the whole of RCHT through mandatory Child Protection training and also be directed towards all staff having roles and responsibilities relating to children and young people attending the Emergency Department, Minor Injury Units or Paediatric observation unit. 7.2. Publication and Distribution This policy, once approved, will appear on the RCHT Intranet Documents Library. There will be direct access to this from Sisters Shelf and AZ Services. 7.3. Communication The policy will be communicated via the RCHT New Policy Document alert to all users 7.4. Access To reduce the risk of out of date policies being in circulation this policy will only appear on the RCHT Intranet Documents Library. 7.5. Storage Media The Policy will be posted on the RCHT Intranet Documents Library. 8. Monitoring compliance and effectiveness Element to be monitored Lead Prospective audit of adherence to this policy. Named Nurse for Child Protection Clinical Matron for Child Health Tool Identification on Dati Risk management Group Risk management news letter Frequency Reporting arrangements Acting on Si monthly Audit using DATIX Audit/Monitoring reports will be distributed to the Lead Clinicians and Paediatric Lead Nurse. SCOG Approved and monitored by departments and overseen by SCOG Page 7 of 14
recommendations and Lead(s) Change in practice and lessons to be shared The Named Nurse/Named Doctor with the Clinical Matron for Child Health and the Risk management group newsletter. 9. Updating and Review This policy will be reviewed three years form the date of issue. It may be required to review prior to that date if patient safety reports identify areas for concern or if relevant additional national statutory guidance is published 10. Equality and Diversity This document complies with the Royal Cornwall Hospitals NHS Trust service Equality and Diversity statement which can be found in the 'Equality, Diversity & Human Rights Policy' or the Equality and Diversity website. Royal Cornwall Hospitals NHS Trust is committed to a Policy of Equal Opportunities in employment. The aim of this policy is to ensure that no job applicant or employee receives less favourable treatment because of their race, colour, nationality, ethnic or national origin, or on the grounds of their age, gender, gender reassignment, marital status, domestic circumstances, disability, HIV status, seual orientation, religion, belief, political affiliation or trade union membership, social or employment status or is disadvantaged by conditions or requirements which are not justified by the job to be done. This policy concerns all aspects of employment for eisting staff and potential employees. Equality Impact Assessment The Initial Equality Impact Assessment Screening Form is at Appendi. Page 8 of 14
APPENDIX 1 Parent/Guardian or young person does not want to wait to be seen and treated or has left the department Complete safeguarding questions on attending paperwork using all the information you have available Check PAS or CPIS for alerts NO Are there possible safeguarding concerns regarding the injury, history or presentation? YES Inform Senior ED Doctor/Emergency Nurse Practitioner or Paediatric Middle Grade for advice regarding further management Offer advice and support to family and attempt to de-escalate Ensure any relevant health information is given including open access documents Document all conversations and safety net advice in the notes Parents/guardian should sign Leave Without Being Seen (LWBS) form Complete a DATIX form Health team to telephone parents/guardian to enquire about child s health and offer further review if required within 24 hour period and document this conversation in notes Child leaves the department Information shared with the GP and Community Health Team (eg HV, School Nurse or Paediatric discharge summary) Inform Senior ED Doctor/Emergency Nurse Practitioner or Paediatric Middle Grade for advice regarding further management Offer advice and support to family and attempt to de-escalate if child still in department Ensure any relevant health information is given including open access documents Document all conversations and safety net advice in the notes Parents/guardian should sign Leave Without Being Seen (LWBS) form Complete a DATIX form If there are on-going Children s Safeguarding Concerns then follow Safeguarding Children procedures and make a referral to MARU If child has left department and on-going safety of child is a concern then consider involving police services to bring the child back to hospital for review Health team to telephone parents/guardian to enquire about child s health and offer further review if required within 24 hour period and document this conversation in notes Page 9 of 14
APPENDIX 2 (Sample) Page 10 of 14
Appendi 3. Governance Information Document Title Date Issued/Approved: 30.08.2015 Date Valid From: 30.08.2015 Date Valid To: 30.08.2018 Children presenting to the Emergency Department, Minor Injury Units or Paediatric observation unit who Leave Without Being Seen (LWBS) Directorate / Department responsible (author/owner): Anna Brimacombe: Named Nurse Child Protection Contact details: 01872 252596 Brief summary of contents Children presenting to the Emergency Department, Minor Injury Units or Paediatric observation unit who Leave Without Being Seen (LWBS) Suggested Keywords: Target Audience Eecutive Director responsible for Policy: Leave Without Being Seen (LWBS) RCHT PCH CFT KCCG Sheena Wallace Date revised: 30.08.2015 This document replaces (eact title of previous version): Approval route (names of committees)/consultation: Discharge against medical advise Safeguarding Children Operational Group. (SCOG) Divisional Manager confirming approval processes Mrs Jan Walters Divisional Lead Name and Post Title of additional signatories Name and Signature of Divisional/Directorate Governance Lead confirming approval by specialty and divisional management meetings Signature of Eecutive Director giving approval {Original Copy Signed} Name: {Original Copy Signed} Publication Location (refer to Internet & Intranet Intranet Only Page 11 of 14
Policy on Policies Approvals and Ratification): Document Library Folder/Sub Folder Links to key eternal standards Related Documents: Clinical/ Children Safeguarding South West Child Protection Procedures (SWCPP) Children Act (1989) Working Together to Safeguard Children (2015) Training Need Identified? No Version Control Table Date 1 Version Summary of Changes New Document specific to Children April 2017 2 Amended to page13 incorrect information contained within policy Changes Made by (Name and Job Title) Anna Brimacombe Named Nurse for Child Protection Wendy Perkin Named Nurse for Safeguarding Children All or part of this document can be released under the Freedom of Information Act 2000 This document is to be retained for 10 years from the date of epiry. This document is only valid on the day of printing Controlled Document This document has been created following the Royal Cornwall Hospitals NHS Trust Policy on Document Production. It should not be altered in any way without the epress permission of the author or their Line Manager. Page 12 of 14
Appendi 4. Initial Equality Impact Assessment Form Name of the policy Children presenting to the Emergency Department, Minor Injury Units or Paediatric observation unit who Leave Without Being Seen (LWBS) Directorate and service area: Women Children and Seual Health Name of individual completing assessment: Anna Brimacombe, Named Nurse Child Protection 1. Policy Aim* Who is the strategy / policy / proposal / service function aimed at? Is this a new or eisting Policy? Eisting Telephone: 01872 252596 Aim of policy to provide staff with clear guidance and instruction if children who present to the Emergency Department then leave without being seen. 2. Policy Objectives* Clear guidance for staff when a child who is brought to the Emergency Department leaves without being seen 3. Policy intended Outcomes* 4. *How will you measure the outcome? 5. Who is intended to benefit from the policy? 6a) Is consultation required with the workforce, equality groups, local interest groups etc. around this policy? b) If yes, have these *groups been consulted? C). Please list any groups who have been consulted about this procedure. As above Annual audit Children who attend Emergency Department but then leaves without being seen No 7. The Impact Please complete the following table. Page 13 of 14
Are there concerns that the policy could have differential impact on: Equality Strands: Yes No Rationale for Assessment / Eisting Evidence Age This forms part of safeguarding the welfare of all children regardless of equality group. Se (male, female, transgender / gender reassignment) Race / Ethnic communities /groups Disability - Learning disability, physical disability, sensory impairment and mental health problems Religion / other beliefs Marriage and civil partnership Pregnancy and maternity Seual Orientation, Biseual, Gay, heteroseual, Lesbian You will need to continue to a full Equality Impact Assessment if the following have been highlighted: You have ticked Yes in any column above and No consultation or evidence of there being consultation- this ecludes any policies which have been identified as not requiring consultation. or Major service redesign or development 8. Please indicate if a full equality analysis is recommended. Yes No 9. If you are not recommending a Full Impact assessment please eplain why.no areas indicated Statuary requirement Signature of policy developer / lead manager / director Anna Brimacombe Date of completion and submission Names and signatures of members carrying out the Screening Assessment 1. 2. Keep one copy and send a copy to the Human Rights, Equality and Inclusion Lead, c/o Royal Cornwall Hospitals NHS Trust, Human Resources Department, Knowledge Spa, Truro, Cornwall, TR1 3HD A summary of the results will be published on the Trust s web site. Signed Anna Brimacombe Date _August 2105 Page 14 of 14