The Management f Suspected Illicit Substances and Alchl by Service Users/Visitrs in Inpatient and Residential Areas CLP051 Page 1 f 11 This dcument is uncntrlled nce printed. Please refer t the Trust intranet fr the current versin CLP051 Management f Suspected Illicit Substances and Alchl review Nv. 20
Table f Cntents The Management f Suspected Illicit Substances and Alchl by Service Users/Visitrs in Inpatient and Residential Areas CLP051... 1 Why we need this Plicy... 2 What the Plicy is trying t d... 3 Which stakehlders have been invlved in the creatin f this Plicy... 3 Any required definitins/explanatins... 3 Key duties... 4 Plicy detail... 4 Training requirements assciated with this Plicy... 6 Mandatry Training... 6 Specific Training nt cvered by Mandatry Training... 6 Hw this Plicy will be mnitred fr cmpliance and effectiveness... 6 Fr further infrmatin... 7 Equality cnsideratins... 7 Reference Guide... 8 Dcument cntrl details... 8 APPENDIX 1 - Cntract Supprting Safe Management f Suspected Illicit Substance & Alchl use by a Service User... 10 Why we need this Plicy Alchl and/r illicit substances are nt allwed n any NHFT prperty. The aim f this plicy is t ensure the effective management f suspected illicit substances and alchl, in relatin t crrect and legal remval and dispsal. This plicy will utline the respnse f staff shuld alchl r illicit substances be fund r suspected in acute inpatient areas. This will ensure staff, visitrs and service users care and safety is nt cmprmised. Patients wh are discharged because f cntinued illicit drugs r misuse f alchl must underg a full risk assessment and have a discharge plan (see CLP052, CLP056, CRM001). The Trust is cmmitted t treating peple with dignity and respect in accrdance with the Equality Act 2010 and Human Rights Act 1998. Thrughut the prductin f this plicy due regard has been Page 2 f 11 This dcument is uncntrlled nce printed. Please refer t the Trust intranet fr the current versin CLP051 Management f Suspected Illicit Substances and Alchl review Nv. 20
given t the eliminatin f unlawful discriminatin, harassment and victimisatin (as cited in the Equality Act 2010). What the Plicy is trying t d The relatinship between mental ill health, alchl and illicit substances (a cntrlled drug which a persn pssesses unlawfully, i.e. the drug has nt been supplied t that individual by prescriptin) is well established; these cnstitute a risk t the successful treatment f service users and/r the safety r welfare f any persn in acute inpatient areas. There are ccasins where cncern will exist with regard t the ptential presence and availability f alchl, illicit r suspicius substances within acute inpatient areas. The Trust will therefre adpt a range f appraches t address issues as cncerns arise, and will challenge and supprt the actin f individuals accrding t this plicy, where the cncern des nt have an impact n the safety and wellbeing f thers. Illicit substances cme in many frms such as - tablets, liquids and pwders and may nt be easily identifiable. Staff members shuld seek t clarify what a substance is and shuld cnsider the patients/visitrs histry in the attempt t clarify what the substance is t enable infrmed decisin making. Staff shuld always exercise cautin (in the best interest f the service user/visitr). Any fund substance f cncern is t be cnfiscated and dispsed f in an apprpriate manner. It is expected that this plicy will be implemented with sensitivity t service users/visitrs needs Which stakehlders have been invlved in the creatin f this Plicy Ward Managers, Cnsultants Acute Inpatients Trust Plicy Bard attendees Any required definitins/explanatins Whilst alchl is nt itself an illegal substance, its detrimental effects n mental health issues are well dcumented. Althugh the Trust recgnises that all individuals have a right t make lifestyle chices regarding their persnal cnsumptin. Use f substances by a service user generates significant risks t that persn and thers in the same envirnment i.e. ptential effects n prescribed psychtrpic medicatins, increased risk f disinhibited r vilent behaviur twards self and thers. Therefre its pssessin and use is prhibited in acute inpatient settings. NHFT - Nrthamptnshire Healthcare NHS Fundatin Trust Page 3 f 11 This dcument is uncntrlled nce printed. Please refer t the Trust intranet fr the current versin CLP051 Management f Suspected Illicit Substances and Alchl review Nv. 20
Key duties Fllwing an assessment and when a mental health prfessinal has gd reasn t believe that a service user/visitr has alchl r illicit substances in their pssessin, it is their duty t act n this suspicin leading t the cnfiscatin f alchl r the substance in the interest f the service user/visitr cncerned and ther service users. Unqualified staff must cnvey any such suspicins t the qualified member f staff in charge f the unit wh must then take apprpriate actin. Shuld cncern exist regarding the safety and wellbeing f staff, clients and/r visitrs arising frm the ptential supply f suspicius substances the plice will be called and asked fr advice and supprt where apprpriate. Staff must be aware that nce cnfiscated, illicit substances, including alchl, must nt be returned t the individual r their relatives, as this wuld leave the member f staff acting as a supplier. Service user/visitr cnfidentiality shuld be respected. Any ptential decisin that verrides service user/visitr cnfidentiality, e.g. thrugh infrming the plice, can nly be made fllwing cnsideratin by the service users cnsultant and senir matrn/service manager. All patients prir t discharge, whether underging a detxificatin r nt will have a full risk assessment undertaken and will leave the facility with a discharge plan. Relevant services will be cntacted t ensure fllw up where required. Service users admitted int acute services that have a knwn histry f substance/alchl misuse and are knwn t bring substances nt hspital premises will meet with their key wrker t negtiate and sign a cntract utlining their respnsibilities fr this plicy (Appendix 1). Plicy detail Where suspicins f an individual having alchl/illicit substances in their pssessin, the nurse in charge f the shift will cnduct an assessment f the risks invlved in addressing the issue and frmulate a management plan tgether with ther team members. The management plan will be enacted which will include: Reminding the individual f ward plicy Asking the service user/visitr t surrender the alchl/illicit substance (minimum f tw members f staff must be present) In the case f thse service users admitted t an inpatient unit t underg an alchl detxificatin prgramme, abstinence frm alchl is an essential requirement f the individual s safe and effective treatment. These service users are required t sign a detxificatin treatment cntract stating clearly that btaining Page 4 f 11 This dcument is uncntrlled nce printed. Please refer t the Trust intranet fr the current versin CLP051 Management f Suspected Illicit Substances and Alchl review Nv. 20
and/r imbibing alchl during a detxificatin regime will lead t their discharge frm this treatment and frm inpatient services. If the service user refuses: A search will be cnducted, in the presence f anther member f staff, as per plicy fr the searching f services users, visitrs and rms (CLP057). If cncerns relate t the pssessin f alchlic beverages: Service users must be infrmed that alchl and its use are nt permitted n Trust premises. Effrts shuld be made t fully infrm the service user f the inherent risks assciated with bringing alchl nt Trust prperty. The service user shuld als be infrmed that alchl will be cnfiscated and dispsed f unless immediately remved frm Trust premises by a carer/relative. If cncerns relate t the pssessin f a suspected illicit substance: Service users will be infrmed that the plice will be infrmed. If cncerns relate t a service user returning t the hspital premises suspected f being under the influence f illicit substances/alchl: That service users mental health will be assessed t fully identify any risks. It may be necessary t refuse direct entry nt the ward area (CRM001 Risk Management Plicy, CLP021 Wrking with Risk Plicy). Service users subject t detentin under the Mental Health Act must be fully risk assessed and discussed with their medical team t determine the safest and mst apprpriate curse f actin. On cnfiscatin and dispsal f suspected illicit substances, the fllwing prcedures will apply. The senir staff member in line with Trust Plicy will recrd the incident n Datix. (Incident Reprting Plicy CRM002) The substance will be place in a sealed envelpe, indicating the Incident number as shwn n the Incident Frm nly (n frmal identificatin t the persn). This will be signed by the tw members f staff (as witnesses) ACROSS the seal and stred the in the cntrlled drugs cupbard (until dispsal by the plice, this shuld be within 24 hurs). The dispsal f the substance is nt the respnsibility f the Pharmacy Department. A brief descriptin f the cntents will be made n the utside f the envelpe (the staff member shuld nt guess at what the substance is) eg: Brwn resinus substance r White tablet, identity unknwn Medical staff must be called t make an assessment f the service user s physical and mental state if there is cause fr cncern. Where the cnfiscated substance is alchl then this will be dispsed f by emptying it dwn the sink. Page 5 f 11 This dcument is uncntrlled nce printed. Please refer t the Trust intranet fr the current versin CLP051 Management f Suspected Illicit Substances and Alchl review Nv. 20
Visitrs: Where suspicins arise f a visitr having alchl/illicit substances in their pssessin. The visitr will be asked t leave the premises immediately and infrmed that the plice will be cntacted and asked t attend. The service user/visitr will be infrmed that any suspected illicit substance fund, will be destryed/dispsed f by the plice. Implementatin and Disseminatin Fr service users and carers wh are unable t cmmunicate in English, every effrt must be made t ensure understanding f the situatin. This may be achieved by using the fllwing: Pre prepared leaflets/signs/visual aids Apprved translating service Family assistance if apprpriate Supprt frm the equality & diversity lead Supprt frm PALS Training requirements assciated with this Plicy Mandatry Training There is n mandatry training assciated with this plicy. Specific Training nt cvered by Mandatry Training All staff within inpatients are expected t familiarise themselves with this plicy in cnjunctin with its assciated plicies (see Sectin 10). Individual clinical areas shuld review their prcedures fllwing any ccurrence f this type f incident. This can be fllwed up during individual staff supervisin sessins. Ad hc training sessins based n an individual s training needs as defined within their annual appraisal r jb descriptin. Hw this Plicy will be mnitred fr cmpliance and effectiveness The table belw utlines the Trust s mnitring arrangements fr this dcument. The Trust reserves the right t cmmissin additinal wrk r change the mnitring arrangements t meet rganisatinal needs. Page 6 f 11 This dcument is uncntrlled nce printed. Please refer t the Trust intranet fr the current versin CLP051 Management f Suspected Illicit Substances and Alchl review Nv. 20
Aspect f cmpliance r effectiveness being mnitred Duties Management f Illicit Substances and Alchl Training Methd f mnitring Individual respnsible fr the mnitring Mnitring frequency T be addressed by the mnitring activities belw. The senir member in line with Trust Plicy will recrd the incident n Datix Ward Matrns As and when incidents ccur, mnitr quarterly Grup r cmmittee wh receive the findings r reprt Operatinal Management Teams Inpatient staff will keep themselves up t date with this plicy. Grup r cmmittee r individual respnsible fr cmpleting any actins Senir Matrn Where a lack f cmpliance is fund, the identified grup, cmmittee r individual will identify required actins, allcate respnsible leads, target cmpletin dates and ensure an assurance reprt is represented shwing hw any gaps have been addressed. Fr further infrmatin Please cntact the Service Managers fr Adult Mental Health Inpatient Areas, Heads f Service fr Adult Inpatients and the Deputy Directr f Mental Health, Learning Disability and Specialty Services. Equality cnsideratins The Trust has a duty under the Equality Act and the Public Sectr Equality Duty t assess the impact f Plicy changes fr different grups within the cmmunity. In particular, the Trust is required t assess the impact (bth psitive and negative) fr a number f prtected characteristics including: Age; Disability; Gender reassignment; Marriage and civil partnership; Race; Religin r belief; Sexual rientatin; Pregnancy and maternity; and Other excluded grups and/r thse with multiple and scial deprivatin (fr example carers, transient cmmunities, ex-ffenders, asylum seekers, sex-wrkers and hmeless peple). Page 7 f 11 This dcument is uncntrlled nce printed. Please refer t the Trust intranet fr the current versin CLP051 Management f Suspected Illicit Substances and Alchl review Nv. 20
The authr has cnsidered the impact n these grups f the adptin f this Plicy. The trust will ensure that individual s with a sensry, mental r physical r physical disability have apprpriate care plans and risk assessments in place s that early persn centred interventins are implemented and the risk t themselves and thers is minimised. All effrts will be made t prvide apprpriate reasnable adjustments that cannt be used t harm thers. Care plans will be available in a frmat as required by the patient (easy read). Natinal statistics with regard t restrictive practice shw an ver-representatin f BME grups, therefre, demgraphic analysis in terms f race and ethnicity f patients thrugh datix will be scrutinized by the as part f the PMVA Mnitring Grup n a quarterly basis. Staff will be expected t wrk in a way that is culturally sensitive and cmpetent way. Wrk is underway with the Mving Ahead Prject Delivering Equality in Mental Health Services fr BME t supprt any adverse impacts identified fr BME Service User Grups. Patients whse first language is nt English will be supprted thrugh the use f translatin services. Cnsideratin must be given t a persn s age with awareness regarding the frailty fr lder service users hwever every precautin is taken t ensure individual health and safety. Service users will be treated as the gender they identify at the time and the trust will ensure that all patients receive care within an identified area f a same sex ward r crridr. Individual religius beliefs and activities will be respected, where they d nt pse a further threat t thers. The trust will ensure that females wh are pregnant r have recently given birth have access t maternal mental health services including if necessary transfer t a specialist ward. Fr females wh have recently given birth, all effrts will be made t ensure cntact with the new brn is safely maintained thrugh an assessment f risk. Reference Guide There are n references r bibligraphy assciated with this dcument Dcument cntrl details Authr: Service Managers fr Adult Mental Health Inpatient Apprved by and date: TPB 21.11.18 Respnsible cmmittee: Clinical Exec. Any ther linked Plicies: CLP021 Wrking with Risk CLP024 Nn-cncrdance with Care and Treatment Plans CLP042 Privacy and Dignity CLP052 Plicy fr seven Day/Frty-eight hur In-patient fllw-up CLP056 Transfer and Discharge Plicy CLP057 - Searching f Service Users, Visitrs and Rms CRM001 Risk Management Strategy CRM002 Plicy fr the management f Incidents IGP101 Infrmatin Gvernance Plicy and Management Framewrk Page 8 f 11 This dcument is uncntrlled nce printed. Please refer t the Trust intranet fr the current versin CLP051 Management f Suspected Illicit Substances and Alchl review Nv. 20
IGPr010 Data Prtectin Prcedure IGP107 Health Recrds Management Plicy CLP051 Versin cntrl: Versin 3 Versin N. Date Ratified/ Amended Date f Implementatin Next Review Date Reasn fr Change (eg. full rewrite, amendment t reflect new legislatin, updated flwchart, minr amendments, etc.) 2.0 01.09.2015 01.09.2015 01.09.2017 New gvernance f trust plicies template. 3.0 21.11.17 21.11.17 21.11.2020 Review Page 9 f 11 This dcument is uncntrlled nce printed. Please refer t the Trust intranet fr the current versin CLP051 Management f Suspected Illicit Substances and Alchl review Nv. 20
APPENDIX 1 - Cntract Supprting Safe Management f Suspected Illicit Substance & Alchl use by a Service User I,..... f Ward Agree t the fllwing cnditins: 1. I agree that at n time during my admissin will I use r abuse alchl/r nn prescribed drugs. I am aware that the use r pssessin f nn-prescribed drugs may be a criminal ffence and in all instances will be treated as such. 2. I agree that nursing staff have the right t decline entry t the ward f any persns that are suspected f being in pssessin f such substances. 3. I agree t prvide a sample f breath, bld r urine fr testing during my stay as a curse f actin shuld I be requested t d s. This wuld fllw staff infrming me f cncerns that my mental health may be cmprmised due t substance misuse. 4. I fully understand the trust plicy n alchl and nn-prescribed drugs. I understand that any breach f this cntract & its cnditins may result in a review f my treatment, and may result in my discharge frm the ward. 5. I understand that if risks cmprmise my safety r safety f staff and ther service users resulting frm a breach in this cntract plice may be requested t assist. This is inline with the trusts plicy and prtcl n zer tlerance. 6. I agree that that I will cmply with any request by the nurse in charge f the ward fr a persnal prperty search, if I am suspected f pssessing any illicit substances and fund t be in breach f this agreement. This is inline with the trusts plicy n searching service user/prperty. Service User Signature: Date: Key wrker/ Nurse Signature: Date: Ward Dctr Signature: Date: Page 10 f 11 This dcument is uncntrlled nce printed. Please refer t the Trust intranet fr the current versin CLP051 Management f Suspected Illicit Substances and Alchl review Nv. 20
Page 11 f 11 This dcument is uncntrlled nce printed. Please refer t the Trust intranet fr the current versin CLP051 Management f Suspected Illicit Substances and Alchl review Nv. 20