Guidelines for In-patient and Residential staff in Mental Health and Learning Disability Services for contacting the On call -Training Grade Doctor/GP DOCUMENT CONTROL Version 4.2 Ratified by Quality and Safety Sub Committee Date Ratified 30 January 2017 Name of Originator / Author Clinical Effectiveness Lead Name of Responsible Clinical Quality Group Committee / Individual Date Issued 3 March 2017 Review Date June 2017 (extension agreed from December 2016 to June 2017) Target Audience Staff in Mental Health and Learning Disability In- Patient and Residential areas Training Grade Doctors/GPs and Medical staffing department
SECTION CONTENTS PAGE 1. INTRODUCTION 3 2. PURPOSE 3 3. SCOPE 3 4. 4.1 4.2 4.3 4.4 5. 5.1 5.2 5.3 5.4 RESPONSIBILITIES, ACCOUNTABILITIES AND DUTIES The Board of Directors Matrons/ Managers in In-patient and Residential Areas Nurse in charge in In-patient and Residential Areas On call Training Grade Doctor PROCEDURE/IMPLEMENTATION When do on call hours fall? Who makes the decision to contact the on call training grade Doctor/GP? When should the on call training grade doctor/gp be contacted? Action to be taken in the event of a delay in the Doctor attending 6. TRAINING IMPLICATIONS 5 7. MONITORING ARRANGEMENTS 6 8. EQUALITY IMPACT ASSESSMENT SCREENING 8.1 Privacy, Dignity and Respect 8.2 Mental Capacity Act 9. LINKS TO ANY ASSOCIATED DOCUMENTS 7 10. REFERENCES 7 11. APPENDICES Appendix 1 Log sheet for out of hours calls Appendix 2 Contacting the on call Doctor 3 3 3 3 4 4 4 4 5 6 7 7 7 8 9 Page 2 of 9
1. INTRODUCTION The European Working Time Directive (EWTD) is a Directive from the Council of Europe (93/104/EC) to protect the health and safety of workers and lays down minimum requirements in relation to working hours and rest periods. The Directive was enacted into UK law as the Working Time Regulations, which took effect from October 1998. The Government negotiated an extension to prepare for full implementation for doctors in training with a commitment to being compliant by August 2009. The nature of on call duties can mean that on call training grade Doctors may not achieve these required rest periods and these guidelines for staff aim to reduce the number of unnecessary calls, which may be made to the on call training grade Doctor/ GP. 2. PURPOSE The purpose of these guidelines is to make staff aware of the requirements of rest periods for on call training grade doctors/gps and that they should not be called out during these periods to undertake routine work. 3. SCOPE This policy is applicable to staff in all Mental Health and Learning Disability Inpatient and Residential areas. The GP element of the guidelines is set out on page 5 and applies to Learning Disability services in Doncaster only where patients may have physical/medical emergencies. 4. RESPONSIBILITIES, ACCOUNTABILITIES AND DUTIES 4.1 The Board of Directors It is the responsibility of the Board of Directors to have procedures in place to enable the Trust to adhere to the EWTD. Under the EWTD the Trust has to audit all call outs. 4.2 Matrons/Managers in In-Patient and Residential Areas Matrons/Managers should make their staff aware of these guidelines. Matrons are responsible for monitoring any call outs of doctors via the weekly monitoring form (Appendix 1) 4.3 Nurse in charge of In-Patient and Residential Areas The nurse in charge of In-patient and Residential areas should adhere to these guidelines. In the event that a doctor has been called out, the nurse in charge will be responsible for making the call and for completing the weekly call out monitoring form (Appendix 1). The monitoring forms must then be sent to the relevant Matron/Manager at the end of each week. Page 3 of 9
4.4 The on call Training Grade Doctor The on call training grade Doctor must complete a EWTD and New Deal Monitoring of hours form during their on call period and return it to the Medical staffing Office by 11am the following day. 5. PROCEDURE/IMPLEMENTATION 5.1 When do on call hours fall? The on call responsibility for the on call training grade doctor or GP only falls outside of normal working hours which are: Between 5 p.m. and 9 a.m. Monday to Friday All day Saturday and Sunday All day on any Bank Holiday 5.2 Who makes the decision to contact the On Call training grade doctor /GP? The decision to contact the on Call Doctor is made by the Nurse in Charge of the ward/residential area who, wherever possible, should make the call themselves and not delegate it to another staff member. It is important that at the time of the call being made, the Nurse in Charge has all the information available which may be needed. In the event that the on call training grade doctor cannot be contacted or will be delayed, refer to Appendix 2 5.3 When should the On Call training grade doctor/gp be contacted? This is not something which can be pre-determined, as each situation will have to be assessed at the time. However, it is important that staff remember that the On Call Doctor is only there for emergencies. The guidance within the Trust s Rapid Tranquillisation Policy & Guidelines, Appendix 1 The early warning score system and score chart should be followed. In Mental Health In-patient areas there will be a training grade doctor on call, however in Learning Disabilities In-patient areas the on call training grade doctor should only be called for psychiatric emergencies and not physical/medical emergencies. In LD In-patient areas, if it is a physical/medical emergency the patient s GP surgery should be contacted and instructions for contacting the out of hours service will be provided. Page 4 of 9
In areas that have a local protocol in place, staff should be made aware of it s content and adhere to the protocol. On call training grade doctors should never be contacted to undertake routine work, such as: - Re-writing of routine prescriptions - The prescribing of anything which identified nurses can prescribe using Patient Group Directions for the supply and administration of medicines for minor ailments by nurses. - To report an AWOL patient. This should be reported to the Crisis Team who are more likely to be contacted by the A & E Department or Police if the patient is found. - To report the return of an AWOL patient (unless the patient s physical or mental state indicates a need for a medical review). - To prescribe night sedation. - To be notified that staff have declined to accept a 136 patient due to them being intoxicated. This list is not exhaustive, and it is important that before staff contact the On Call Doctor they consider if the Doctor can actually do anything, as if the answer is not, then the call should not be made. 5.4 Action to be taken in the event of a delay in the Doctor attending In the event that staff experience problems in contacting an On Call Doctor or in instances when the doctor is going to be unavoidably delayed and the delay may be detrimental to the patients well being or others around them staff are to refer to Appendix 2 for guidance. Staff should also follow the guidance within the Trust s Rapid Tranquillisation Policy & Guidelines, Appendix 1 The early warning score system and score chart and if appropriate arrange for the patient to be transported to the nearest Accident and Emergency (A&E) Department, informing the A&E department of the patients expected arrival and condition. Where staff are unable to make contact with the doctor on call, the consultant on call should be contacted to inform them of the situation and action taken. 6. TRAINING IMPLICATIONS There are no specific training needs in relation to this policy, but the following staff will need to be familiar with its contents, staff in mental health and Page 5 of 9
learning disability in-patient and residential areas, training grade Doctors/GPs and medical staffing department and any other individual or group with a responsibility for implementing the contents of this policy. Staff will be made aware of the guidelines during the local induction of any new clinical staff and this will be cascaded via the Matrons/Managers and Charge Nurses. 7. MONITORING ARRANGEMENTS Area for Monitoring Frequency and reason for staff calling the doctor How Who by Reported To Frequency Ongoing audit through the use of the monitoring form (Appendix 1) Matrons/ Manager Local Implementation Group (LIG) Weekly Number and reason for inappropriate call outs Audit of the monitoring forms submitted by the on call Doctors Medical staffing department LIG Forms are collected after each period of on call and a quarterly report prepared Compliance with the required periods of rest for the on call Doctors Number of instances and reasons for when the delayed Doctor guidance has been implemented Audit of the monitoring forms submitted by the on call doctor Audit of IR1 reports relating to a delayed Doctor situation Medical Staffing department Modern Matrons LIG LIG Forms are collected after each period of on call and a quarterly report prepared As and when a delayed Doctor report is made via the IR1 reporting system 8. EQUALITY IMPACT ASSESSMENT SCREENING The completed Equality Impact Assessment for this Policy has been published on the Trust s Policy web page. Page 6 of 9
8.1 Privacy, Dignity and Respect The NHS Constitution states that all patients should feel that their privacy and dignity are respected while they are in hospital. High Quality Care for All (2008), Lord Darzi s review of the NHS, identifies the need to organise care around the individual, not just clinically but in terms of dignity and respect. As a consequence the Trust is required to articulate its intent to deliver care with privacy and dignity that treats all patients with respect. Therefore, all procedural documents will be considered, if relevant, to reflect the requirement to treat everyone with privacy, dignity and respect, (when appropriate this should also include how same sex accommodation is provided). Indicate how this will be met No issues have been identified in relation to this policy. 8.2 Mental Capacity Act Central to any aspect of care delivered to adults and young people aged 16 years or over will be the consideration of the individuals capacity to participate in the decision making process. Consequently, no intervention should be carried out without either the individuals informed consent, or the powers included in a legal framework, or by order of the Court Therefore, the Trust is required to make sure that all staff working with individuals who use our service are familiar with the provisions within the Mental Capacity Act. For this reason all procedural documents will be considered, if relevant to reflect the provisions of the Mental Capacity Act 2005 to ensure that the interests of an individual whose capacity is in question can continue to make as many decisions for themselves as possible. Indicate how this will be met All individuals involved in the implementation of this policy should do so in accordance with the Guiding Principles of the Mental Capacity Act 2005. (Section 1) 9. LINKS TO ANY ASSOCIATED DOCUMENTS The early warning score system and score chart, Appendix 1 in the Rapid Tranquillisation Policy and Guidelines - Clinical Policies, RDaSH Intranet Incident Reporting Policy, Health and Safety Policies, RDaSH Intranet 10. REFERENCES Department of Health (2009) European Working Time Directive 11. APPENDICES Appendix 1 Log Sheet for out of hours calls Appendix 2 Contacting the on call Doctor Page 7 of 9
APPENDIX 1 LOG SHEET FOR OUT OF HOURS CALLS Only record contact after 5.00 pm on weekdays and all day Saturday/Sunday or Bank Holidays WARD: Date Time Name of Junior Doctor contacted Reason Name and grade of staff contacting Dr If Doctor attended ward, time of arrival Time of leaving Action by Matron This form must be submitted to the Matron/Manager at the end of each week Page 8 of 9
CONTACTING THE ON-CALL DOCTOR APPENDIX 2 Bleep the On Call Doctor to make aware of situation Doctor Contacted Is the Doctor going to be delayed? NO YES Doctor not able to be contacted, i.e. not responding to bleep Have you tried all possible means of contacting Doctor? Await Doctors arrival If Doctor does not attend within a reasonable time span, bleep again Clinical judge ment used to call 999 if medica l emerg ency Await arrival of doctor Ascertain reason and possible length of delay NO Is the delay detrimental to the patients wellbeing or safety of others? Doctor able to attend Clinical judgement YES Explain this to the Doctor and request attendance NO Check on call rota with switch Phone other wards to see if doctor with them. Ask switch to bleep Contact made YES NO Doctor still unable to attend YES Contact Consultant On-Call Notify Matron for the unit on the next working day Record on Wards 24 hour report Advise Doctor that due to the urgency of the situation you will seek advice from the Consultant on- call Who will inform the Unit Manager s of the situation on the next working day? Page 9 of 9