GUIDELINE FOR THE USE OF KEYS AND KEYSAFE CODES FOR ADULT COMMUNITY HEALTH TEAM WORKERS Guideline Reference: 1686 Version: 3.0 Status: Approved Type: Clinical Guideline Guideline applies to (Staff Group) All staff employed by the Suffolk Community Healthcare Consortium Where the procedural documents refer to Suffolk Community Healthcare (SCH) this is referring to those staff employed by the Suffolk Community Healthcare Consortium; a service delivered by West Suffolk NHS Foundation Trust (WSHFT) with The Ipswich Hospital NHS Trust (IHT) and rfolk Community Healthcare and Care Trust (NCH&C) Date adopted/ ratified: March 2017 Review date: March 2020 Signature of Director:
GUIDELINE FOR THE USE OF KEYS & KEYSAFE CODES FOR ADULT COMMUNITY HEALTH TEAM WORKERS Guideline Reference: SCH CP 21 Version: 3.0 Status: Approved Type: Clinical Guideline applies to : All services within SCH Guideline applies to (Staff Groups): All staff Required compliance: This guideline must be complied with fully at all times by the appropriate staff. Where it is found that this policy cannot be complied with fully, this must be notified immediately to the clinical lead Guideline owner: Guideline author: Other contact: Executive Chief Nurse, WSFT Clinical Effectiveness Manager Quality & Patient Safety Assurance Group Date this version adopted March 2017 Last review date vember 2016 Next review date March 2020 Location of electronic master SCH Intranet AGREED GUIDELINE REVIEW / RATIFICATION / ADOPTION PATH: Level 1: Agreed by: Practice Development Team Date: January 2017 Level 3: Agreed by: Quality Patient & Safety Assurance Group Date: 28/3/17 Name and Title of people who carried out the EQIA: Sarah Miller, Clinical Effectiveness Manager Date EQIA completed: 28/2/17 Level 2: Agreed by: Integrated Policy & Documentation Group Date: February 2017 Agreed by: Date: Level 4: Name of Director who signed EQIA: Rowan Procter Signature of Director: Date EQIA signed: 29/3/17
Contents 1. Introduction...1 2. Purpose Of This Clinical Policy...1 3. Policy Agreement Path...1 4. Definitions/ Scope...1 5. Cross Reference To Other Related Polices...1 6. Policy Statement...2 7. KeySafe Security...2 8. KeySafe Criteria...2 9. KeySafe Code Holder Responsibilities...2 10. Issuing/ Collection Of Keysafe Codes/ Record-Keeping...3 11. Key-safe Codes and SystmOne...4 12. Loss Of Keys/ Keysafe Codes...4 13. Entry And Exit Procedures...4 14. Procedure If Unable To Gain Entry/ Patient t At Home...4 15. Procedure In Case Of Untoward Patient Incident...5 16. Contact Numbers...5 Appendix 1: Headed letter for use if patient not at home...6 Appendix 2: Screen shot of key-safe code input on SystmOne...7
GUIDELINE FOR THE USE OF KEYS AND KEYSAFE CODES FOR LOCAL HEALTHCARE TEAM WORKERS 1. Introduction 1.1. The security of patients homes is vital in providing high quality and safe domiciliary care and community healthcare staff have a responsibility to ensure their actions do not place the security of patients, their families or their homes at risk. 1.2. A key-safe is a safe protected with combinations to hold keys of different kinds. These are mainly house keys but other keys, such as drug box or syringe driver keys, may also be stored there. They are available with manual dial combination input system or digital input system and are usually mounted on the wall in any space that is hidden or mostly unnoticed. Some of the key-safes available in the market look like utility boxes, which makes them camouflaged/ covered and are often mounted near the meter box. Some, by necessity, are more obvious. 1.3. They are used to enable safe entry to patients houses by health professionals (and other agencies) where they are unable to open the door themselves due to physical or mental impairment / illness or disability 1.4. A number of members of staff are responsible for accessing patients homes with their consent and permission, in order to provide care. Community Health Team staff may be issued with codes for accessing key-safes in order to gain authorised entry into patients homes. 2. Purpose Of This Clinical Policy 2.1. The Health and Safety at Work etc. Act 1974 places several duties on employers including the following: It shall be the duty of every employer to ensure, in so far as is reasonably practicable, the health, safety and welfare at work of all his employees. (Section 2(1)) and The provision and maintenance of plant and systems of work that are, so far as is reasonably practicable, safe and without risks to health. (Section 2(2a)) 2.2. The purpose of this policy, therefore, is to ensure all community healthcare staff providing care to patients at home are able gain access to and exit their homes safely ensuring the safety, security & well-being of patients & staff. 3. Policy Agreement Path Refer to front sheet for policy agreement path. 4. Definitions/ Scope 4.1. Key-safes are a device that can be fitted externally to a property to enable access into the property. In order to gain access most key safes require a code that will release the cover and therefore display the keys 4.2. Community Staff / Worker - all members of the Community Health Team 5. Cross Reference To Other Related Polices Consent Policy 1
Information Governance Policy Record Keeping Policy Professional Boundaries Policy Resuscitation Policy Moving and Handling Policy Confidentiality Code of Practice Incident Reporting Policy 6. Policy Statement 6.1. The host organisations within the SCH Consortium recognise the duty of care to those members of community based staff who have access to codes for key-safes. 6.2. The host organisations within the SCH Consortium recognise their duty to maintain the security of patients homes and to protect such assets along with the contents. 6.3. In order to maintain the security of patients keysafe codes, the security of the building where the codes are kept should be maintained and only properly authorised persons should be able to access the key-codes. 6.4. Community staff who have patients keysafe codes to let themselves in should always remember that they are entering someone else s home; always knock or ring the bell on entering and produce identification. The patients will need to be told that bona fide staff will carry identification which they must be prepared to show at all times. 7. KeySafe Security 7.1. Key-safe codes should be unique to individual patients and unique to that particular property. There should be no duplication of numbers or group numbers used for specific rounds. 7.2. The same key-safe code must never be used in multiple for different patients. 7.3. Patients & their families/ carers must be requested to advise community health staff of any changes made to the codes. 8. KeySafe Criteria 8.1. Assessment for need is done initially by the Community Health Team visiting the patient at home. The family/ patient will be asked to install/ finance the installation if they have the means, otherwise a referral will be made to Social Care Services via Customer First. 8.2. If the patient qualifies for Suffolk County Council s Home First service they will arrange for installation 8.3. It is advisable that key-safes may not be suitable for use on the front elevation of terraced properties or other properties without a forecourt area. Unless in extreme circumstances when such a location is the only option to gain access to a patients property, the device will need to be sited at the rear of the property or another less visible location. 9. KeySafe Code Holder Responsibilities 9.1. Key-safe code holders are those members of community team who have the designated responsibility and authority to gain access to a patient s home, using a security code, in order for staff to be able to open the key-safe, obtain the key to gain access to the property and to secure the same at the end of the contracted time. 2
9.2. The manager responsible for each team will designate all members of staff to act as responsible keysafe code holders. 9.3. unauthorised members of staff will be issued with the confidential Key-Safe code. 9.4. Key-safe code holders will be responsible for the confidentiality of the key-safe code. The key-safe code holders will also be responsible for maintaining the security of the codes whilst in the community. 9.5. Please note the following: The National Back Office (NBO) Service Management team has received a number of incidents from concerned PDS (Personal Demographic Service) Users who have noticed that access codes for Key Safe boxes and other such door entry systems are being stored within the address field on the national patient index (PDS). The Head of Information Governance at the Department of Health has advised that this practise must cease immediately. The storage of these details on the PDS constitutes a security risk to vulnerable/elderly residents and in some cases the door entry codes have been printed as part of the address on correspondence. These access codes must be stored securely at a local level and if they are stored electronically the data must not be synchronised with the PDS. 10. Issuing/ Collection Of Keysafe Codes/ Record-Keeping 10.1. Members of community healthcare team will be required to collect patients key-safe codes from other members of staff. Staff must then ensure the safety and security of the key-safe codes at all times whilst in their possession. 10.2. The Community Health Team Initial Contact Form is now a template on SystmOne and a paper copy is no longer kept in the patient s home. This will be shared with the patient and consent to records sharing obtained and recorded (see SCH Consent Policy). The patient should be made aware that other members of the Community Health Team (e.g. therapists) may also use the number to gain entry to the property. It is also important to document and review who has access rights to the property on a regular basis (preferably bi-monthly). 10.3. Where paper records are kept at base, a photocopy of this is kept in a locked filing cabinet in the locked community office along with an individual Kardex with all patient contact details including the key-safe code. 10.4. Where community staff are still using diaries, there may be the need to occasionally record a copy of the key-safe code here. Diaries are confidential documents and should be treated as such. It is also important that the number and address are recorded separately so as they cannot be associated with each other. 10.5. Where still in use, teams may also record any key-safe codes in the central work diary where whole caseload details are recorded and again the security of these must be maintained. 10.6. The patient My Care Wishes Folder/ End of Life documentation should also contain a record of the key-safe number so this can be communicated to all the appropriate out-of-hours services if necessary 10.7. The key-safe code holder will be responsible for maintaining the security of the key-safe codes when/ if diaries are in their own home and they must ensure they do not come into contact with any other person. 10.8. When a member of a community health team from the same or another team providing care, requires a key-safe code to a patient s home, the authorisation of such a request should be made via the CCC/ community nurse team leader or appropriate deputy. The patient should also consent to this information being shared. Staff must follow the SCH Consent to Treatment Policy if there any issues/ concerns around Mental Capacity and the ability of the patient to provide informed consent. 3
11. Key-safe Codes and SystmOne 11.1. Keysafe information is recorded by creating a reminder on SystmOne which makes it visible when the patient record is opened but is not at risk of being misused by being stored within the address section 12. Loss Of Keys/ Keysafe Codes 12.1. In the event of the key not being present in the key safe, the community worker will initially make contact with any relatives/ carers & other members of the community to ascertain whether they have removed the key. 12.2. In the event of loss of keys the community staff member will liaise with the family/ carer/ social care services to provide a replacement. 12.3. In the event of theft the community worker will be required to inform her manager and put in place arrangements for the locks to be changed. This is done via social care services if they have been responsible for the issuing of the key-safe or in consultation with the service user and their family. 13. Entry And Exit Procedures 13.1. Patients will have been informed by the Community Health Team about their first visit and should be aware of when it will happen. 13.2. Community staff will be given information prior to the first visit about the method of access required to gain entry to the home and if a key-safe is in situ. 13.3. On entering the house the community worker will call out to announce his/her arrival taking into account people who may have sensory problems (e.g. hearing/ vision difficulties) 13.4. During the visit the key should be either replaced in the key-safe or kept on the community worker s person to ensure it is not left in the house on leaving. 13.5. Before leaving the home make sure the patient has everything at hand that they require for their safety (e.g. personal alarm, telephone etc) 13.6. After completing the current episode of care the community healthcare worker will ascertain the patient s wishes regarding securing the house (e.g. closing windows, ensuring pets are either in or out as desired) and remember to return the key(s) to the key-safe. 13.7. If leaving a property after dark, check with the patient which lights they want on/off, whether they want the curtains drawn and the door locked. 14. Procedure If Unable To Gain Entry/ Patient t At Home 14.1. If the regular arrangement with a particular patient is such that you use the key from the keysafe to access the property and you then find the patient to not be at home, first check everywhere thoroughly to ensure that they have not fallen and injured themselves. 14.2. The Community Health Worker will initially examine patient held records to ascertain if the patient has been transferred elsewhere by another member of the immediate or wider team. 14.3. Should the patient normally facilitate access to the property themselves and on this occasion does not open the door, first telephone the patient. If there is no response contact the next of kin (NOK)/ neighbour/ GP/ Hospital/ Care Agency. If there is no reason to suspect that the patient has been transferred elsewhere, and there is a concern for their safety, enter the property with a colleague or 4
NOK (if possible). If there is no second person available, and it is safe and appropriate to do so, call your base to inform them of the situation and then enter the property. 14.4. The Community Health Worker will also leave a signed compliment slip (see appendix 2) to inform the patient/ family that they have visited the home. 15. Procedure In Case Of Untoward Patient Incident 15.1. In the case of a major incident/ accident the nurse will phone 999/ 112 requesting a paramedic, the police and any other emergency service deemed necessary. 15.2. If deemed appropriate and the patient is not the subject of a DNCPR order and in line with the Resuscitation Policy the Community Healthcare Worker may attempt basic life support whilst awaiting medical aid. 15.3. If the incident is minor and the community healthcare worker can do so safely without harm to themselves or the patient, and they have the relevant skills/ training then they can attempt to rectify the situation. 15.4. Staff should then follow the SCH Incident Reporting Policy to inform their line manager and other appropriate staff members. 16. Contact Numbers All members of the Community Health Team should be aware of and carry with them the contact numbers required Patient s GP practice Customer First: Office Hours & Emergency Duty Service 0808 800 4005 Home First: Office Hours - same as Customer First Emergency Duty Service 01473 299649 5
Appendix 1: Headed letter for use if patient not at home Dear I called at your house today as arranged and let myself in using the key in the key-safe. Unfortunately you were not at home. I would be grateful if you could contact me at your earliest convenience so we can arrange another visit if required. With best wishes Contact details: 6
Appendix 2: Screen shot of key-safe code input on SystmOne The create reminder button is generally located on any accommodation related page within the templates. Please note that the written text beside the button may vary. 7
Equality Impact Assessment Tool Any identified a potential discriminatory impact must be identified with a mitigating action plan to address avoidance/reduction of this impact. This tool must be completed and attached to any SCH approved document when submitted to the appropriate committee for consideration and approval. Name of Policy: Keysafe Policy Equality Impact Assessment Tool Yes/ Comments 1. Does the policy affect one group less or more favourably than another on the basis of: Race Ethnic origins (including gypsies and travellers) Nationality Gender Culture Religion or belief Sexual orientation including lesbian, gay and bisexual people Age Disability - learning disabilities, physical disability, sensory impairment and mental health problems 2. Is there any evidence that some groups are affected differently? 3. If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable? 4. Is the impact of the policy/guidance likely to be negative? 5. If so can the impact be avoided? N/A 6. What alternatives are there to achieving the policy/guidance without the impact? 7. Can we reduce the impact by taking different action? N/A N/A 8