Working alone procedure Approved By: K Huchet Date Approved: 16.02.06 Date for Review: 16.02.09 Relevant FN&HC Policies: Organisational, Health & Safety Statement of Intent This procedure relates to all staff who are working or travelling alone within the organisation s premises or in the community. Its purpose is to ensure that any risks associated with working in isolation are identified and action is taken to remove or minimise those risks. This procedure includes information on: responsibilities of staff and managers dealing with disputes arising from the handling of identified risks alert systems (refer to the risk assessment procedure ) local procedures personal security emergency situations training staff support mechanisms guidance to staff relating to: before incidents occur home visits travelling arriving at the patient s home completed visits when incidents occur after an incident has occurred The general principles are that: risk assessment is integral to all activities undertaken by staff identified risks must be shared with all involved staff all reasonable steps must be taken to minimise any risk The Family Nursing & Home Care Committee recognises its obligation under the Health and Safety at Work (Jersey) Law 1989 to provide as safe and secure an environment for all members of staff as is possible.
Scope/Responsibility It is the responsibility of the staff: to ensure that they do not take any unnecessary risks (see section 8) to seek and follow advice from their manager to follow all organisational policies and procedures to be aware of the alert system used in the organisation, i.e. emergency centres nurse procedure and to use it when appropriate to comply with requests to fulfill daily commitment sheets or work diaries and update on a daily basis and for information on their whereabouts from managers to keep relevant secretaries informed of changes in their schedule and when visiting new patients to report any incidents including threats and potentially dangerous situations using the accident/incident/near miss reporting and environmental assessment procedure If staff are going into unknown or known risk, they should contact the secretary before and after the visit. The length of the visit to be decided by staff member. It is the responsibility of Divisional Managers: to ensure local operational policies, systems and guidance are put in place to minimise general risk to ensure that the environmental assessment form is used to inform other involved parties and the Health and Safety Coordinator of any potential risk to ensure all staff take action to eliminate, minimise or transfer the risk, i.e. safe handling It is the responsibility of Family Nursing & Home Care through the Director/Committee: to exercise its right to withdraw, adapt or limit services when risks have been identified as unacceptable (refer to withdrawal of service procedure ) to support requests for equipment and other resources deemed necessary following risk assessment. Process 1. Disputes When in the judgement of either staff or managers, there is a disagreement regarding an identified risk following a risk assessment, the situation should be discussed with the Health and Safety Coordinator in the first instance. It may be necessary to involve the Health & Social Services Coordinator of Violence and Aggression Training for additional advice. If the situation is unresolved, the grievance procedure should be followed.
2. Alert systems Where there is a history of violence or a known potential for violence, an alert system should be used to notify all staff and colleagues, including other care agencies, e.g. Social Services and General Practitioners, ie. environmental assessment form. When making a referral to any other party, any history of, or known potential for violence or aggression by an individual, their family or close associates, should be clearly noted in the referral. Referrals should note any environmental risks associated with a families situation, e.g. dangerous dog, unsafe property, drug paraphernalia on premises. Where individuals for whom no history is available require an initial assessment, they should, where possible, be invited to attend a safe venue, e.g. clinic or use telephone procedures. 3. Local procedures Family Nursing & Home Care have safety processes in place which take account of local working practices and associated risks, including systems for: register of car identification details staff whereabouts, i.e. commitment sheets, work sheets regular contact with others within the department for all staff who work in the community reporting off duty at the end of the working shift/day checking in and out when working out of hours, i.e. name board at Le Bas designated persons responsible for monitoring process and taking action 4. Personal security All staff should have access to attack alarms and/or mobile telephones as necessary. The emergency centres nurse procedure is available to staff during office hours 1. Additional information is contained later in this document under in the Guidance to Staff. 5. Emergency situations Any urgent security difficulty should be notified to a Divisional Manager at the earliest opportunity. 6. Training All staff must attend training and updates in safety procedures, including fire and manual handling as set out in the training programme (refer to mandatory training procedure ).
7. Staff support mechanisms Staff experiencing difficulties following a security incident may access support via their Manager, the Health & Safety coordinator who may involve trauma debriefing and/or counselling services, Mrs Anne Lane - Hospital Counsellor (62) 2116. GUIDANCE TO STAFF Whilst it is the legal responsibility of the organisation to provide safe systems of work, individuals have a responsibility to follow safe working practices. In the community where individuals are often working alone or in small groups, they also need to remain watchful for their own safety and that of their colleagues. The lists of suggestions given here are not exhaustive but provide examples of the types of actions that contribute towards the creation of a positive safety culture. Before incidents occur check that they are familiar with team procedures, which relate to employee safety. ensure that they undertake all training provided by the organisation, in personal safety and managing aggression through prevention, calming and negotiating, including regular refresher training. be aware that their behaviour can trigger or prevent aggression. Treat patients courteously allowing them to retain optimum control and dignity. obtain as much information as possible about patients, their families and the contact locations. give patients information about their role and the planned appointment so that they know what to expect. be aware of their own safety at all times while travelling and at contact locations. Continually reassess the risks and do not enter any location where they do not feel safe. follow team practices for keeping in touch with base, checking out and checking in at agreed times etc. Follow procedures for signing off at the end of the work period. Home Visits obtain as much information as possible about the patient/client, their families and the location to be visited. Check any existing patient/client notes for environmental assessment forms. wherever possible, phone or write to make appointments for visits, ensuring that people know who they are and what their role is. If they are unable to keep the appointment at the agreed time, let the patient know. follow team practices to ensure that someone else knows where they are going and when they should return. Make sure this person knows if the itinerary changes. if they are uneasy about making the visit, ask their team leader for extra support. get information about the area to be visited and ensure they know exactly where they are going.
ask patients to leave a prominent light on at night to help the nurse/home care assistant find the house. if possible, schedule visits to problem areas for particular times of the day, such as the morning when parents are around taking children to school, and when drug activity and drunkenness should be minimised. dress appropriately for the area or patient to be visited, particularly when the patients culture demands that women are well covered up. Staff should not wear expensive looking jewellery. wear shoes and clothes that do not hinder movement or their ability to run away in an emergency. ensure that their means of communication and any personal alarms are working and accessible. Programme their work base number into a mobile phone so that it can be rung by pressing one button. check that they know the team s emergency procedures should they, or someone else, encounter a problem. check that they have all the equipment required for the treatment or procedures to be carried out. ensure their vehicle has sufficient petrol, is well maintained and appropriately insured for work use. When Travelling as far as possible, allow adequate time for the journey so that they are not rushing. lock the vehicle whilst driving. conceal bags, drugs and equipment when you put them into the car, so that they are not able to be seen when driving and staff are not seen hiding them when parking at their destination. Ensure they are hidden when leaving the vehicle. park as near as is practicable to the address to be visited, in such a position as to be able to drive straight off, and in a well lit area at night. avoid, as far as possible, waste-ground, isolated pathways and subways, particularly at night. keep aware of the nearest place of safety such as shops. drive defensively to avoid incidents of road rage. Keep aware of the latest police recommendations regarding road rage. For example, if another driver gets annoyed: do not make eye contact or make gestures. if followed try to get to a location where other people will be around, such as a petrol station. When arriving at a patients home: assess the situation on approach and be prepared to abandon or postpone the visit if in doubt of their safety. stand well clear of the doorway after ringing or knocking. Stand sideways on so that they present a narrow, protected target. show identity badges.
do not enter a location if they are uneasy about their safety. Make an excuse not to go in if the person answering the door gives any cause for concern, for example if they are drunk, if the patient is not in, or a potentially dangerous relative is present. follow the occupants in when entering houses and other buildings. remain aware of the behaviour of all persons in the house, looking for any signs or signals that may indicate a potential problem. remain aware of the environment and maintain escape routes in case problems arise. treat patients courteously, remembering that staff are a guest in the patient s home. When visits are completed ensure that all parties are satisfied with the treatment or interaction that has occurred. If there are problems make sure that everyone knows what should happen next. Make sure they undertake all that has been agreed. always return to base or phone in at the expected time. If plans change or there are delays, phone to let the team or colleague know 2. While incidents are happening Put their own safety first. Leave a situation if they feel unsafe. Professional codes of conduct do not require them to jeopardise their own safety. It is better to leave and find alternative ways of providing care for the patient. if they are sure the aggression is not directed towards them personally and that the person simply needs to offload about their situation, allow the person to have their say. Try to calm them down and then try to discuss the situation and help them to think of ways to deal with the problems. if a relative or carer is becoming agitated while the staff member is trying to carry out a procedure on the patient, give them a task to do such as fetching water or a towel. recognise the limits of their own ability to deal with a situation and the time when it becomes prudent to leave/ask for assistance. use panic alarms only in situations where there is a clear escape route. Use them for surprise only, not for summoning help, unless certain there is someone nearby who will definitely come to help. to escape from a physical hold, breakaway techniques should be employed. However if they are unsure of their own competence regarding these, then the techniques used should be of the minimum degree necessary, be reasonable in the circumstances, and used in a defensive manner. Remember that using physical techniques inappropriately could exacerbate the situation and could also be interpreted as assault. control and restraint techniques should not be used by individuals working alone. call for assistance from the police or from the work team, using agreed codes if appropriate, i.e. emergency centres nurse procedure.
provide information about complaints procedure and alternative sources of help, if appropriate. After incident has occurred: contact their team leader/supervisor and/or return to base. allow themselves time to recover and, if possible, seek practical support from their colleagues. Even after very minor incidents, feelings may be difficult to control and may affect their ability to deal with any further problems that arise. This is a perfectly normal reaction. If in doubt take time out! contact the police if appropriate. seek proper medical attention for any physical injuries. be prepared for the natural post trauma reactions, which may occur very soon after the incident or may be delayed. ask for debriefing, and for further counselling if post trauma reactions persist. share information with others who might visit and add information to patient notes, if appropriate. report the incident through the formal reporting procedures so that: (i) the incident can be reported (ii) safety measures can be modified to protect themselves and other staff in the future, and (iii) they have a more secure basis for any legal redress relating to the incident Ref: From the Safer Working in the Community - NHS Executive (Sept 98) Working alone procedure - document history Version Who Changed Date Approved by 1.1 Working Party 16.02.06 Version Narrative 1.1 Annual Review changes made