` Policy No: OP84 Version: 1.1 Name of Policy: Patient Escort Policy Effective From: 29/10/2014 Date Ratified 10/09/2014 Ratified SafeCare Council Review Date 01/09/2016 Sponsor Director of Nursing, Midwifery and Quality Expiry Date 09/09/2017 Withdrawn Date Patient Escort Policy v1.1
Version Control Version Release Author/Reviewer Ratified by/authorised by 1.0 19/09/2014 Faye Butler SafeCare Council Date 10/09/2014 Changes (Please identify page no.) Patient Escort Policy v1.1 2
Contents Section Page 1 Introduction... 4 2. Policy scope... 4 3. Aim of policy... 4 4 Duties (roles and responsibilities)... 4 5 Definitions of terms... 6 6 Providing an escort for transfer... 6 7. Training... 7 8. Equality and diversity... 8 9. Monitoring compliance with the policy... 8 10. Consultation and review... 8 11 Implementation of policy... 8 12 References... 9 13 Appendices... 9 Appendix 1 (Patient Escort QE Site Quick Reference Guide)... 10 Patient Escort Policy v1.1 3
Patient Escort Policy 1 Introduction Gateshead Health NHS Foundation Trust is committed to the provision of high quality health care in all aspects of its services to patients and staff. There are many occasions when a patient needs to be transferred in the hospital to other wards or departments and which may require escort. This policy is therefore intended to offer safeguards and guidance to ensure staff and patient safety throughout the transfer process. 2 Policy scope This Policy applies to all health care professionals working within Gateshead Health NHS Foundation Trust involved in the assessment of patients to determine the need for escort during transfer within the hospital. It provides clear guidance and instruction to all staff with regard to the transfer and escort of adult and paediatric patients within and across the Queen Elizabeth Hospital site. All staff using this policy should ensure that the basic principles of respect, explanation, privacy and dignity apply to all patients in the transfer setting. They must use this policy in conjunction with a range of existing good practice guidance from professional bodies and existing Trust policy with particular reference to: Bed management, patient transfer and escalation plan (OP33) Transfer and discharge policy (OP13) Safeguarding patient privacy and dignity (OP29) Manual handling policy (RM06) Control of infection policy (IC01) Personal protective equipment (IC02) Hand hygiene policy (IC04) Safeguarding adults policy (OP75d) Safeguarding children policy (OP75a) Resuscitation policy (RM27a) 3 Aim of policy The key aims of this policy are to ensure the safe transfer of patients between wards and departments. In addition it will support the safety of those patients who will be spending time in other departments away from their ward base with or without an escorting healthcare professional or assistant. It will also provide clear guidance for staff that will ensure staff and patient safety. It applies to all transfers, both in and out of normal working hours. 4 Duties roles and responsibilities The Trust Board: The Trust has ultimate responsibility for providing effective healthcare services to patients. They are responsible for ensuring there is support available to ensure the safety and wellbeing of patients in our care. Patient Escort Policy v1.1 4
The Chief Executive: The Chief Executive is ultimately responsible for ensuring effective corporate governance within the organisation and therefore supports the Trust wide implementation of this policy. Trust Managers: Managers are responsible for ensuring all members of staff understand how the Patient Escort Policy applies to them and their patients. Managers are also responsible for ensuring that where necessary, local procedures are developed, to support the implementation of this policy. Managers should review the effectiveness of the implementation of this policy, and take appropriate remedial action when they become aware of any acts or omissions that contravene it. Healthcare professionals: It is the responsibility of the clinician in charge of the patient to assess the needs of the patient and make an informed decision regarding their escort needs during transfer prior to authorising their departure from the clinical area. The healthcare professional is responsible for undertaking a pre transfer assessment before a patient leaves a clinical area, this is to determine if a nurse escort is required, and to take appropriate steps to obtain one, All healthcare professionals must therefore demonstrate an appropriate understanding of the escort requirements and the procedure for reporting concerns. All Nursing /Medical staff escorting patients: Familiarise themselves with this policy, its contents and appendices Ensure that prior to escorting a patient transfer they have been given adequate information regarding the patient to be able to care sufficiently for them during the transfer process. Provide effective care for the patient during transfer by being aware of the patients condition and current needs. Maintain the patient s dignity and respect throughout. Stay with the patient until care has been handed over face to face to the receiving area. Registered Nurses/Midwives are personally accountable for their own safe practice, actions and omissions as outlined in the NMC Code. Medical staff are personally responsible for their own safe practice, actions and omissions as outlined in GMC duties of a Doctor/ good medical practice. Nursing Assistants and Pre registered nurses should only undertake patient transfer if basic life support training is complete and up to date and when it has been deemed appropriate to their duties by their Ward/unit manager. This can be delegated to the nurse in charge on a day to day basis. All non clinical staff (e.g. porters) escorting patients: Familiarise themselves with this policy, its contents and appendices Ensure that prior to escorting a patient transfer they have been given any necessary information regarding the patient to be able to safely transfer.(e.g. any infection control risks, mode of transfer, escort requirements) Maintain the patient s dignity and respect throughout. Patient Escort Policy v1.1 5
Familiarise themselves with emergency telephone numbers and location of receiving area. 5 Definitions of Terms Clinician any qualified member of staff with the knowledge, skill and competency to assess the patients requirement for escort. Within this policy, clinician refers to all clinical staff including doctors, nurses and midwives. Where it is stated the clinician in charge or the clinician coordinating this refers to the person who is caring for the patient and responsible for making the arrangements for transfer, in most cases this will be the registered nurse or midwife. Escort defined as to accompany a person for protection with regards to safety and psychological well being during transfer from one area to another. (Oxford Illustrated Dictionary.) The escorting member of staff has a responsibility to ensure that the patient is safe throughout the transfer and that their immediate physical and psychological needs are met. Any person involved in the transfer of a patient should have the necessary knowledge, skills and experience to be able to achieve a safe transfer. Health care professionals any staff group responsible in the assessment process regarding the decision to escort. Levels of Care for Adult and Paediatric patients this refers to the intensity of nursing care required by the patient. The following levels of care have been taken from the Intensive Care Society Standards (ICS) published in 2002 and Paediatric Intensive Care Standards (2001): Level 0 Patients whose needs can be met through normal ward care in an acute hospital. Level 1 Patients at risk of their condition deteriorating, or those recently relocated from higher levels of care whose needs can be met on an acute ward with additional advice and support from the critical care team. Level 2 Patients who require more detailed observation or intervention. This may include support for a single failing organ system or postoperative care, and those stepping down from higher levels of care. Level 3 Patients who require advanced respiratory support alone, or basic respiratory support together with support of at least two organ systems. This level includes all complex patients requiring support for multi organ failure. 6 Providing an escort for transfer 6.1 Prior to the transfer of patients within the QE site, an assessment of potential risk, using clinical judgement and policy guide must be undertaken to ensure the patient is escorted and transferred safely without harm. This policy and its supportive appendices aim to ensure safe and appropriate transfer and escort of a patient and reduce risks by: Providing guidance on patient assessment prior to transfer Patient Escort Policy v1.1 6
Provide guidance for making the correct decisions regarding appropriate escort and mode of transfer Allocation of appropriate escort to maintain patient safety during transfer 6.2 The registered nurse must use their clinical judgement to make an appropriate assessment of the patients clinical condition to determine if an escort is required and to ensure the escort is able to care for the patient during transfer. 6.3 Nurses should use the quick reference guide (appendix1) to assist with making this decision if required. 6.4 A registered Nurse Escort however MUST be provided if any of the following apply: The Patient is causing clinical concern The patient has had a recent MEWS/PEWS trigger The patient has a potential risk to airway E.g. post op / post procedure / post sedation / recent seizures or vomiting) The Patient has acute respiratory problems The Patient is dependent on continuous oxygen greater then 4L/min The Patient is receiving continuous high risk medication Infusions or treatments E.g. Blood / Opiates/ PCA / Epidural / Antibiotics / Insulin /Heparin / Potassium based infusions The patient requires continuous cardiac monitoring 6.5 Appropriate monitoring must be able to continue during patient transfer in accordance with the patient s condition and plan of care. 6.6 Health care assistants are responsible for patients during transfer if they have accepted the delegated task from a registered nurse. 6.7 A registered nurse should provide health care assistants undertaking transfer with a full handover of any relevant patient needs/ issues prior to the transfer 6.8 Following the assessment of the patient the patient movement should be booked onto portertrak for transfer. If the patient requires escort, escort should be entered on the system. No escort should be entered if the patient has been assessed as not requiring an escort. There is no need to stipulate qualified or unqualified on the system. 7 Training Members of staff who make the decision to escort should have undergone appropriate support in order to ensure that they develop the competencies required. The policy will be promoted at ward and department local induction, to ensure that all members of staff have an understanding of the role of the escort and how to access the policy. Patient Escort Policy v1.1 7
8 Equality and diversity The Trust is committed to ensuring that, as far as is reasonably practicable, the way we treat members of staff and patients reflects their individual needs and does not discriminate against individuals or groups on the grounds of any protected characteristic.. This policy is therefore intended to offer safeguards to both patients and members of staff prior to transfer to another ward or department. In this way, the policy promotes equality of opportunity and values diversity. The policy adopts a human rights approach by considering a wide variety of situations, and encourages supportive, reasonable arrangements to promote fairness, respect, equality, dignity and autonomy. 9 Monitoring compliance with the policy Standard/process/issue Policy complies with OP27 Policy for the development, management and authorisation of policies and procedures Monitoring and audit Method By Committee Frequency OP27 Checklist Upon Review Staff are aware of the policy and able to implement it effectively Refer to Training and Local Induction. Annual review Informal feedback from patients and carers about patient escort issues Discussed in the PALS / Complaints quarterly analysis reports PALS & Complaints Manager Quarterly 10 Consultation and review The policy was developed using best practice guidelines, in consultation with key staff groups and following a pilot of the Quick Reference Guide (Appendix 1). 11 Implementation of policy This policy will be circulated by the Trust Secretary as detailed in OP27 Policy for the development, management and authorisation of policies. Individual healthcare professionals have a responsibility to ensure they understand the role of the nurse escort and take appropriate steps to implement this policy effectively, including reporting any concerns as appropriate. Patient Escort Policy v1.1 8
Managers are responsible for ensuring all members of staff understand how the Patient Escort Policy applies to them and their patients. Managers are also responsible for ensuring that where necessary, local procedures are developed, to support the implementation of this policy. Managers should review the effectiveness of the implementation of this policy, and take appropriate remedial action when they become aware of any acts or omissions that contravene it. 12 References Internal Patient Transfer and Escort Policy (March 2009) The Royal Free Hampstead NHS Trust Patient Escort Policy (January 2011) County Durham and Darlington NHS Foundation Trust Clinical Policy for the Safe Transfer and Escort of Patients Heart of England NHS Foundation Trust (April 2012) 13 Appendices Appendix 1: Patient Escort (QE Site) Quick reference guide Patient Escort Policy v1.1 9
Appendix 1: Patient Escort (QE Site) Quick Reference guide This aims to guide staff with appropriate escort requirements and does not replace the clinical judgement and ultimate decision of the Registered Nurse Assessment of Patient Risk Minimum Escort requirement Mode of transfer Minimum Skills required Maintaining own airway No Oxygen support required during transit Stable observations no NEWS triggers in last 4 hours No medical devices in progress during transfer Alert and orientated Low Adults Porter Children HCA or Preregistered student Nurse Walk Wheelchair Bed/Cot Trolley Familiar with trust transfer policy Understands Transfer process. Clinical staff BLS/PLS Maintaining own airway Stable on Continuous Oxygen less than 4L/Min Stable observations no NEWS triggers in last 4 hours No medical devices that may require intervention during transfer. Confused /disorientated High risk of falls / likely to wander Requires continuous cardiac monitoring Risk to airway (e.g. post op / post procedure / post sedation / recent seizures or vomiting) Acute respiratory problems Requires continuous oxygen greater then 4L/min Recent NEWS trigger within the last 4 hours Continuous Infusions or treatments in situ E.g. Blood /PCA/Epidural/Antibiotics/Insulin Patient causing clinical concern / increasing NEWS score Clinical challenging behaviour Med Adults HCA, Pre registered student Nurse or Therapist & Porter Children Registered Paediatric Nurse Wheelchair Bed/Cot Trolley Awareness of patient s current clinical condition and needs. Familiar with trust transfer policy Understands Transfer process. BLS / PLS High Adults Registered Nurse/ and Porter Children Registered Paediatric Nurse and HCA / Pre registered student +/ Medic if indicated For manifestations of aggression consider security escort Bed/Cot Trolley Aware of patient s current clinical condition and needs. Familiar with trust transfer policy Understands Transfer process BLS / PLS Requires Invasive / Non Invasive Ventilatary Support Acute respiratory problems Unstable Circulatory System Complex Patients requiring support for multi organ failure Critical Adults Critical Care Clinician / Practitioner and Critical Care Nurse/ART Nurse +/ porter Children PICU Retrieval Team or Critical Care Clinician/Paediatric Clinician & Consultant/Middle Grade & Registered Nurse Bed/Cot Trolley Aware of patients current clinical condition and needs Appropriate Critical care skills Familiar with trust transfer policy Understands Transfer process ALS / PLS Patient Escort Policy v1.1 10