lone working - bcpft.nhs.uk

Version 1.1. March 2018

Lone Working

Target Audience

Who Should Read This Policy

All Trust Staffs

Lone Working Policy


2

Ref. Contents Page

1.0 Introduction 4

2.0 Purpose 4

3.0 Objectives 4

4.0 Process 4

4.1 Risk Assessment, Risk Management and Hazard Identification 4

4.2 Management Awareness 5

4.3 Prediction, prevention and Management 5

4.4 Potential/Actual Incident Reporting 7

4.5 The Buddy System 7

4.6 Lone Worker Devices 7

4.7 Escorting Patients and Vehicles 8

5.0 Procedures connected to this Policy 9

6.0 Links to Relevant Legislation 9

6.1 Links to Relevant National Standards 9

6.2 Links to other Key Policies 9

6.3 References 9

7.0 Roles and Responsibilities for this Policy 10

8.0 Training 15

9.0 Equality Impact Assessment 16

10.0 Data Protection and Freedom of Information 16

11.0 Monitoring this Policy is Working in Practice 16

Appendices

1.0 Safety Tips 18

2.0 Lone Worker Risk Assessment Checklist 20

3.0 Risk Assessment Checklist to Assist Home Visits 26

4.0 Table 1 Consequence scores 32

5.0 Lone worker incident actions flowchart 33

Lone Working Policy


3

Explanation of terms used in this policy

Working alone – this term is used to define any working practice which involves an employee

undertaking duties not in the presence of or not easily accessible to other employees.

Workplace – deemed to include all/any Trust premises. Premises where Trust staff may be required to work within the course of their normal duties, Domestic properties being visited within the

community by Trust staff for the purpose of offering care and treatment to either service users and/or

carers within the community.

Lone Working Policy


4

1.0 Introduction Black Country Partnership NHS Foundation Trust is committed to the safety and well-being of all employees. Under the Health and Safety at Work Act 1974, the Trust is responsible for the health, safety and welfare at work of all its employees and the health and safety of those affected by their work. These responsibilities cannot be transferred to employees even in the case of employees who work alone or without close supervision. It is the Trust's duty, as an employer, to organise and control solitary workers. For example the situations in which potential risks can arise when working alone are many and varied so the Trust needs to ensure foreseeable risks have been identified and addressed by managers who have a responsibility to ensure safe systems are in place. Equally, individuals need to ensure they work in a safe manner and accept personal responsibility for their own safety and that of their colleagues and patients/service users in their care. This policy is to be read in conjunction with the Prevention and Management of Violence and Aggression policy, Health and Safety Policy, Incident Reporting and the Risk Management Strategy and Policy, Medicines Management Policy.

2.0 Purpose This policy aims to promote safe working practices for lone working staff and to heighten staff awareness regarding safety issues when working alone. It aims to provide guidance for managers and individuals, support the development of safe systems of working where the health, safety and well-being of lone workers can be carefully considered within a variety of settings.

3.0 Objectives This policy applies to all groups of employees, but in particular those who work in isolated locations and/or undertake known lone worker high-risk activities. Lone worker High-risk activities may include:

Undertaking work within isolated areas.

Undertaking work within known high-risk areas.

Visits to service users and/or carers e.g. their home, secluded areas.

Working out of normal working hours.

Working at base or within other Trust premises.

Approved Mental Health Practitioner assessments.

Transporting, dispensing, supplying medication, equipment or valuables.

Travelling between sites/homes/offices.

Transporting cash e.g. carrying cash bags, banking, post office.

4.0 Process

4.1 Risk Assessment, Risk Management and Hazard Identification

Understandably, it is essential for all employees to be aware of risks within their working environments, therefore there is a significant requirement for robust risk assessment and risk management. It is imperative for all staff to undertake appropriate risk assessments of potential risks before undertaking any lone visits and/or lone working. In order to promote safer working, all staff members are advised that at if any time they have to work alone they need to be

Lone Working Policy


5

vigilant to changing and therefore a full risk assessment of the environments and/or location to be visited needs to be taken into consideration. Understandably, when working with patient’s/service users risks will always be present to some degree. Therefore, in the event that a risk is identified, the employee must instigate an appropriate risk assessment and report any relevant identified risks to their manager. The manager is responsible for ensuring that a risk management plan to control, reduce or eliminate the identified risk is developed and that the plan is shared with fellow workers and communicated effectively. Risk assessments for site based lone workers must include:

safe access and egress

risk of violence

safety of equipment for individual use

channels of communication in an emergency

site security

security arrangements i.e. alarm systems and response to personal alarms

level and adequacy of on/off site supervision. Risk assessments for mobile lone workers must include:

client risk assessment where applicable

arrangements for domiciliary visits, including consideration of alternatives

travelling between appointments

reporting and recording arrangements

communication and trace ability

personal safety/security.

4.2 Management Awareness

All managers should be aware of staff who, potentially could be in a situation where they work alone without close or direct supervision and that appropriate action is taken in accordance with this policy to support these workers. Such workers may include:

Late workers i.e. last person to leave the premises.

Mobile workers working away from their fixed base.

People in isolated locations i.e. only one person on the premises.

4.3 Prediction, Prevention and Management

It is essential that staff members are trained in the appropriate skills and necessary communication skills to be able to predict, prevent, manage and de-escalate potentially violent situations within a legal and ethical framework, where the rights and needs of the patient/service user are balanced against the rights and safety of lone workers. Managers and individuals can achieve this by ensuring:

Briefing awareness sessions on risks and localised personal safety procedures are provided in-house as part of a new employee’s/seconded staff induction programme.

Risk assessments are undertaken, reviewed and made easily available to all staff.

Clinical risk assessments, contingency plans and CPA documentation are routinely reviewed, updated and reflected within planning. These include Single Assessment Process etc. for older adults.

Lone Working Policy


6

4.3.1 Community & Estates Those working in the community face additional risks. It is difficult to modify the working environment because it is often the patient’s home or specific sites, so it is especially important to consider working arrangements carefully. If a home visit is not essential for healthcare reasons, arranging to meet the patient/client elsewhere may reduce the risk. If a lone visit to a site for estates reasons is not entirely necessary and can be done jointly then make these arrangements.

Generic assessments of the risks for visiting particular areas or client group(s) may help staff to decide on the precautions needed to reduce the risk of violence to staff to an absolute minimum.

4.3.2 Home Visits The potential risk of violence should be assessed before any home visit. Such assessments need to consider:

Information passed on at referral

Information from other agencies, such as the police, social services

Past history of violence (patients or relatives)

Recent medical and personal history including information on

Behaviour

Medication

Aggressive outburst. The following precautions for visits that present a risk of violence, or where there is not enough information to make a proper assessment should be considered:

Meeting the patient/client elsewhere at a neutral location, or on Trust premises where control measures can be discreetly introduced

Two or more staff to make the visit

See if an escort can be provided and/or liaise with the police around this.

Special liaison with local police/other agencies (possibly a combined visit)

When provided ensure the use of lone working device at all times. Staff who conduct home visits or work in the community must follow the necessary procedures outlined in this policy. 4.3.3 Communications Community workers must have access to a means of communication whilst away from their base unit in order to comply with the lone/community working arrangements. If for some reason no message has been received from the member of staff, systems must be in place to trace their movements and the appropriate response activated. Please refer to Appendix 2 & 3 to gather information from the GP who will identify baseline risks prior to the initial visit. This information can then be used to assist the risk assessment and the initial home visit.

Lone Working Policy


7

4.4 Potential/Actual Incident Reporting

Incident reporting is an integral part of security management. It allows the necessary information to be gathered to:

Identify the problem.

Assess and manage the risk.

Develop solutions.

It is essential that staff report all incidents that have occurred including ‘near miss’ incidents as this will enable lone working concerns to be investigated thoroughly. From this, lessons learnt can be fed back into risk management processes, enabling further preventative measures to be developed and sanctions being taken (where appropriate). Incident reporting will also assist in the review of lone worker procedures ensuring that they are developed and revised to minimise the risk of, and the potential for, similar incidents reoccurring.

4.5 The Buddy System

It is essential that lone workers keep in contact with colleagues and ensure that they make another colleague aware of their movements. This can be done by implementing management procedures such as the ‘buddy system’. To operate the buddy system, an organisation must ensure that a lone worker nominates a buddy. This is a person who is their nominated contact for the period in which they will be working alone. The nominated buddy will:

be fully aware of the movements of the lone worker

have all necessary contact details for the lone worker, including next of kin

have details of the lone worker’s known breaks or rest periods

attempt to contact the lone worker if they do not contact the buddy as agreed

follow the agreed local escalation procedures for alerting their senior manager and/or the Police if the lone worker cannot be contacted or if they fail to contact their buddy within agreed and reasonable timescales.

The following are essential to the effective operation of the buddy system:

the buddy must be made aware that they have been nominated and what the procedures and requirement for this role are

contingency arrangements should be in place for someone else to take over the role of the buddy if the nominated person is unavailable. For example if the lone working situation extends past the end of the nominated person’s normal working day or shift, if the shift varies, or if the nominated person is away on annual leave or off sick.

Local procedures for use of the buddy system should be referred to and used as a guide where use of this system has been highlighted as necessary through risk assessments.

4.6 Lone Worker Devices

It is essential to recognise that lone worker devices will not prevent incidents from occurring. They will not make people invincible, nor should they be used in a way that could be seen to intimidate, harass or coerce someone. However, if used correctly in conjunction with robust procedures, they will enhance the protection of lone workers. Lone workers

Lone Working Policy


8

should still exercise caution even if equipped with such devices and continue to use the dynamic risk assessment process. Lone workers should remember that a device will only be useful if checked regularly, properly maintained and kept fully charged. It is the responsibility of managers and lone workers to develop risk assessments relating to the specific job role, indicating the necessary level of lone worker measures that need to be implemented in order to reduce the risk to a manageable level. If lone worker devices (Trust issued mobile phones) have been identified through risk assessments as a necessary measure for the prevention and management of risks when lone working, then these must be provided by the Trust. Lone workers provided with devices MUST use them in accordance with their training. Failure to do so may result in HR involvement at the discretion of management.

4.7 Escorting Patients and Vehicles

Before a decision is taken to escort a patient/service user, a full risk assessment should take place. This should consider the safeguards that need to be in place before and during the escorting process. Consideration should be given to the physical and mental state of the patient when planning an escort, and to whether they are capable of being transported. The level of staff experience and their qualifications, and the number of staff needed to manage the patient during the transfer should be taken into account. The type of transport to be used (e.g. ambulance, patient transport service, contracted taxi service or lone worker’s vehicle such as ambulance fast responder car) should also be considered. Staff who escort patients using a contracted taxi service should still be considered lone workers and the necessary precautions taken. If there is a need for a lone worker to escort a patient, they should assess the risk of conveyance and seat the patient accordingly. It is preferable to seat the patient behind the front passenger seat and ensure that their seat belt is fastened, or seat the patient within the vehicle as per the MDT agreed seating plan for that particular vehicle. This will enable the lone worker to operate the vehicle safely. There have been reported incidents of patients seated as front-seat passengers grabbing at handbrakes and steering wheels while being transported. Lone workers should not escort a patient by car if there are any doubts about their safety in doing so and alternative arrangements should be made. Lone workers should not agree to transport a patient’s animals. If a conflict arises (or a patient becomes aggressive), the lone worker should pull over into a safe place and exit the vehicle – if possible, ensuring that the keys are removed. They should follow local procedures, which may involve calling the police, their manager, a colleague or their buddy. Appropriate planning and provision should be made for the safe return of a lone worker to a familiar place, once the patient has been dropped off. This is particularly important if the

Lone Working Policy


9

lone worker has to return from an unfamiliar place late at night and travel to their place of work alone.

5.0 Procedures connected to this Policy

Lone Working - SOP 01 - CYPF LD Nursing

Lone Working - SOP 02 - Dudley Children’s Continence Service

6.0 Links to Relevant Legislation

Health and Safety at Work Act 1974

6.1 Links to Relevant National Standards

Care Quality Commission (CQC)

NHS Litigation Authority (NHSLA)

National Institute for Health & Clinical Excellence (NICE)

6.2 Links to other Key Policies

Risk Management Policy

Health and safety policy

Record-keeping Policy

Stress Management Policy

Incident Reporting Policy

Investigation of incidents, complaints and claims Policy

6.3 References

Not alone. A guide for Better Protection of Lone Workers in the NHS. NHS Security Management Service (2005). http://www.cfsms.nhs.uk/doc/lone.worker/not.alone.pdf

A framework for reporting and dealing with non-physical assaults against NHS staff and professions NHS Security Management Service (2004). http://www.cfsms.nhs.uk/doc/sms.general/non.physical.assault.notes.pdf

http://www.cfsms.nhs.uk/doc/lone.worker/not.alone.pdf

Lone Working Policy


10

7.0 Roles and Responsibilities for this Policy

Title Role Key Responsibilities

Trust Board - The Trust Board is ultimately responsible for fulfilling legal requirements relating to health, safety and welfare of those employees who work for the Trust including the protection of lone workers.

- The Board is responsible for assuring and improving the quality of clinical care by implementing clinical governance.

- The key principles of which are quality improvement, risk and performance management, systems for accountability and

responsibility, formal audit and to minimise risks, undertake investigations and learn lessons from adverse events.

The Chief Executive

- Overall responsibility for the fulfilment of the relevant statutes.

- Advising the Trust Board on the review of existing policy arrangements and allocation of resources to implement health and

safety procedures.

- Referring matters of a critical nature to the Trust Board for resolution and ensuring that adequate safety arrangements exist

within the Trust.

- Responsible for the safety of all workers.

Lone Working Policy


11


Executive Directors

- On behalf of the Chief Executive, the Director of Nursing, takes lead responsibility for Local Security Management across the Trust and will be the nominated Security Management Director (SMD) liaising with the Counter Fraud Security Management

Services (CFSMS).

- The SMD will be responsible for:

- Ensuring that appropriate security management provisions are made within the NHS organisation to protect lone working

staff.

- Ensuring that measures to protect lone workers complies with all relevant health and safety legislation, Secretary of State

Directions and takes into account NHS SMS guidance.

- The protection of lone workers by gaining assurance that policies, procedures and systems to protect lone workers are

implemented.

- Raising the profile of security management work at board level and getting their support and backing for important security

management strategies and initiatives.

- The nomination and appointment of a Local Security Management Specialist (LSMS) and through continued liaison to ensure that security management work including the protection of lone workers is being undertaken to the highest standard.

- Overseeing the effectiveness of risk reporting, assessment and management processes for the protection of lone workers. Where there are foreseeable risks, the SMD should gain assurance that all steps have been taken to avoid or control the

risks.

- In conjunction with the other Executive Directors ensuring the provision of training, guidance and support to managers on the implementation of this policy.

- Ensuring that systems exist to maintain records of accidents and dangerous occurrences and the reporting of incidents involving violence or aggression to HSE where appropriate. This includes notification to the HSE incidents reportable under

The Reporting of Diseases and Dangerous Occurrence Regulations 1995 (RIDDOR) and incidents reportable to the CFSMS.

- Ensuring that employees who have been involved in a violent or aggressive situation are fully supported and assisted in any

subsequent civil claim or application for Criminal Injuries Compensation provided that they were performing their authorised

duties in the course of their employment.

- Lone working incidents within the Trust are considered at the Health & Safety committee and significant concerns are then

reviewed at the Quality and Safety Steering Group.

Lone Working Policy


12


Clinical Directors, Divisional Directors

- All Directors are responsible for ensuring that for each service and department within their directorate they:

- Ensure that risk assessments are carried out to identify the likelihood of a violent or aggressive situation occurring and that

such situations are reduced or minimised by devising control strategies and risk management. Such risk assessments not only consider clinical issues but also environmental, procedural and practice issues.

- Develop control measures including robust risk management and safe systems of work are implemented in accordance with

health and safety risk assessments.

- Complete adverse incident forms (DATIX) in accordance with the Incident Reporting Policy.

- Report incidents reportable under RIDDOR to the Head of Health and Safety without delay either by telephone or email followed by the electronic RIDDOR report on the Trust’s intranet.

- Ensure systems are in place to disseminate information on risk management measures and responsibilities to all relevant staff.

- Monitor the implementation of this policy and provide support for line managers to ensure that their responsibilities are met.

- Local arrangements that support this policy are devised and reviewed.

Lone Working Policy


13


Divisional Managers / Service Manager /Ward /Team Managers

- Each Divisional Manager/Service Manager has key responsibilities to:

- Ensure, within their area of responsibility, that this policy is complied with and that employees are sufficiently aware of and

conversant with this policy to perform their duties.

- Ensure that risk assessments are carried out to identify the likelihood of a violent or aggressive situation occurring and that

such situations are reduced or minimised by devising control strategies and risk management. Such risk assessments not

only consider clinical issues but also environmental, procedural and practice issues including:

- assessing the level of training provided to staff;

- assessing communications with other teams, outside agencies and within the team to ensure that accurate, contemporaneous and relevant risk information is relation to clinical risks;

- ensure all staff are aware of the arrangements to fulfil this policy

- monitor and review arrangements in consultation with staff so that the local procedures can be reviewed effectively

- assessing the response to emergency situations, i.e. when a lone worker fails to return from a visit, response to building

alarms, response to mount a MAPA response team etc.;

- assessing the environment for factors which inhibit best practice i.e. vision, audibility, staff call alarms, patient to nurse call

alarms, colour of decorations and furnishings, noise levels, signage and information, sources of potential weapons, dead end corridors, security, doors and interview spaces, assessing lone worker situations including escorting of service users on or off

a hospital site.

- Ensure that all new employees are made fully aware of local lone working procedures, as soon as is practicable, following

their appointment.

- Investigate violent or aggressive incidents taking action to avoid a recurrence, whilst supporting employees and directing them to the appropriate support agencies ensure that assessment and control measures are reviewed, clearly documented

and amended in an appropriate format where necessary.

- Ensure that the training needs of all Trust employees in their department are identified and that these needs are addressed.

- Ensure that employees are provided with supervision, information, instruction, education and training as is necessary on the

likely risks and precautions that may be required and are provided with the opportunity to attend appropriate training identified through appraisal processes and required by this policy.

- Ensure all visiting and escorting staffs are provided with the necessary equipment that has been identified from the risk assessment.

- The Integrated Governance Department will report all RIDDOR incidents to the Health and Safety Executive on receipt of a Datix incident notification. Ensure that employees are supported if they have responded in any way they believed as

appropriate during an incident. Inappropriate action may be seen as a sign of a training and development need.

- Ensure that employees are able to take time from their work to attend such counselling as the Trust Occupational Health or Staff Support Service deems necessary. It should be recognised that counselling may be necessary not just for those people

who have experienced or observed a one-off violent or aggressive situation where injury may or may not be apparent but also for those who have suffered exposure to prolonged violence and aggression not characterised by a single event.

Lone Working Policy


14


All Employees

- All employees are responsible for:

- Carrying their ID Badge and being prepared to identify themselves in line with Trust Policy;

- Informing their Line Manager of all activities which they feel have increased the level of risk from exposure to hazards when

lone working;

- Providing their line manager with up to date personal details, vehicle details and next of kin contact details;

- Ensure that any relevant information obtained personally or from other agencies/partners is disseminated accordingly using

the Trust systems and recording mechanisms in place;

- Assisting their line manager in carrying out assessments and the development of safe systems of work for lone working

activities;

- Comply with signing in/out arrangements from other sites whether Trust or non-Trust;

- Comply with all mandatory training requirements for their individual role;

- Reporting all incidents including near misses from lone working activities on the Trust’s Incident Report Form;

- Using all information, safe systems of work and equipment provided by the Trust to minimise risk when lone working;

- Ensuring they do not put themselves or others at risk when lone working.

- Ensure that they familiarise themselves with any alarm system within the premises in which they are working;

- Informing their line manager of any personal issues or health problems which may increase the level of risk from exposure to hazards when lone working.

Other Lone Workers

- All those who are working within the control of or under supervision of Trust employees are responsible for:

- Advising their supervisor or contact of any issues relating to hazards and risks when working alone;

- Following all safe systems of work and utilising any equipment provided to minimise the risk of working alone;

- Reporting any incidents or near misses to their supervisor or contact with regards to lone working.

Health & Safety

- Health & Safety with support of the LSMS is responsible for:

- Providing best practice advice and guidance to Line Managers and lone workers;

- Providing advice on information, instruction and training in relation to lone working;

- Researching and reviewing technological advances for lone working solutions and advising on their suitability.

Lone Working Policy


15

8.0 Training Staff working for the BCPFT should know that their safety comes first. Staff should be aware of how to deal with situations where they feel they are at risk, or unsafe. Staff should also be able to recognise how their own actions can influence or even trigger an aggressive response.

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?

Managers will ensure that all lone workers’

training needs are assessed and that they

receive appropriate

training for example: Verbal and non-

verbal

communication skills

Conflict Resolution

Training

Personal

safety/security Care and

responsibility skills

First Aid training

Medical devices

equipment, including Lone

worker protection devices, manual

handling

equipment Health and safety

awareness

Diversity and

equality

All identified lone workers

No, staff will receive specific training in relation to this

policy where it is identified in their individual training needs

analysis as part of their

development for their particular role and

responsibilities

E-Learning modules and face to face where

appropriate e.g. first aid training (see First Aid

policy for training

requirements)

Self-delivered through E-Learning

As and when required –

determined by expiry of E-

Learning

module

Managers/ Learning and Development Team

Lone Working Policy


16

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 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

Copies of Lone working

assessments (domiciliary or

non-domiciliary) retained on personal files provide

evidence of management compliance against this

Random Sample Survey Health and Safety

Manager

Annually Health and Safety

Committee

Health and Safety

Committee

Minutes of

meetings /

Action plans signed off

mailto:[email protected]

Lone Working Policy


17

policy

Lone Working Policy

Version 1.1 June 2018 18

Appendix 1

Safety Tips

Before the visit/task All staff should check on the Electronic Patients System (OASIS) if the client is known to the service prior to a first time visit. All staff should have access to this information and this information should be effectively communicated to other service providers visiting the same client. Each department should keep a record of initial risk assessments carried out on a first time visit. A suitable assessment must be made in relation to the initial visit considering information from internal systems and other agencies. This assessment will enable staff to correctly identify whether there are any potential hazards i.e. dangerous pets, history of violence in the house hold, risky area etc. and the number of staff required to complete the visit safely. If there are risks known by the psychiatric services not identified by the GP then this information will be fed back to psychiatric services, the GP and other agencies providing a service to the client as a two way process. Guidance is available from the “Violent Patients Scheme” (marker to be added to OASIS) for high risk visits. “Where there is a history of violence and/or the patient/service users location is considered high risk, the Lone/community Worker must be accompanied by a colleague, by a security officer; or, in some cases by the police; and; Where possible, the visit should take place in a neutral location or within a secure environment.

An assessment should be made as to the suitability of lone visits to a particular household or area.

For evening/night time visits staff should always work in pairs and wherever possible re-schedule the visit to daylight hours.

Before going out check that batteries in personal attack alarms and mobile telephones are fully charged and that the equipment is in good working order.

If access to a mobile phone is restricted, make sure you have change to use a public telephone.

Ensure that your car is road worthy, the lights are working properly and there is sufficient fuel in the tank.

During the Visit

Always drive with the car doors locked.

Avoid parking in isolated or poorly lit locations.

Ensure that you do not park in a confined space or area where you could be blocked in. Always park so that the vehicle can be driven away without first having to reverse or manoeuvre.

Before the start of your journey always lock property in the boot of your car. Never leave anything on display. When vacating your car ensure all windows and doors are secure

Set car alarm

Lone Working Policy


Do not stop for strangers or if you see someone broken down. If you see an accident do not stop to assist it could be hoax. Wait until you come to a telephone and call the police.

Make sure you are at the correct address and take particular care when entering high rise flats.

Staff should always carry their official ID card.

If the patient has a dog or other pet, which may make the member of staff uncomfortable or nervous, the member of staff should contact the client before the visit and ask for the pet to be secured during the visit.

If it has been identified from the risk assessment that the client is a smoker staff should contact the client before the visit to ask if they could refrain from smoking during the assessment or could a room be used where they have not been smoking for the duration of the assessment.

In the event of the patient or other persons present becoming violent or aggressive during the visit, staff should leave immediately and notify their base. In appropriate cases, the police should be notified together with the LSMS.

If alone and apprehensive about a particular location or situation do not go in, request assistance or drive to the nearest police station or other public area if the circumstances warrant it. Always trust your instincts.

After the Visit

Upon completion of the visit, report back to base or contact point in line with locally agreed methods or frequency.

Have vehicle keys to hand to enable quick prompt entry and lock vehicle once entered to prevent unauthorised access.

If a person ‘of concern’ is noted within the vicinity of the vehicle, return to a populated area and request assistance.

If upon entry to a vehicle an unauthorised person enters the vehicle, staff members are advised to immediately exit the vehicle and request assistance or return to a populated area.

If upon entry, following the locking of the vehicle, a person of concern approaches the vehicle, only manoeuvre away if safe to do so. If it is not possible to manoeuvre staff should alert others of the situation by way of mobile phone or the sounding of the horn.

Report any damage to vehicle or other appropriate incident to the police immediately

Any adverse incident to staff member or vehicle should be reported as soon as practicable on the incident reporting system. If theft or damage to vehicle full details of vehicle, including make registration number, owner etc., together with estimate of loss to be entered on the incident form.

Other agencies involved e.g. social services etc., must also be informed.

Lone Working Policy


Appendix 2

Lone Worker Risk Assessment Checklist

This checklist is designed to assist you in making a full risk assessment where you think it might involve a degree of risk to yourself or others. It is designed to provide a reminder to some of the issues that may exist. It is a guide and should not be regarded as an exhaustive or definitive list. Please expand on any issue relevant to your work. Significant findings should be recorded on the risk assessment below template below. ADDRESS OF HOME VISIT: …………………………………………………………... NAME OF CLIENT TO BE / BEING VISITED: ……………………………………….. NAME OF ASSESSOR (Block): ………………………………………………………. JOB TITLE/GRADE: …………………………………………………………………….. SIGNATURE: …………………………………… DATE: …………………………...

Working Alone Assessment Yes No Don’t know or N/a

1.

As part of your job do you ever have to work

a. On your own in the community?

b. On your own visiting other employers‟ premises?

c.

In isolation from others at the workplace?

d.

In isolation from others out of the workplace?

e.

On your own at home?

2.

If you answered yes to any of the above, do you work like this:

a.

All of the time?

b.

Most of the time?

c.

Some of the time?

d. At certain periods of the day/night or week?

Or, do you work like this:

a.

As a normal part of your job?

Lone Working Policy


b. Because of staff shortages?

3. If you work alone away from base:

a. Is your daily itinerary known at base?

b. Is there a procedure for reporting in?

4. Have you been given information and training about the health and safety risks of your job and the preventative measures in place, for example:

a. How to lift safely?

b. How to use equipment safely?

c. How to use chemicals safely?

d. How to avoid infection hazards?

e. What to do if a violent incident occurs?

5. Have you been given information and training about what to do in an emergency?

6 If you work at a fixed location but in isolation from others:

a. Is there a procedure for checking in and out?

b. Have you been given information and training about the safety risks of your job and the precautions in place?

c. Is there any means of raising the alarm or calling for assistance?

7. If you work on your own at home

a. Has your workstation been assessed by your employer and proper equipment provided?

b. Have you been given information and training about the health and safety risks of RSI from excessive keyboard work or prolonged awkward postures and the need to take frequent breaks?

c. Are there procedures for keeping in regular contact with your work base so that you don’t feel isolated and suffer stress?

d. Do you know what to do if things go wrong?

Risks/shortfalls identified

Lone Working Policy


Control to be/implemented to manage risks/shortfalls

Name of Service: ………………………………………………………………………………………………………………..

Service Manager Name (Block): ………………………………………………………………………………………….

Signature: …………………………………… DATE: ………………………….......

Lone Working Policy


LONE WORKING (NON DOMICILLARY) RISK ASSESSMENT

SECTION A: Screening Q1. Is the person expected to work in isolation from colleagues? Yes/No* If ‘yes’ go to section B. If ‘No’ go to Q2. Q2. Does the person regularly decide to work at the main base alone? Yes/No* If ‘yes’ go to section B. If ‘No’ the assessment need go no further. (A copy of this assessment should be retained on personal file until a re-assessment identifies any change or additional risks.)

SECTION B – Risk Assessment. Comment and remedial action

Can one person adequately control the risks of the job?

Does the workplace present a special risk to the lone worker?

Is there a safe way in and out for one person? Can any temporary access equipment which is necessary, such as ladders or trestles, be safely handled by one person?

Can all the plant, substances and goods involved in the work be safely handled by one person? Consider whether the work involves lifting objects too large for one person or whether more than one person is needed to operate essential controls for the safe running of equipment

Is there a risk of violence?

Are women especially at risk if they work alone?

Are younger workers especially at risk if they work alone?

Is the person medically fit and suitable to work alone?

What training is required to ensure competency in safety matters? Training is particularly important where there is limited supervision to control, guide and help situations of uncertainty. Training may be critical to avoid panic reactions in unusual situations.

What can and cannot be done while working alone?

Lone Working Policy


How will the person be supervised? Procedures will need to be put in place to monitor lone workers to see they remain safe. These may include:

Supervisors periodically visiting and observing people working alone

Regular contact between the lone worker and supervisor using either a phone or radio

Automatic warning devices which operate if specific signals are not received periodically from the lone worker, e.g. systems for security staff

Other devices designed to raise the alarm in the event of an emergency and which are manually or automatically operated by the absence of activity

Checks that a lone worker has returned to their base or home on completion of a task

What happens if a person becomes ill, has an accident, or there is an emergency?

SECTION C - OVERALL ASSESSMENT OF RISK

Q. What is your overall assessment of the risk of injury? Very Low (Green); Low (Yellow); Moderate (Amber); High (Red)* (See Appendix 4) Moderate (Amber) and High (Red) risk(s): Complete Section D Very Low (Green) and or Low (Yellow) risk(s): Retain a copy of this assessment. No further action is required unless or until the assessed risk changes and a re-assessment is required.

Lone Working Policy


SECTION D – REMEDIAL ACTION (FOR MODERATE (AMBER)/ HIGH (RED) RISKS ONLY:

Q. What remedial steps should be taken in order of priority?

I. …………………………………………………………………………………… II. …………………………………………………………………………………… III. ……………………………………………………………………………………

SUMMARY OF ASSESSMENT

Personnel involved:……………………….. ………………………………………………. ………………………………………………. Location:……………………………………. ………………………………………………. ………………………………………………. Activity:……………………………………… ………………………………………………. ……………………………………………….

Overall priority for remedial action: Low/med/high* Remedial action to be taken;…………………. …………………………………………………… …………………………………………………… date by which action is to be taken:………….. date of assessment:……………………………. date of reassessment:…………………………. Assessors name:……………………………….. Sign:………………………………………………

Person responsible for assuring assessment is actioned:………………………………………. Staff member’s signature: ……

` *circle as appropriate Discuss findings of the risk assessment with all persons at risk. Agree priorities for action. Once controls have been implemented, what is your overall assessment of the risk of injury? Very Low (Green)/Low (Yellow)/Moderate (Amber) / High (/Red)* (See Appendix 4) Amber and red risk will need looking at again at frequent intervals to manage; the residual risk may be unacceptable

Lone Working Policy


Appendix 3

Risk Assessment Checklist to Assist Home Visits

This checklist is designed to assist you in making a full risk assessment where you need to undertake a home visit which you think might involve a degree of risk to yourself or others. It is designed to provide a reminder to some of the issues that may exist. It is a guide and should not be regarded as an exhaustive or definitive list. Please expand on any issue relevant to your work. Significant findings should be recorded on the risk assessments provided below. ADDRESS OF HOME VISIT: …………………………………………………………... NAME OF CLIENT TO BE / BEING VISITED: ……………………………………….. NAME OF ASSESSOR (Block): ………………………………………………………. JOB TITLE/GRADE: …………………………………………………………………….. SIGNATURE: …………………………………… DATE: …………………………...

Risk Assessment Checklist to assist home visits

Yes No Don’t know or N/a

1.

Have you undertaken Conflict Resolution Training? If yes give date: - ……………………………

2.

Are you aware of the need to gather all the available information about the client in advance of the consultation from all relevant agencies and healthcare professionals and pre-viewing the case?

3.

Have you gathered the information relating to this client from the appropriate healthcare personnel to enable you to make a suitable and sufficient assessment of the risks?

4.

When you are working at a location that is not your normal work base does your work base know where you are and when you will return

5.

Would your base know what to do if you failed to return

6.

Would you be confident that this procedure would be effective

7.

Is your base continually manned so as to be able to react in the event of you either raising an alarm or your failure to either return or make contact by due time

8.

Would staff at your base recognise changes to your normal work pattern and be concerned to raise an alarm

9.

Are these emergency arrangements periodically tested to ensure that they actually operate

10.

Do you only meet clients on home visits that you or close colleagues have met on at least one occasion

11.

Is there a need to report back to base on arrival at the home

12. Is there a need to report back to base on departure from the home

Lone Working Policy


13.

Do you have direct access to a telephone to summon assistance in difficult situations

14.

Do you have arrangements that use “Codewords” to indicate difficulty without arousing suspicion

TRAVEL TO THE VISIT and PARKING

15. Does your base know the details of your car

16. If you temporarily change car do they know the details

ON ARRIVAL

17. Do you note as you enter the lock /door handle arrangement to aid a rapid exit if the need arises

18. Are you ever left alone in the house with a client

REPORTING BACK TO BASE

19. Do you always report back to base any variation to your itinerary

20. Do you always report back to base at the end of the shift (to stand down the watching- over arrangements)

INCIDENT REPORTING

21. Have you been involved in an incident in the last 12 months, if so how many occasions ……………

22. Did you report these incidents to your manager

23. Do you complete an incident report on Datix for all incidents that occur

24. Are concerns that you bring to your line managers attention acted upon

25. Are concerns arising from such incidents communicated to other healthcare personnel to assist them in forming adequate pre-visit assessment (as you needed in questions 3 and 4)?

Risks/shortfalls identified

Lone Working Policy


Control to be/implemented to manage risks/shortfalls

Name of Service: ………………………………………………………………………………………………………………..

Service Manager Name (Block): ………………………………………………………………………………………….

Signature: …………………………………… DATE: ………………………….......

Lone Working Policy


LONE WORKING (DOMICILLARY) RISK ASSESSMENT

SECTION A – screening Q1. Are you expected to work in isolation from your colleagues in the community? If ‘yes’ go to section B. If ‘No’ go to Q2. Yes/No* Q2. Is there any evidence from a previous visit, Trust records or other agencies that suggest that the visit will pose hazards?

Yes/No* If ‘yes’ go to section B. If ‘No’ the assessment need go no further.

SECTION B – AFTER COMPLETING THIS SECTION GO TO SECTION C

Comment and remedial action

Environmental hazards: (consider both external and internal).

Dark alleyways, tower blocks, where to park car safely.

Does the level of lighting, heating, electrics pose a hazard?

Is there suitable seating for staff and patients?

Do pets pose a threat?

Home hygiene? Adequate

Poor

The patients or others in the home:

Patient hygiene? Adequate Poor Is the patient mobile? Is a manual handling patient risk assessment required? Yes/No Violence and aggression (including sexual harassment):

If YES, have they been reported via the incident reporting

Lone Working Policy


Have staff been subject to physical or verbal abuse from the client, client’s family or friend.

system and to the rest of the team?

Lone worker: Is the person medically fit and suitable to work alone?

What can and cannot be done while working alone? Any dos and don’ts?

Supervision of lone workers: Procedures will need to be put in place to monitor lone workers to see they remain safe. These may include:

Regular contact between the lone worker and supervisor using either a phone or radio

Automatic warning devices which operate if specific signals are not received periodically from the lone worker, e.g. systems for security staff

Other devices designee to raise the alarm in the event of an emergency and which are manually or automatically operated by the absence of activity

Checks that a lone worker has returned to their base or home on completion of a task

What happens if a lone worker becomes ill, has an accident, or there is an emergency?

SECTION C - OVERALL ASSESSMENT OF RISK

Q. What is your overall assessment of the risk of injury? Very Low (Green); Low (Yellow); Moderate (Amber) High (Red)* Moderate (Amber) and High (Red) risk(s): Complete Section D Very Low (Green) and or Low (Yellow) risk(s): Retain a copy of this assessment. No further action is required unless or until the assessed risk changes and a re-assessment is required.

Lone Working Policy


SECTION D – REMEDIAL ACTION

Q. What remedial steps should be taken in order of priority? IV. …………………………………………………………………………………… V. …………………………………………………………………………………… VI. ……………………………………………………………………………………

SUMMARY OF ASSESSMENT Personnel involved:……………………….. ………………………………………………. ………………………………………………. Location: (cclients name, address, DOB) ………………………………………………. ………………………………………………. ………..……………………………………… ………………………………………………. Activity:…………..………………………….

Overall priority for remedial action: Low/med/high* Remedial action to be taken;…………………. …………………………………………………… …………………………………………………… date by which action is to be taken:………….. date of assessment:……………………………. date of reassessment:…………………………. Assessor’s name:……………………………….. Sign:………………………………………………

Person responsible for assuring assessment is actioned:………………………………………. Staff members' signature …

*circle as appropriate Discuss findings of the risk assessment with all persons at risk. Agree priorities for action. Once controls have been implemented, what is your overall assessment of the risk of injury? Very Low (Green); Low (Yellow); Moderate (Amber); High (/Red) Moderate (Amber) and High (Red) risks will need looking at again, the residual risk may be unacceptable

Lone Working Policy


Appendix 4

Table 1 Consequence scores

Choose the most appropriate domain for the identified risk from the left hand side of the table Then work along the columns in same row to assess the severity of the risk on the scale of 1 to 5 to determine the consequence score, which is the number given at the top of the column.

Consequence score (severity levels) and examples of descriptors

1 2 3 4 5

Domains Negligible Minor Moderate Major Catastrophic

Injury /Harm to staff

Minimal, no intervention or treatment needed. No absence.

Minor, first aid treatment required. Less than 3 days absence

Injury/Harm necessitating medical treatment. Resulting absence of between 4 and 14 days. RIDDOR reportable incident

Serious injury resulting in long term disability /incapacity. Absence greater than 14 days.

Significant /multiple injuries resulting in permanent disability/irreversible ill health, or death

Table 2 Likelihood score (L)

What is the likelihood of the consequence occurring?

The frequency-based score is appropriate in most circumstances and is easier to identify. It should be used whenever it is possible to identify a frequency.

Likelihood score 1 2 3 4 5

Descriptor Rare Unlikely Possible Likely Almost certain

Frequency How often might it/does it happen

Will only occur / recur in rare or exceptional circumstances. Less than 5% chance of it happening

Would not expect it to occur / recur, but it is possible it may do so Less than 10% chance of it happening

Can expect this to occur / recur occasionally, Between 11% - 49% chance of it happening

Can expect this to happen / recur but it is not a persistent issue 50 50 chance of it happening

Undoubtedly will happen recur frequently In more than 9 out of 10 times

Table 3 Risk scoring = consequence x likelihood ( C x L )

Likelihood

Likelihood score 1 2 3 4 5

Rare Unlikely Possible Likely Almost certain

5 Catastrophic 5 10 15 20 25

4 Major 4 8 12 16 20

3 Moderate 3 6 9 12 15

2 Minor 2 4 6 8 10

1 Negligible 1 2 3 4 5

For grading risk, the scores obtained from the risk matrix are assigned grades as follows

1 - 5 Very Low 6 - 9 Low

10 - 15 Moderate

16 - 25 High

Lone Working Policy


Appendix 5

Lone worker incident actions flowchart

Incident occurs If NHS organisation uses the NHS lone worker service, the activity

below is triggered The lone worker:

1. activates lone worker alarm device if issued 2. removes themselves from the

situation/environment to a place of safety 3. contacts:

(a) police (b) manager/buddy

5. The lone worker returns to work base as soon as practicable to complete an incident report form or a serious untoward incident form.

6. If a physical assault, a completed

DATIX form is submitted.

7. The line manager initiates a post- incident review in conjunction with

risk, health and safety and LSMS.

Post-incident review process begins – including:

o medical review (consultant/doctor) o LSMS investigation o security review (LSMS) o quantifying/regulating (risk

management) o counselling/support as appropriate to

employee or other individuals affected by incident

o following up on all witnesses to the incident.

o conduct risk assessment.

Review process also provides feedback on processes/systems in place, identified weaknesses and lessons learned.

Lone worker device activated

for a genuine alarm

Alarm receiving centre (ARC) operator monitors the incident. A recording is made and the lone worker’s location is identified.

ARC operator conducts a full risk assessment of the incident and takes appropriate action, following the pre-determined escalation path.

If risk is severe, they contact the emergency services.

The LSMS listens to the recording. If no action by the police has been taken, the LSMS will, if necessary, take appropriate action to progress criminal, civil or local sanctions in conjunction with the police and Crown Prosecution Service.

For information If incident was a false alarm (i.e. accidental activation):

1. recording is closed with user’s agreement

2. record is deleted.

Lone Working Policy


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

V1.1 June 2018 Reviewed by Policy Lead with minor Amendments.

V1.0 Aug 2014 Alignment of policies following TCS.

Title of Policy Lone Working Policy

Unique Identifier for this policy BCPFT-ORG-POL-0814-060

State if policy is New or Revised Revised

Previous Policy Title where applicable n/a

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

Organisational

Executive Director whose portfolio this policy comes under

Executive Director of Nursing, AHPS, Psychology and Quality

Policy Lead/Author Job titles only

Local Security Management Specialist

Committee/Group responsible for the approval of this policy

Health and Safety Committee in conjunction with the Policy Ratification

Month/year consultation process completed *

n/a

Month/year policy approved June 2018

Month/year policy ratified and issued July 2018

Next review date July 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

lone working - bcpft.nhs.uk

Documents