escorting vulnerable and at risk service users

Version 1.1 May 2018

Escorting Vulnerable And At Risk Service Users

Target Audience

Who Should Read This Policy

All Clinical Staffs

Escorting Vulnerable and at Risk Service Users


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Ref. Contents Page

1.0 Introduction 3

2.0 Purpose 4

3.0 Objectives 4

4.0 Process 4

5.0 Procedures connected to this Policy 7

6.0 Links to Relevant Legislation 8

6.1 Links to Relevant National Standards 8

6.2 Links to other Key Policies 8

6.3 References 8

7.0 Roles and Responsibilities for this Policy 8

8.0 Training 9

9.0 Equality Impact Assessment 10

10.0 Data Protection and Freedom of Information 10

11.0 Monitoring this Policy is Working in Practice 11

Appendices Trip/Transport/Visit – Risk Assessment 13



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Explanation of terms used in this policy

Escorts- professional members of staff that accompany patient on leave

Procedural Documents - the collective term for policies, procedures or guidelines

Policy - sets out the aims and principles under which services, divisions, or units will operate. A policy

outlines roles and responsibilities, defines the scope of the subject covered, and provides a high level

description of the controls that must be in place to ensure compliance

Risk Assessment - An assessment which identifies any factors that may impact on the safety of the service user or the employee

Students – people currently on placement and undertaking a learning experience at the NHS establishment



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1.0 Introduction This policy has been developed to support and guide clinical staff when considering transportation of vulnerable and/or at risk service users. The guidance links to the NHS Litigation Authority Risk Management standards. 2.0 Purpose This policy provides guidance for all staff involved in the planning and implementation of escorted activities of in-patients who require an escort as a consequence of their:

Individual risk management plan

Observation level

Leave status

Mental Health Act status.

3.0 Objectives Primarily this policy refers to hospital in-patients who may:

Abscond

Harm themselves

Neglect themselves or disregard their own personal safety

Harm others. However, this guidance may also be relevant to individuals living in community facilities, especially where the residence is designated as an in-patient service. In practice, the appropriateness of, and the requirement for, escorted activity of this sort may vary according to the nature and purpose of the service. For example escorted visits may be more frequent within inpatient areas rather than residential/rehabilitation services. Clearly, the emphasis for escorted transport needs to be on the degree of risk or vulnerability, and not the nature of the activity. Therefore, when considering transportation for service users always consider how the escort or travel planning arrangements may impact or limit the social, recreational, educational or rehabilitative aspects for service users. Consequently, this policy does not apply to those situations where staffs simply accompany an individual, or individuals, in order to support and facilitate such activities. In other words, this policy is not intended to interfere with social care approaches that emphasise

4.0 Process

4.1 General Principles

All risk assessments must be recorded in care records.

Risk can be variable, depending on circumstances. Risk assessments should have short-term perspectives and be frequently reviewed in the patients/service users care plan: a maximum review period should be clearly identified.

Interventions can increase as well as decrease risk. Good relationships between the nurse and the service user make risk assessment and management easier, more accurate and may reduce risk.

If the service user is to be transported and escorted by an unqualified member of staff, it is the qualified clinician’s responsibility to assess the risk involved in the transportation.

A risk re-assessment should be carried out at each time of transportation.

Consideration as to whether two staff is required will always be needed.

Service users who present as a risk to others are also likely to be vulnerable to other forms of risk. e.g. self-harm, self-neglect or abuse by others.



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Risk cannot be eliminated entirely but all actions need to demonstrate measures that aim to reduce identified risks.

Assessment of risk should be documented in the care records and form part of the service users’ care plan.

When undertaking an escort within the grounds of a hospital or other residential establishment, the escort must be aware of the physical boundary identified for that unit.

Throughout the escorted activity, the escort maintains their ‘duty of care’ to the service user. The service user must not be placed in a vulnerable position where their safety or welfare could be jeopardised e.g. the escort and service use separate and meet up later.

If a service user leaves the unit or service with an escort, they must return to the unit or service together. This is particularly significant in cases where the off-site activity unexpectedly runs over the escort’s shift hours – the duty of care remains in place until the service user is returned safely to the unit. In these cases the manager/team leader may need to consider time owing arrangements.

The escort must be mindful of any purchases or acquisitions made by the patient during an escorted activity. Patients should be advised against acquiring items that may jeopardise their own health or safety or that of others. If such purchases are made, or cannot be deferred, they must be brought to the attention of the Person-in-Charge upon return to the unit/service.

The escort must be able to contact and communicate with their base e.g. the ward, service and unit. If the off-site activity runs over anticipated times of return the escort must make an update/’safe and well' call to the unit.

4.2 Escorts Where possible, escort activities should be planned in advance. Escorted activity provides a valuable opportunity for therapeutic engagement and affords the patient normalising, safe and therapeutic time away from the hospital or unit. Wherever possible, the patient or patients should be involved in the planning of escorted activities e.g. in relation to date, time, nature and purpose of the activity etc. Where this is not possible or practical, the patient(s) should be informed of the arrangements at an early stage and given as much advanced notice as is possible. All professions can appropriately fulfil the role of escort. Wherever possible, decisions about the appropriate professional to act as the escort, and the required level of competence, should form part of the forward planning process. In certain circumstances e.g. escorting a patient to court, the escort must be a registered/qualified practitioner. In such circumstances, unregistered or unqualified staff can be used to supplement the registered or other suitably qualified escort. Unless the care plan specifies otherwise, e.g. in relation to planned therapeutic risk taking, the escort must, at all times, be in the company of the patient. The escort must not let the patient out of their view unless it is fitting to do so e.g. for ‘comfort breaks’ (use of toilet facilities) or within sports centre changing facilities. Patients are entitled to request an escort of the same sex and, where possible, every effort should be made to meet their request. However, there may be situations where this will not be possible or practical. 4.2.1 Students Students must not escort patients outside the boundary of the hospital or residential unit on their own. However, they may accompany the identified escort as part of their learning experience. Unaccompanied students may escort patients within the boundary of the hospital or unit if they are considered to be competent and if it is appropriate to the activity and the assessed needs of the



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patient. The risks to the patient and the student must be taken into consideration; if there is any uncertainty, the student should accompany another identified escort. Responsibility for this decision rests with the nurse-in charge who maintains responsibility for the safety and welfare of the patient. Wherever possible, student learning objectives related to the activity should be identified. Further guidance on student learning objectives in relation to escort duties can be obtained from Clinical Student Placements. 4.3 Service users detained under the Mental Health Act For those who are formally detained under the Mental Health Act, the patient's Consultant must authorise the appropriate leave of absence and arrangements prior to the escorted activity. In the absence of the consultant, this permission must be granted by the doctor who is temporarily in charge of the patient’s treatment e.g. another consultant, a locum consultant or an appropriately approved specialist registrar (Department of Health 1999) For restricted patients detained under section 37/41 of the Act, authorisation for leave has to be approved by the Home Secretary. 4.4 Transport When considering transport requirements related to an escorted activity, staffs’ own personal transport should be used judiciously. However, personal transport may be appropriate where:

It is more suitable in terms of normalisation

It is not possible to obtain or use other means of transportation and the activity cannot be rescheduled

It is warranted because of the urgency of the situation.

If personal transport is used, the vehicle’s owner must have the correct insurance

Cover authorising them to use the vehicle for such purposes. Check with your own insurance car company for more details about passengers in the course of work duties.

Where a staff member is the driver of the vehicle, the number of escorts required must be reassessed and an additional escort or escorts arranged.

Damage to personal vehicles incurred as a result of the escort e.g. cigarette burns, stained or soiled seats, broken fixtures remain the responsibility of the driver under their insurance arrangements.

4.5 Assessment of risk

The aim of the assessment is to identify any factors that may impact on the safety of the service user or the employee during transportation. A pro-forma for risk assessment is attached to this policy for guidance and use e.g. it aims to act as a prompt or provide a useful format for services to retain evidence that a risk assessment has been undertaken. Identification of risk should consider the following:

How serious is the risk?

Is the risk general or specific?

Is the risk immediate?

Is the risk volatile?

Can the risk be reduced by any treatment or management plan identified? Assessment of risk in relation to transportation will usually include:-



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(i) History

Are these following risk factors stable or have any of them changed recently?

Previous violence and / or suicidal behaviour.

Poor compliance with medication.

Presence of substance use.

Any identified precipitants and / or mental state changes or behaviour that precipitated violence and / or relapse.

Any recent severe stress, particularly loss or threat of loss situations.

History of jumping from moving cars, disrupting driver, unable to follow simple safety requests. (ii) Environmental/Vehicle Safety The employee is responsible for ensuring that the vehicle being used is safe for the transportation of service users. The vehicle should meet all the statutory requirements of road safety. Insurance, MOT certificates and vehicle licence should be inspected annually to ensure ongoing patient safety. The vehicle should be appropriately insured for the transportation of clients. (iii) Mental State

- The service user is agreeable to being transported. - Any specific threats made by the service user. - Evidence of emotions related to violence, for example irritability, anger, hostility and

suspiciousness. (iv) Medical Issues

- Any medical condition that may affect mental state. For example – epilepsy, diabetes, heart problems.

- Physical limitations that affect usage of a car or walking to or from a car. If the qualified staff member has made a risk assessment that the service user is safe to be transported, then transportation and escort can proceed.

If the qualified staff member identifies a risk, has concerns or is unwilling to transport in their own cars the service user should not be transported or escorted and alternative arrangements considered. All risk assessments must be retained/recorded in care records and easily accessible for escorts prior to leaving the unit or service.

5.0 Procedures connected to this Policy A detailed record must be made, prior to escorted activities and include:

The patient’s physical description upon leaving.

Clothes worn for the activity upon leaving.

The destination.

The expected duration of the activity.

The anticipated time of return.

Vehicle registration number (or mode of transportation)

Name(s) of escorts(s).

Mobile phone contact number.



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6.0 Links to Relevant Legislation

Mental health Act

Section 132/133: Patient’s rights under the mental health act

Consent to treatment 6.1 Links to Relevant National Standards

National Regulatory standards

Care Quality Commission

NHS Litigation Authority: Risk standards for mental health

National Institute of Clinical Excellence

6.2 Links to other Key Policies

Lone Worker Policy

Mental Capacity Act Policy

Mental health Act Policy

Mental Capacity Act - SOP 02 - Consent to treatment (Inc. Covert Administration of Medicines)

Care Programme Approach (CPA)

Risk Management strategy.

Clinical Risk Assessment.

6.3 References Royal College of Psychiatrists London. Assessment and Clinical Management of risk of harm to other people. Council Report CR53 April 1996. Risk, choice and Independence, DoH 2007 NHS Litigation Risk Management standards for mental health (visit the NPSA website for updates on patient safety)



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7.0 Roles and Responsibilities for this Policy

Title Role Key Responsibilities

Team Leaders adherence Check that staff; - who drive as part of their professional role are appropriately insured

- are not disbarred from driving

- are not taking passengers on health grounds.

Line Managers Implementation Check that staff;

- who drive as part of their professional role are appropriately insured - are not disbarred from driving

- are not taking passengers on health grounds.

Individual staff Adherence - to ensure they are appropriately covered by insurance - be aware that should they drive whilst undertaking duties but are disbarred on legal or health grounds then they do so at

their own risk.

8.0 Training What aspect(s) of

this policy will require staff

training?

Which staff groups require this

training?

Is this training covered in the Trust’s Mandatory and Risk

Management Training Needs Analysis document?

If no, how will the training be delivered?

Who will deliver the training?

How often will staff require

training

Who will ensure and monitor that staff have this

training?

Mental Health act

training

All staff (

dependant on roles and responsibilities

will depict level of

MHA training required )

Yes – roles and responsibilities

will depict level of MHA training required

Andrew Waldron As required by

role

Manager of service

Mental Capacity Act training

All staff ( dependant on roles

and responsibilities

will depict level of MHA training

required )

Yes –on roles and responsibilities will depict level

of MHA training required

Learning and development team

As required by role

Manager of service



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9.0 Equality Impact Assessment

Black Country Partnership NHS Foundation Trust is committed to ensuring that the way we provide services and the way we recruit and treat staff reflects individual needs, promotes equality and does not discriminate unfairly against any particular individual or group. The Equality Impact Assessment for this policy has been completed and is readily available on the Intranet. If you require this in a different format e.g. larger print, Braille, different languages or audio tape, please contact the Equality & Diversity Team on Ext. 8067 or email [email protected]

10.0 Data Protection and Freedom of Information

Data Protection Act provides controls for the way information is handled and to gives legal rights to individuals in relation to the use of their data. It sets out strict rules for people who use or store data about individuals and gives rights to those people whose data has been collected. The law applies to all personal data held including electronic and manual records. The Information Commissioner’s Office has powers to enforce the Data Protection Act and can do this through the use of compulsory audits, warrants, notices and monetary penalties which can be up to €20million or 4% of the Trusts annual turnover for serious breaches of the Data Protection Act. In addition to this the Information Commissioner can limit or stop data processing activities where there has been a serious breach of the Act and there remains a risk to the data. The Freedom of Information Act provides public access to information held by public authorities. The main principle behind freedom of information legislation is that people have a right to know about the activities of public authorities, unless there is a good reason for them not to. The Freedom of Information Act applies to corporate data and personal data generally cannot be released under this Act. All staffs have a responsibility to ensure that they do not disclose information about the Trust’s activities; this includes information about service users in its care, staff members and corporate documentation to unauthorised individuals. This responsibility applies whether you are currently employed or after your employment ends and in certain aspects of your personal life e.g. use of social networking sites etc. The Trust seeks to ensure a high level of transparency in all its business activities but reserves the right not to disclose information where relevant legislation applies. The Information Governance Team provides a central point for release of information under Data Protection and Freedom of Information following formal requests for information; any queries about the disclosure of information can be forwarded to the Information Governance Team.

mailto:[email protected]

http://simple.wikipedia.org/wiki/Information

http://simple.wiktionary.org/wiki/right



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11.0 Monitoring this Policy is working in Practice

What key

elements will

be monitored? (measurable

policy objectives)

Where

described in

policy?

How will they be

monitored? (method +

sample size)

Who will

undertake this

monitoring?

How Frequently?

Group/Committee

that will receive and

review results

Group/Committee

to ensure actions

are completed

Evidence this has happened

annual audit of

risk assessments

Audit findings

to be reported to the relevant

Directorate Governance

and Care Group

Clinical Audit.

Consultants,

service managers, team leaders and

nurse-in charge

relevant Directorate

Governance and Care Group

Consultants, service

managers, team leaders and nurse-in

charge

Clinical risk assessments.

Trip/transport/visit – risk assessment.

CPA documentation

Notes from MDT meetings/ward reviews

Care plans.



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Appendix

Trip/Transport/Visit – Risk Assessment

The following pro-forma has been prepared to assist staff involved in trips or visits in completing their risk assessment as required by the Trusts policy. This pro-forma acts as a prompt to focus the mind on areas where risks can arise. Please feel free to modify the pro-forma to suit your circumstances. The completed form must be discussed with and approved by the Nurse-in-charge prior to the trip/visit. In addition the Staff escort must keep a copy of the document with them at all times during the visit/trip. A copy of the completed form should be retained in the client’s records as part of your records retention strategy. Part A: To be completed by /trip/visit/ co-ordinator/named nurse Description of visit/trip

Name/Unit No. of Client

Coordinator

Participating Staff (list)

Mode of transport to/from area and within area (if applicable)

Full address of where event takes place.

Date of risk Assessment

Risk Assessor



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Risk reviewed by Nurse in Charge (name)

Date:

Part B: Risk Assessment form - to be completed by staff in charge of visit or trip.

Risk description Control Measures in place Risk Aggregate - Likelihood x Severity Risk classification

(Low, Medium

High)

Means of transport

presenting a risk to

staff or client’shealth and

safety

- Prior checks made on vehicle suitability.

- Avoidance of driver fatigue by taking

appropriate breaks during the journey. - Check valid insurance documents

Staff/client numbers/ratio

making it difficult to supervise activities

- Ratio of xx clients to 1 member of staff adopted to ensure proper supervision.

- Prior instructions/ training of client and staff e.g. Briefing for client & staff re health and

safety information for general awareness.

-

Trip/ visit includes disabled personnel

resulting in the need for special

arrangements.

- Planning of event to include checks if disabled personnel involved.

- Manage event as far as is reasonably practicable taking cognisance of DDA.

- Availability of equipment e.g wheelchair, walking aids etc.

- Availability of suitable toilet facilities etc.

Risk description Control Measures in place Risk Aggregate

Likelihood x Severity

Risk classification

(Low, Medium High)

Emergency situation arises

putting the lives of

-

- Briefing for all participants at start of event on how to respond to emergency situations.

- First aid/medical arrangements pre-



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client/staff at risk arranged in case of need.

-

Extremes of weather adversely

affecting the health and safety of staff

and/or client

- All staff are adequately prepared with proper clothing (including high visibility

apparel if needed) - Suitable lines of communication always

available.

Client/ member of staff gets lost

during trip / visit

- Staff allocated to client asked to stay in contact at all times.

- Security issued with contact details including mobile phone numbers where

possible. - Staff to familiarise with local surroundings.

- Details of local emergency services always

available whenever possible.

Risk description Control Measures in place Risk Aggregate Likelihood x Severity

Risk classification (Low, Medium

High)

Unacceptable behaviour by client

or staff leading to severe event

disruption and

possible loss of reputation

- Event organiser/leader briefs staff/client on expected behaviour/rules and regulations at

the start of event. - Staff on hand to enforce good behaviour.

- Staff/client encouraged to immediately

report unacceptable behaviour to members of staff.

Allergies resulting

in client staff suffering an allergic

reaction

- Co-ordinators to check if anyone suffers

from allergies before event takes place if condition known, prior arrangements are

made to manage the risk (i.e. appropriate medication, care taken not to expose

individual to risk).

Lone Working

resulting in personal health and

safety risks

- Avoid lone working at all cost.

- Follow Trust’s Lone Working Policy



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Security risks to

staff and client

- Contact information for local police available



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Policy Details

* For more information on the consultation process, implementation plan, equality impact assessment,

or archiving arrangements, please contact Corporate Governance

Review and Amendment History

Version Date Details of Change

1.1 May 2018 Additional explanation of terms used in policy; updated section 6.0, 8.0 and 11.0.

1.0 Jan 2015 Reformatted to meet new Trust policy template

Title of Policy Escorting Vulnerable And At Risk Service Users

Unique Identifier for this policy BCPFT-CLIN-POL-08

State if policy is New or Revised Revised

Previous Policy Title where applicable Transportation and Risk Assessment guidance

Policy Category Clinical, HR, H&S, Infection Control etc.

Clinical – General

Executive Director whose portfolio this policy comes under

Executive Director of Nursing, AHPs and Governance

Policy Lead/Author Job titles only

Risk Services Manager

Committee/Group responsible for the approval of this policy

Nursing Board

Month/year consultation process completed *

n/a

Month/year policy approved September 2018

Month/year policy ratified and issued September 2018

Next review date May 2021

Implementation Plan completed * Yes

Equality Impact Assessment completed * Yes

Previous version(s) archived * Yes

Disclosure status ‘B’ can be disclosed to patients and the public

Key Words for this policy

Policy, Service users detained under the MHA, Transport, Accountability and responsibility, Risk Assessment pro-forma