Lone Worker Policy

November 2014

FAMILY NURSING & HOME CARE RATIFICATION FORM

Type i.e. Strategy, Policy, Policy Education Package etc.

Name Lone Worker Policy

Category Organisational

i.e. organisational, clinical,

Corporate, Finance etc

Version 1.3

Author Jane Le Ruez Lane

Approved by Julie Gafoor i.e. Operational

Governance Group

Date Approved 06/11/14

Review Date 06/11/17

Person responsible for Patient Safety Facilitator

review

Approved by i.e.Sub

Committee, H&SS

Policy Amendments

Version No. Amendments

Copy of this form to be given to Information Governance Officer

1.0 Statement of Intent

This procedure relates to all staff at Family Nursing & Home Care 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:

Raising awareness of safety issues relating to lone working

Ensuring lone working is risk assessed in an appropriate and dynamic way and that safe systems and methods of work are put in place to reduce risk, so far as is reasonably practicable.

The availability of appropriate staff training to equip them to recognise risk and provide practical advice on safety of working alone, including how to use technology provided.

Organisational structures, defined roles and responsibilities, communications, links, and support in place to help lone workers if they need assistance.

Full reporting and recording of any incidents relating to lone working

Reducing incidents of violence and abuse and injuries to staff relating to lone working

2.0 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 Organisation 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 reasonably practicable. The protection of lone workers is in accordance with the Directions to health bodies on measures to deal with violence against NHS staff and Directions to health bodies on security management measures, 2003 and 2004 respectively and as amended 2006.

3.0 Scope/Responsibility

The Organisation

The Organisation have overall responsibility for the security; safety and welfare of all

staff including lone workers by ensuring arrangements are in place to control the

risks

The organisation is also responsible for ensuring that there are resources available

for putting this policy into practice, including resources deemed necessary following

risk assessment and that arrangements are in place for monitoring the effectiveness

of this policy and that they are regularly reviewed.

In addition the organisation is responsible for exercising the organisation’s right to

withdraw, adapt or limit services when risks have been identified as unacceptable

(refer to ‘withdrawal of service procedure’) and to support requests for equipment

and other resources deemed necessary following risk assessment.

All Departmental Senior Managers are responsible

for; ensuring lone worker risk assessments are

undertaken lone worker policies and procedures are

introduced; safe systems of work are adopted; ; Training is available; Training attendance records are kept ensuring statutory compliance; accident incident reporting; communication; support; liaison; and audit within their service (Quality Assurance Standards 4, 7, 9, 13,16)

Line Managers/Caseload holder

The line manager has a responsibility to ensure that all relevant policies and

procedures are implemented and disseminated to lone working staff for

which they are responsible. They must ,as far as is reasonably practicable, ensure that the staff are

appropriately protected before entering a lone working situation through robust risk management processes and appropriate control measures introduced to reduce risk . Risk assessment must be shared with other service providers to promote safety

Agree a “minimum data set” that would be carried out on first admission. This would include a “Staff Safety Checklist for Community Visits” to be kept with the base card in the office See guidance to completing the Form (appendix 1) in the Guidance Section

These control measures will include ensuring that lone workers receive sufficient information, lone worker training, instruction and advice. The line manager must also ensure that any necessary physical measures are put in place, appropriate technology is available where this is reasonably practicable, and where the safety of lone workers is threatened, that alternative arrangements are made.

Regular reviews of arrangements should be overseen by the line manager /caseload holder to ensure that all measures are effective and continue to meet the requirements of the lone worker.

Identified risks must be entered on the Divisional risk register

When an incident occurs, the line manager should ensure that the employee involved completes an incident reporting form as soon as possible, in line with local policy. They should also make sure that the incident is reported to the relevant manager for follow-up action, including, where appropriate, contact with the police.

If someone is assaulted, threatened or otherwise intimidated the line manager should make sure that the individual has access to appropriate medical care and psychological care and that the police have been notified and that a manager is with the individual should a statement be required. They also require a list of relevant contacts so that they can be referred to the relevant person (e.g.occupational health, staff support network, counselling or psychological services). This is to ensure that they undergo a debrief and a physical assessment, that any injuries are documented and that they receive access to proper post-incident support.

After an incident, the risk assessment should be revisited as soon as possible, the adequacy of existing control measures reviewed and the divisional risk register updated accordingly. This should take place before carrying out a formalised investigation, reviewing lessons learned and taking appropriate action taken to try to prevent a recurrence.

The Organisation’s Occupational Health Provider, will provide support and

counselling to any member of staff and for assessing their fitness to work.

Staff who are Lone Workers The lone worker must;

Attend relevant induction and training, which will be held 6 monthly, to enable them to plan appropriately, risk-assess before a visit and undertake continuous dynamic risk assessment of the situation they find themselves in, being aware of any changing circumstances and taking necessary action to minimise the possibility of an incident occurring.

Complete staff safety form on first admission and liaise with other service providers regarding any identified risks

Under no circumstances put themselves at avoidable risk. If a situation arises that staff feel that their safety is in question, they should withdraw and seek and follow advice from their manager.

Undertake all relevant training where appropriate.

Report any incidents including threats and potentially dangerous situations using the ‘accident/incident/near miss reporting’ and ‘environmental assessment procedure’ (see section one)

Risk assess any potential areas of concern and share this with other service providers.

Utilise dynamic risk assessments during the visit which will further protect staff on future visits.

In 1998 the Home Office and fire service produced operational

guidance on dynamic risk assessment. This guidance defines dynamic assessment as the "continuous assessment of risk in the rapidly changing

circumstances of an operational incident, in order to implement the

control measures necessary to ensure an acceptable level of safety".

4.0 Risk Assessment The key to risk assessment is to identify hazards, understand how and why incidents occur in lone working situations and learn from that understanding to make improvements to controls and systems to reduce the risk to the employee. To achieve this, the following factors should be considered and documented:

type of incident risk (e.g. physical assault/theft of property or equipment) frequency/likelihood of incident occurring and having an impact on individuals, resources and delivery of patient care

severity of the incident: cost to the healthcare organisation in human and financial terms

confidence that the necessary control measures are in place or improvements are being made

the level of concern and rated risk

what action needs to be taken to ensure that improvements are made and risks reduced.

5.0 Training

All staff must attend training and updates in risk assessments and safety procedures,

including fire and manual handling as set out in the training programme (refer to

‘mandatory training procedure’).

Training will be mandatory for all staff who come into contact with potentially

challenging situations

This training includes new and existing staff. Compliance of the core staff group is

95% as per NHSLA guidance.

Lone workers will attend Conflict Resolution Training & Challenging Behaviour to enable

them to carry out their duties in a positive, confident, caring and safe manner, and be

able to recognise, de-escalate and manage potentially violent situations.

Conflict Resolution training for lone workers will include modules covering risk

assessment, disengagement techniques, de-escalation techniques and post-incident

support.

Lone Worker training will be scenario-based specifically for lone workers and include

the use of any Lone Worker device which will be provided.

All managers working with staff who are Lone Workers will receive training in

“Managing Lone Workers”

6.0 Technology

Technology should not be seen as a solution in itself. Consideration must be given to the legal and ethical implications of its use, as well as to its limitations.

The Clinicians and Managers will take responsibility for ensuring that technology

is used appropriately and effectively and that it is proportionate to the problem it is

intended to address.

Examples of technology used within FNHC in relation to Lone Workers

includes:-Mobile phone

Tetra Radios Personal panic attack alarms CCTV

The successful introduction of a lone worker alarm system relies on staff utilising

these systems.

7.0. References:

This policy has been adapted from the Draft HSSD Lone Worker Policy & FNHC lone

worker policy 200

Secretary of State Directions to Health Bodies on measures to deal with violence against NHS staff 2003 Directions to Health Bodies on Security Management Measures 2004 Directions to Health Bodies on Security Management Measures amended 2006 Health & Safety at Work Jersey Law 1989

Appendix 1

FNHC STAFF SAFETY CHECKLIST FOR COMMUNITY VISITS

1. INTRODUCTION All employers have a legal duty to assess the risks arising from work activities that may affect employees or others. The purpose of a risk assessment is to identify sources of potential harm and the likelihood and consequences of such harm occurring and recommend prioritised, preventative measures to be implemented. This process requires a judgement to determine whether the planned or existing control measures are adequate. The intention is that risks should be controlled before harm can occur.

Under Health & Safety Law, a risk assessment should be completed in every workplace, this includes every domestic residence where FNHC staff will work.

However, staff who work in patients' homes have less control over their working environment than staff who work in FNHC or other premises. Therefore, the purpose

of the Staff Safety Checklist for Community Visits is to help staff identify significant

risks that need to be shared with other members of the team, or other agencies, and to identify where action should be taken to reduce or manage the risk/s effectively.

Staff carrying out the assessment must be sensitive to the fact that they are

assessing someone’s home; the patient, their family and carer, should be advised

that an assessment will be carried out, and they should be encouraged to be

involved. However, the Assessor should consider whether there are certain issues

that it would be better not to discuss in the home environment (e.g. threats of

violence and aggression). 2. THE PROCESS OF RISK ASSESSMENT

The Staff Safety Checklist for Community Visits is focused on individual patient homes and circumstances and has been designed as a self-contained form.

For Community teams not already using the Checklist the implementation plan

should be to use the Checklist for all new patients and to complete a Checklist for

any existing patients where there are known risks.

2.1 STEP 1 - COMPLETE THE FORM

For each patient complete the whole of the Staff Safety Checklist for Community

Visits on your first visit and detail, on the back of the form. The shaded boxes on the

Checklist highlight a risk and the control measures for these risks should be

documented on the back of the form.

Use the Checklist to identify significant risks - each Team should agree what

constitutes a significant risk. If the risks cannot be eliminated or reduced to an

acceptable level with the existing control measures document on the back of the form

what further action is required to reduce the risk to an acceptable level. Discuss

these risks with your line manager who will explore and agree with the Team the

available options, which may include the re-siting of care.

Question 10 enables any risks that are not contained on the Checklist to be

documented on the back of the form.

Community assessments may identify risks that staff or the organisation have no control over e.g. in relation to building access. However, it is still important that these

risks are identified, recorded and the information on the risks and existing control

measures made available to staff who may visit the patient or property. If the assessment process indicates that these risks are unacceptable the community staff

must discuss this matter immediately with the line manager and explore the options available e.g. re-siting of care etc.

It is good practice to share the information on the Checklist with the patient, however,

the organisation acknowledges that there may be times when the sharing of the

information may exacerbate a situation and increase the risk to the member of staff.

Therefore the sharing of the information contained on the Checklist with the patient

or carer is left to the discretion of the member of staff.

The form will be returned to base and kept with the patient’s base card.

2.2 STEP 2: DEVELOP LOCAL PROCEDURES

The community nursing teams will have an agreed system in place for filing the

assessments so that they are accessible to their colleagues should they have to

attend the patient's house. All identified risks, and their control measures, must be

communicated to colleagues who may be covering for annual leave or sickness.

FNHC staff have a duty of care to share identified risks with other staff or agencies

attending the patient or location where the risks will affect their personal well being or

care that can be offered. This sharing of information can only be undertaken if it is in

the line of duty and does not breach patient confidentiality. Before sharing any

information on identified risks with other agencies obtain authorisation from your line

manager to ensure that this falls within FNHC policy.

2.3 STEP 3: REVIEW

The assessment must be reviewed and up-dated if there has been: a change in circumstance

an incidence of violence/aggression

an adverse event

a gap of 6 months or more since the last visit.

FNHC STAFF SAFETY CHECKLIST FOR COMMUNITY VISITS

NAME: ............................................…………………………………………URN.

ADDRESS: ..............……………………………......................………………………...................

.....................……………………………………………….……....................................

DATE OF BIRTH: ...............….......……......... GP: ..........................…………................................

CONTACT TEL NO ………………………………...........………………………………………………..........

1 UNPREDICTABLE BEHAVIOUR OR VIOLENCE/AGGRESSION - PATIENT

YES

NO

Does the patient have a known history of unpredictable behaviour or violence and

aggression?

UNPREDICTABLE BEHAVIOUR OR VIOLENCE/AGGRESSION - OTHERS

2 Has any member of staff felt threatened, intimidated or harassed by any member of the YES NO household?

3

PETS/ANIMALS YES

NO

Is there a known problem with any animals in the house or on the property?

4a

ACCESS / EGRESS TO THE PROPERTY YES

NO

Is the property easy to locate? If not document directions on how to find property.

4b Is off road parking available? YES NO

4c Is the property to be visited <5 minutes walk from where the car can be parked? YES NO

4d Is entry to the building well lit? YES NO

4e Is entry to the building visible from the road? YES NO

4f Are external stairways and lifts in good condition? YES NO

4g Are any additional hazards relating to access to the building detailed overleaf? YES NO

4h Are doors locked whilst staff are inside the house and therefore “quick” exit routes barred? YES NO

5a

SLIPS/TRIPS AND FALLS WITHIN THE HOME YES

NO

Are floor surfaces, including stairs, within the home in good condition?

5b Is the floor free from tripping hazards e.g. wires, objects, rugs etc? YES NO

6a MANUAL HANDLING - Has an individual patient handling assessment been completed? YES NO N/A

6b Is there adequate and appropriate lifting equipment in situ in the house? YES NO N/A

6c Is the manual handling equipment maintained? YES NO N/A

6d

Does the amount of, or layout of, furniture increase the handling risk? (e.g. limits YES

NO N/A

manoeuvrability, causes excessive stretching etc)

7

ELECTRICAL SAFETY - Is electrical equipment that staff may come into contact with in YES

NO

N/A good condition (visually check for frayed leads, damaged plugs or sockets)

8a INFECTION CONTROL - If sharps are used is there a sharps bin in the house? YES NO N/A

8b If contaminated dressings are being handled are there adequate disposal arrangements. YES NO N/A

9

AT RISK GROUP: Would this person be considered particularly at risk in certain situations

YES

NO

ie: severe weather conditions either heat wave or extreme cold weather, because of their health, home environment or support received

109 HAVE OTHER RISKS BEEN IDENTIFIED? IF SO DETAIL OVERLEAF YES NO

Shaded boxes highlight a risk - complete form overleaf to document control measures

Signed: ………………………Position: …………………………………Date: …………………

Print Name:………………………………………………………………………….

Risk Existing Control Measures in Place Action Plan Date

Action No (what is already in place to reduce each risk) (what further action is required to reduce the risk)

Completed

Signed: ……………………………………………………………….. Position: ………………………………………………………………. Date:

This must be filed within the base and risks identified shared with other service providers

Appendix 2

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.

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 use of alcohol should be minimised.

Dress appropriately for the area or patient to be visited, particularly when the patient’s 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.

Note that 999 & 112 are the police emergency numbers

Ensure their vehicle has sufficient petrol, is well maintained and appropriately insured for work use.

When Travelling

Staff should: 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.

Before incidents occur

Staff should:

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

Staff should: Not attend self referrals unless they have spoken with a GP to determine

safety of visit.

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/risk assessment forms and alerts on trac care.

Check Control Measures In place from The Staff Safety Checklist forCommunity Visits

Consider parking areas, walking distances /areas & entering a property 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. .

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.

Keep work mobiles on at all times if possible during working hours or checked regularly for messages

When Arriving at a patients home:

Staff should:

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 appear to be under the influence of alcohol or drugs, 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

Staff should:

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.

While incidents are happening

Staff should:

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.

Provide information about ‘complaints procedure’ and alternative sources of help, if appropriate.

After incident has occurred:

Staff should: 1. Contact their team leader/supervisor and/or return to base. 2. 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!

3. Contact the police if appropriate. A manager must be with you when you provide a statement.

4. Seek proper medical attention for any physical injuries. 5. Be prepared for the natural post trauma reactions, which may occur very

soon after the incident or may be delayed. 6. Ask for debriefing, and for further counselling if post trauma reactions persist. 7. Share information with others who might visit and add information to patient

notes, if appropriate. 8. 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