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CHHS18/074

Canberra Hospital and Health ServicesOperational ProcedurePatient Escort and Transport within Canberra Hospital campusContents

Contents....................................................................................................................................1

Purpose.....................................................................................................................................3

Alerts.........................................................................................................................................3

Scope........................................................................................................................................ 3

Section 1 – Escorting Patients...................................................................................................4

Medical officer escort criteria...............................................................................................4

Registered nurse or midwife escort criteria..........................................................................4

Transport Delay.....................................................................................................................5

Documentation:....................................................................................................................5

Allied Health escort...............................................................................................................5

Section 2 – Transport – General Procedure..............................................................................6

Acquiring information and equipment for patient transfer:.................................................6

Patient Transfer and preparation..........................................................................................7

Arrival at transfer destination...............................................................................................8

Completion of transfer..........................................................................................................8

Section 3 – Transport : MHJHADS Bed Based Services within Canberra Hospital Campus only8

Section 4 – Transport – Emergency Department (ED) and Capital Region Cancer Centre (CRCC)-Rapid Assessment Unit................................................................................................11

Section 5 – Transport – Medical Imaging (After Hours)..........................................................12

Section 6 – Transport – Infectious/Transmission Based Precautions......................................12

Related Policies, Procedures, Guidelines and Legislation.......................................................14

References.............................................................................................................................. 15

Definition of Terms................................................................................................................. 16

Search Terms.......................................................................................................................... 16

Attachments............................................................................................................................18

Attachment 1: Risk Assessment for transport of a Person Admitted to an MHJHADS Bed Based Service across the Canberra Hospital and Health Services Campus.........................19

Doc Number Version Issued Review Date Area Responsible PageCHHS18/074 1 04/03/2018 01/03/2021 Clinical Support

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Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

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Attachment 2: Common Signs of Impending Violent or Aggressive Behaviour...................25

Attachment 3: Instruction Regarding Infectious Status.......................................................27


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Purpose

This document outlines the procedure for transporting and escorting patients currently admitted to Canberra Hospital and Health Services (CHHS) bed based services and refers to transfers within the Canberra Hospital campus only. It aims to ensure: safety for patients and staff during the patient transfer process efficient and effective transfer processes that adhere to required clinical and operational

demands safe, appropriate and continuous physiological and psychological care is provided for

patients during intra-hospital transport.

Back to Table of Contents

Alerts

Patient privacy and confidentially must be maintained at all times throughout the patient transfer process

The treating registered nurse/registered midwife (RN/RM) must sign the patient’s clinical notes prior to any transfer occurring

Personal mobile phones are to be set on silent mode or switched off during all patient transfers.


Scope

This document refers to intra-hospital transfers within the Canberra Hospital campus only and applies to all Canberra Hospital and Health Services (CHHS) staff working within their scope of practice including: medical officers registered/enrolled nurses and registered midwives allied health staff wards persons administrative staff students working under supervision.

This document does not relate to those patients transferred from other hospitals or agencies temporarily for a procedure.



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Section 1 – Escorting Patients

All patients requiring transport within the hospital campus will be escorted by an appropriately qualified person, unless an escort is deemed unnecessary according to the professional judgement of the medical officer (MO), registered nurse (RN) or registered midwife (RM) who is responsible for the patient. Each patient’s physiological and psychological need for an escort during intra-hospital transport should be individually assessed.

The MO or RN/RM who is responsible for the patient or the clinical nurse/midwife consultant (CNC/ CMC) will make the decision and take responsibility regarding: the need for an escort the skill level of the escort the number of staff required to perform the escort safely (i.e. MO, RN/RM, enrolled

nurse (EN), allied heath professional and/or wards person).

If the MO or RN/RM makes the decision that the patient does not require an escort other than a wards person, they must always document this decision in the clinical record.

Medical officer escort criteria MO escort is required if one or more of the following criteria is met: a modified early warning score (MEWS) or early warning score (EWS) > 6 intubated transport to the intensive care unit (ICU), coronary care unit (CCU) or operating room as

a result of a medical emergency team (MET) call any clinical instability as decided by the medical officer attending the patient an ICU inpatient escort requiring any organ support

Registered nurse or midwife escort criteria RN/RM escort is required if one or more of the following criteria is met: a modified early warning score (MEWS) or early warning score (EWS) > 4 Patient Controlled Analgesia (PCA) pump or epidural/intrathecal infusion within the

previous 24 hours, or has received intravenous narcotics or sedation in the previous one (1) hour

intravenous infusions in progress with medications added (e.g. insulin, magnesium) drains in situ (e.g. chest drain) tracheostomy or is ventilated an altered Glasgow Coma score (GCS) are combative (an EN or AIN can perform this escort) physically restrained (an EN or AIN can perform this escort) requiring 1:1 nursing care for any reason (an EN or Assistant in Nursing/midwifery

[AIN/M] can perform this escort) transferring ward is unable to give a handover to a RN, RM, EN or Allied Health

Professional over the phone in the receiving area


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a hard collar and/or requires spinal precautions patient has received a drug that has potential effect on central nervous system (e.g.

morphine, fentanyl), (as per clinical situation-many patients take these drugs daily long term for chronic pain and may not require a RN/RM escort)

all women in labour or women experiencing an obstetric emergency (may be a MO escort)

NoteConsideration is to be given to the escort requirements of the patient needing extraassistance due to mobility restrictions or communication barriers.

AlertIf a patient is assessed as requiring an escort other than a wards person and no suitably qualified person can be released from the ward without compromising the care and safety of other patients, staff must contact the nurse manager, shift coordinator or after-hoursCNC (as appropriate) to arrange an appropriate escort. Document in the clinical record who was contacted and when and what their response was.

Transport DelayDelay transport only if: there is potential to compromise patient care and safety on the ward which outweighs

the clinical urgency of the transport no alternative arrangements can be made to provide a patient escort and the patient

requires an escort as per the above criteria

Documentation:All transfers must be documented in full in the patient’s clinical record. This includes: suitability for wards person only transport the name of the RN and/or Allied Health Professional that has received the handover in

the receiving area decision to delay transport for any reason.

For patients being transported to the operating theatre/procedure room with no escort other than the wards person, 2 RN/RMs must check the patient’s operating theatre checklist and sign the relevant documents prior to transport.

Allied Health escortProcess for Allied Health Professional (AHP) transport differs from the MO and RN/RM escort criteria as follows: RN/RM does not document in the medical file prior to transfer, verbal handover of

transfer to therapy space/gym, or to procedure rooms occurs AHP sessions are documented in clinical record by the AHP/Allied Health Assistant (AHA)

or student.


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AHP will discuss the requirements for an escort to AHP sessions with the transfering inpatient area (this may be delegated to an AHA or student who will liaise with nursing staff prior to transfer)

Physiotherapist, AHA and Allied Health students can transfer patients with drains insitu without a nursing escort

No transport slip is used

Procedure for Allied Health Professional TransfersAllied Health Professionals (AHP) transport patients from inpatient areas to areas where AHP sessions are conducted. This includes therapy space/gym, negative pressure rooms for induced sputum procedure, testing areas and car transfers Physiotherapists within their scope of practice transfer patients with a tracheostomy to

therapy space/gym without a nursing escort. Therapy spaces/gyms have appropriate equipment for this to occur and follow the CHHS Clinical Procedure Tracheostomy Management – Adult patients

Patients with an altered GCS transfer to the gym without a nursing escort e.g. patients with a closed head injury. If the patient has an acute change in their GCS they would not be suitable for therapy/procedure

AHA transfer patients onto portable prescribed oxygen for transfer

Exercise Physiology Department Exercise Physiology Department utilises own wardsman/HP/AHA to transport patients

from ward to therapy space Ward Pool staff are accessed and utilised on occasions when Exercise Physiology

wardsman is not available. Verbal handover of transfer to therapy space occurs by wardsman to HP/AHA staff Therapy session/procedures are documented in clinical record by HP/AHA/Exercise

Physiology Student and co-signed as necessary if student completed file notes Wardsman/HP/AHA transfer patients with drains insitu if deemed appropriate by

nursing staff HP/AHA transfer patients onto portable prescribed oxygen for transfer as required.


Section 2 – Transport – General Procedure

Acquiring information and equipment for patient transfer:1. Receive patient details and transfer slip from the ward services support pool (WSSP)

coordinator which will contain the following information patient’s Unique Identification Number (URN) patient’s name patient’s date of birth patient’s pick-up location/ward patient’s destination location/ward transportation method (i.e. bed/trolley/wheelchair/vehicle)


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transmission based precautions/infectious status (i.e. contact/airborne/droplet) (see section 6 below for transport of patients with transmission based/infectious precautions)

any special requirements (supplemental oxygen/medical officer or nurse escort) 2. ensure all transfer and patient details have been recorded on transfer slip3. collect wheelchair or stamina lifter required for transfer4. collect supplemental oxygen and twin-o-vac suction unit for transfer if required5. proceed to patient pick-up location.

Patient Transfer and preparationOn arrival at the pick-up location, the wards person will:1. refer to Patient Journey Board (white board or TV screen) with room allocations to locate

patient’s bed and room number2. locate patient’s RN/RM/EN to confirm patient’s transfer details. Ensure attending

RN/RM/EN signs patient’s clinical record stating patient is able to be transferred without an escort (if applicable)

3. proceed with patient’s notes and RN/RM/EN to patient’s room

Note: Patients cannot be transferred without signature of attending RN/RM/EN attending RN/RM/EN must be notified immediately if wards person has concerns

regarding the safe transportation of patient WSSP coordinator and patient’s destination/receiving ward must be notified of any

delays greater than 10 minutes.

4. introduce yourself to patient on entering patient’s room5. ask patient to state their name and date of birth, and cross check details including URN

with their patient identification (ID) band to ensure you have the correct patient for transfer (refer to Patient Identification and Procedure Matching Procedure)

Note: Prior to transport, the ward/area receiving patient transfer is responsible for obtaining

all correct patient information from attending RN/RM/EN or CNC/CMC if patient ID band and transfer slip do not correspond, attending RN/RM/EN or CNC/CMC

will notify the receiving area and WSSP coordinator of issues and delay if the patient does not have an ID band, they are not to be transferred, an exception to

this may be Building 7 transfers as ID bands may be removed to de-identify patients, or some outpatient areas e.g chemotherapy units.

6. Explain process and destination of transfer to patient 7. Prepare patient for transfer following the applicable steps below:

ensure patient is covered and comfortable adjust bed to safe working height raise bed side rails to safely secure patient


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unplug bed from wall with power cord loosely coiled and secured on bed clinical staff to assist with transferring equipment and to ensure it is working

correctly prior to transport (unplug medical equipment such as infusion pump, patient controlled Analgesia (PCA’s) and air mattresses from wall with power cords loosely coiled and secured on bed)

secure patient clinical record under head end/pillow of bed to maintain confidentiality and to provide ready access in case of medical emergency, for wheelchair transfers place clinical record in suitable cover (i.e. pillow case)

secure oxygen bottle on stamina lifter or wheelchair for transfer nursing staff must assist with oxygen transfer from wall to portable and ensure

oxygen is working and the correct output level set prior to transport.

Note:Observe patient throughout transfer for a change in baseline condition. Inform RN/RM/EN of any concerns or observations on arrival at destination.

Arrival at transfer destination8. inform department/ ward of patient’s arrival9. assist nursing/midwifery staff with bed to bed transfer or manoeuvring of patient if

required10. handover clinical record to RN/RM/EN/AHP (if without nurse escort)11. Staffstaff member completing the transfer must transfer oxygen from portable to wall12. wipe down wheelchair/trolley using a detergent wipe 13. proceed back to WSSP or your designed work area.

Completion of transferUpon arrival at the WSSP or designated work area:1. inform coordinator that transfer has been completed2. document time of job completion and any additional information including initial transfer

slip3. place completed transfer slip in ‘Jobs completed’ tray.


Section 3 – Transport : MHJHADS Bed Based Services within Canberra Hospital Campus only

Note:In this section and attachments 1 and 2 only the patient /client /consumer will be referred to as the ‘person’

This section relates to transport from: One MHJHADS bed based unit to another MHJHADS bed based unit Emergency Department (ED) to a MHJHADS bed based unit A MHJHADS bed based unit to an inpatient ward or outpatient clinic


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Canberra Hospital ward to a MHJHADS bed based unit

Adult Acute Mental Health Services (AAMHS) vehicle Persons admitted to MHJHADS bed based services across the Canberra Hospital campus

are transferred using the Adult Acute Mental Health Services (AAMHS) vehicle. The AAMHS van is a government transport vehicle which is fit for purpose and designed to support the safe transport of admitted people.

The vehicle is located on the Canberra Hospital campus under Building 12 adjacent to the lifts opposite the Level 1 foyer. Access to this vehicle can be arranged through Mental Health Short Stay Unit. Ward Services or a security officer (depending on person’s security plan) will drive the vehicle on request.

All persons admitted to MHJHADS bed based units within Canberra Hospital campus who require transport across the campus will have a documented risk assessment (Attachment 1). This must be completed by clinical staff prior to the transport of the person. This risk assessment must be completed in collaboration with Wards Services and will reflect a risk rating of Low, Moderate, and High.

Risks identified include: risk of absconding risk of self-harm risks associated with any physical condition risk of aggression (see Attachment 2).

Note:Any person subject to section 309 orders in accordance with the Crimes Act 1900 are to be automatically assessed as high risk for the purposes of transport. Security staff to be called and to remain with S309 person.

An initial security risk assessment is completed when custody is transferred from ACT Corrective Services to ACT Health Security Services. This informs the level of risk (see Attachment 1). Consider association issues with any person subject to section 309 orders e.g. two persons who cannot associate with each other due to a court order, being co-conspirators, crown witness against the other, etc.

Who to contact when a MHJHADS person requires transport within Canberra Hospital Campus(the security guard assigned to persons subject to Section 309 will make transfer arrangements)

Transport from Transport to Who to contact for transportED AMHU or Inpatient

Withdrawal UnitContact wards person supervisor via switch to facilitate the transport

AMHU, MHSSU or Inpatient Withdrawal Unit

Other areas on the Canberra Hospital campus

Contact wards person supervisor via switch to


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Transport from Transport to Who to contact for transportfacilitate the transport

CHHS inpatient ward a MHJHADS inpatient unit on the Canberra Hospital campus

Contact wards person supervisor via switch to facilitate the transport

AMHU (overnight transfers) AMHU (overnight transfers)

Contact wards person supervisor via switch to facilitate the transport

Note:People considered medically unstable for transfer from one of the MHJHADS bed based services to the CHHS will require appropriate medical intervention and a suitable transport service – this may include the use of the ACT Ambulance Service (ACTAS). The clinical area has the responsibility for organising additional medical care during transport if required.

Based on the completed risk assessment (attachment 1), a Medical Officer, RN and attending wards person or ward services supervisor must consider the most appropriate transport option. Consider whether the person can be safely transported by staff in the vehicle and determine the level of escort required in accordance with the person’s physical and mental condition.

In the event a MHJHADS or wards services staff member decide it is unsafe to transport a person, based on the completed risk assessment, the transfer will not occur. To escalate this:o MHJHADS clinical staff are to contact their Assistant Director of Nursing (ADON)

(business hours) or MHJHADS Director on Call (after hours). Canberra Hospital clinical/nursing staff will contact their CNC and/or their ADON (during business hours) or the After Hours Hospital Manager (AHHM) after hours to advise of concerns

o Wards persons are to contact the wards person supervisor/manager or the ward services after hours manager

o Follow up discussions must occur between the wards person supervisor and on-call nurse manager, and if necessary, between the relevant MHJHADS Operational Director (Director on call after hours)/Executive Director on-call CHHS, the Assistant Director Ward Services and CHHS After Hours Hospital Manager (AHHM).

Special consideration should be given in a case of an acutely violent or aggressive person where additional steps must be taken to ensure safety for everyone involved (see Attachment 2). Consideration should be given to whether the person should remain either in the ED or the relevant unit until further clinical assessment suggests that their risk status has decreased, or whether ACT Ambulance Services (ACTAS) should be contacted for assistance with the transport.

Where an escort is necessary for a person considered to be low to medium risk, the minimum acceptable staff level would be one driver and three (3) escorts (see Attachment 1)

After reviewing the risk assessment, escort staff will determine the most appropriate seating arrangements. One or two staff members are to sit in the back of the vehicle


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with the person (this should include at least one clinician, or one clinician and one wards person if required)

Female persons must have at least one female escort in the back of the van during the transfer

Both the person being transported and the escort should be seated in the rear of the vehicle. The person being transported must be seated behind the passenger seat of the vehicle facing the front of the vehicle and NOT behind the driver. Safety belts should be worn at all times by all occupants

Child proof locks fitted to the rear doors of the vehicle must be activated On arrival at the destination, the driver should stand adjacent to the person’s door until

the escort has alighted The nurse escort is to remain with the person until care is handed over to a clinically

responsible staff member in the unit (e.g. admitting nurse). i.e. Association Issues (Two persons subject to Section 309 who cannot associate with each other due to a court order, being co-conspirators, crown witness against the other, etc.)


Section 4 – Transport – Emergency Department (ED) and Capital Region Cancer Centre (CRCC)-Rapid Assessment Unit

This section refers to adult patients requiring transport from the ED or the CRCC-Rapid Assessment Unit to an inpatient bed in the CHHS

Prior to transferring the patient unescorted by a nurse or medical officer ensure the patient has:1. An allocated ward in the CHHS2. Vital signs attended to < 30 minutes prior to transfer3. Modified Early Warning Score (MEWS) < 44. Verbal handover has been given to the receiving nurse

Exclusion Criteria:Patients who must have a nurse escort include: Patients requiring cardiac monitoring during transport Patients requiring respiratory support during transport Patients with cervical spine collars in situ Patient transfer checklist incomplete Altered LOC or decreased GCS – confused, history of seizures or are post-ictal Drug infusion in progress (other than IVT without additives) Intravenous (IV) narcotic administered within the last 30 minutes Any patient going to theatre Intoxicated patients

Transferring the Patient to the Ward Area1. Complete patient transfer checklist


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2. Document transfer in patient clinical record3. Contact wards person to request unescorted transfer to the ward4. Collect admission paperwork from ward clerk5. Wards person to transfer paperwork with patient to ward area


Section 5 – Transport – Medical Imaging (After Hours)

For transfers to Medical Imaging during business hours follow transport/escort guidance as per Sections 1 and 2:

For out of hours transfers to Medical Imaging: Medical Imaging Staff working out of hours will carry a duress alarm for safety.

o if there is concern about the health of the patient call a Code Blue (MET)o if there is concern about the behaviour of the patient and staff safety call a Code

Black. All patients requiring ‘out of hours’ ultrasound must be escorted by either a medical

officer, nurse or midwife in accordance with the specified criteria in section 1. The escort should stay until the examination is finished and assist with infectious

protocols and manual handling and to prevent the sonographer from working in isolation.


Section 6 – Transport – Infectious/Transmission Based Precautions

Patients with transmission based precautions (i.e. contact, droplet or airborne precautions) will be transported in accordance with the Healthcare Associated Infections Procedure. Staff undertaking transport should confirm with treating clinicians the infectious status of the individual, and any required transmission based precautions. Refer to Attachment 3 for further information. It is important to communicate with staff receiving the patient of the known infectious status of the patient to ensure correct infection prevention and control processes are in place to correctly care for the patient and to reduce risk to staff, patients and visitors. Follow the infectious/transmission based precautions as per the Febrile Neutropenia Management Clinical Procedure for patients who are considered to have febrile neutropenia


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Note:Remember Standard Precautions apply at all times: Standard Precautions are work practices that are required to maintain the basic level of

infection prevention and control. Standard precautions are recommended for the treatment and care of all patients, all

body fluids, secretions and excretions (excluding sweat), regardless of whether they contain visible blood (and include dried body substances such as blood or saliva), non-intact skin and mucous membranes.

Transmission based precautions when collecting the patient: ensure hand rub is on the end of the patient’s bed before transport wards persons are to perform hand hygiene as per the 5 Moments of Hand Hygiene for Contact Precautions, staff are to wear a gown, gloves are optional for Droplet precautions, staff are to wear Personal Protective Equipment (PPE),gown,

gloves and surgical mask for Airborne precautions, staff are to wear PPE (gown, gloves and P2 or N95

mask/respiratory patient is prepared for transport (with or without a nurse) on leaving the room, the wards person removes gloves and gown, and then performs

hand hygiene the nurse, if accompanying the patient, is to do the same if, during transport, the patient or their equipment requires attention, then perform

hand hygiene on arrival at the destination, ensure the receiving staff are informed of the patient’s

multi-resistant organism (MRO)/respiratory status.

Communication between staff is key for the success of this initiative, and correct handover from all staff is vital.If the patient does not have an MRO but has a respiratory illness, the patient must wear a mask (either surgical for droplet or duckbill for airborne). Remind patients that they must leave the mask in place during transport, and when they remove their mask they must perform hand hygiene.


Related Policies, Procedures, Guidelines and Legislation

Policies ACT Health Violence and Aggression by Patients Consumers or Visitors Prevention and

Management Policy Incident Management Policy Larger (Bariatric) Adult Patients – Active Management of Larger (Bariatric) Patients Policy Patient Identification and Procedure Matching Policy


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Procedures ACT Health Violence and Aggression by Patients Consumers or Visitors SOP After Hours Director on Call – Reporting Process, Roles & Responsibilities Mental Health,

Justice Health and Alcohol & Drug Services (MHJHADS) Clinical Handover Procedure Clinical Handover within MHJHADS Procedure Emergency Department and Mental Health Interface Procedure Febrile Neutropenia Management, Clinical Procedure Identification, Mitigation and Management of Aggression and Violence for MHJHADS Healthcare Associated Infections Procedure Incident Management Policy Incident Management SOP Incidents Reportable to the Executive Director and Intervention Following the Death of a

Person Procedure Initial Management, Assessment and Intervention for People Vulnerable to Suicide

Procedure Larger (Bariatric) Adult Patients – Active Management of Larger (Bariatric) Patients

Procedure Management of section 309 patients procedure Adult Mental Health Unit Operational Procedure Searching – Limits to Staff Ability to Search a Consumer’s Person and Property Neurological Observations – For Adults and Paediatrics Procedure Patient Identification and Procedure Matching Procedure Transfer for Emergency Physical Care: Alexander Maconochie Centre (AMC) and Dhulwa

Mental Health Unit (DMHU) procedure Vital Signs and Early Warning Scores Procedure


References

1. Caruana, M, Culp K (1998) intrahospital transport of the critically ill adult: a research review and implications. Dimensions of critical care nursing, 17(3): 146-16.

2. Cook R, Gardener G, Gardener A (2000) A national survey: Transporting patients within Australian hospitals. Australian Health review, 23(4): 108-114.

3. Fought SG, Nemeth L (1992) intra-hospital transport: a framework for assessment. Critical care nurse quarterly, 15(1): 87-90.

4. Frost J, Morgan L (1991) a crucial journey, which needs a standard. Professional nurse, 6(12).

5. Gardener G, Gardener A, Cook R, Owen J, Van Diermen C (2002) the geography of hospital care: An ethnography of intra-hospital patient transport. Unpublished internal research report, the Canberra Hospital & University of Canberra Research Centre for Nursing Practice, Canberra ACT.

6. Howland WA (1995) caring for a moving target, nursing, 25 (9):54-55


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7. Kalish BJ, Kalisch PA, Burns SM, Kocan MJ, Prendergast v (1995) intra-hospital transport of neuro ICU patients. Journal of neuroscience nursing, 27(2):69-77

8. Smith MC (1976) patient responses to being transferred during hospitalization. Nursing research, 25(3):192-196

9. Wallace M (1993) Health Care and the Law. The law book company, Sydney10. Wilson P (1998) safe protection transportation: nurses can make a difference. Nursing

times, 94(26)) 66-67


Definition of Terms

Airborne precautions: are required to minimise the risks associated with the transmission of infectious particles by the dissemination of very small (</= 5 microns) airborne droplet nuclei suspended in the air for extended periods of time, or dust particles containing infectious agents.

Contact precautions: are necessary in health care settings where infection transmission may occur due to direct or indirect contact with a transmissible agent.

Droplet precautions: are required when large infectious droplets are generated from a source person during coughing, sneezing or talking.

Glasgow Coma Score (GCS): commonly used tool to complete neurological assessment including eye opening, verbal and motor responses.

Modified Early Warning Score (MEWS): a track and trigger system where vital signs are recorded at the bedside and a score is allocated to the vital signs that are outside of the normal range. The individual scores are summed to a total and can then indicate the severity of abnormal vital signs to assist in the identification of deteriorating patients.

Transmission Based Precautions: are used for patients who are known or suspected to be infected or colonised with highly transmissible and/or infectious pathogens. They must be used in conjunction with Standard Precautions


Search Terms

Transport, Escort, Infectious, Infectious Precautions, Transmission Based Precautions, Precautions, Vehicle



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Attachments

Attachment 1 – Risk Assessment for transport of a Person Admitted to an MHJHADS Bed Based Service across the Canberra Hospital Campus

Attachment 2 – Common Signs of Impending Violent or Aggressive BehaviourAttachment 3 – Instruction Regarding Infectious Status

Disclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Services specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

Policy Team ONLY to complete the following:Date Amended Section Amended Divisional Approval Final Approval 21/01/2018 Complete Review Lisa Gilmore, ED CSS CHHS Policy Committee20/06/2018 Inclusion of patient

identifier dot point and Allied Health Professionals into scope.

Lisa Gilmore, ED CSS Lisa Gilmore, ED CSS

This document supersedes the following: Document Number Document NameTCH10:008 Escorting PatientsOS11:001 Patient Transport (Ward Services)


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Attachment 1: Risk Assessment for transport of a Person Admitted to an MHJHADS Bed Based Service across the Canberra Hospital and Health Services Campus

This form ‘Request for Transport of a Person Requiring Mental Health Care’ (see below) is available on the clinical forms register to be used when any Canberra Hospital and Health Services (CHHS) staff member transfers an admitted person to an MHJHADS Bed Based Service or to and from other clinical areas and wards within the CHHS campus using the Adult Acute Mental Health Services (AAMHS) vehicle. This form is to be completed prior to the person leaving the respective unit.

This may include transfer to and from: MHJHADS bed based unit to another MHJHADS bed based unit Emergency Department (ED) to:

o MHJHADS bed based unito Adult Mental Health Unit (AMHU)o Mental Health Short Stay Unit (MHSSU)o Alcohol and Drug Services Withdrawal Unit

A MHJHADS bed based unit to an inpatient ward or outpatient clinic

Risk ratingLow RiskPerson assessed as Low Risk: must be escorted by a clinician and one wards person sit in the rear of the vehicle facing the front of the vehicle, diagonally opposite from the

driver the escort staff member will sit in the back of the vehicle with the person the door safety latch must be used at the on position.

Moderate RiskPerson assessed as Moderate Risk: will require vehicle transport escorted by two wards persons and one nurse must sit in the rear of the vehicle facing the front of the vehicle, diagonally opposite from

the driver one nurse and one wards person will sit in the back of the vehicle with the person the door safety latch must be used at the on position

High RiskPerson assessed as High Risk: No transport can occur consider whether the person should remain in the ED or relevant unit until their risk

status has decreased Based on operational requirements it may be necessary to move the person for their

safety and the safety of staff. Mechanical restraints (handcuffs) can be applied by a Doc Number Version Issued Review Date Area Responsible PageCHHS18/074 1 04/03/2018 01/03/2021 Clinical Support

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qualified and trained Security Officer. Consideration could also be given to transporting them to Dhulwa which has the infrastructure and a dedicated response team to handle aggression and violence

For persons subject to section 309 orders in accordance with the Crimes Act: security staff to be called and to remain with person subject to Section 309 if transport of a person who is high risk and subject to Section 309 orders occurs in the

van there must be two security staff, one nurse and a wards person (to drive the vehicle only)

Note:A Security Officer should be utilised for any person subject to Section 309, irrespective of the level of risk assessed. On arrival to the Emergency Department, a person subject to Section 309 will be allocated a security officer to assume custody of the consumer and who must be present with the person at all times. Consider association issues with any person subject to section 309 orders e.g. two persons who cannot associate with each other due to a court order, being co-conspirators, crown witness against the other, etc.


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Attachment 2: Common Signs of Impending Violent or Aggressive Behaviour

Common Precursors A variety of behaviours referred to as ‘escalation’ may indicate actual or impending aggression and the presence of a calming support person can often de-escalate the client or situation.

The four emotive/behavioural states commonly displayed on presentation of aggression are: Fear Frustration Manipulation Intimidation

A variety of behaviours may indicate impending or actual aggression/violence. These can present as, but are not limited to, the following forms: loud clipped or angry speech pacing angry facial expressions refusal to communicate threats or gestures physical or mental agitation restlessness persecutory ideation delusions or hallucinations with violent content person themselves reporting violent feelings intoxication or disinhibiting medications psychosis or paranoia e.g. a delusional or perceived belief that the person is being

persecuted or threatened anxiety/panic attacks

Inhibition can be decreased due to: confusion, e.g. delirium or dementia neurological disorders e.g. epilepsy intoxication of alcohol or substances disinhibiting medication, including diazepam poor impulse control e.g. in some people with a developmental disability alcohol/nicotine withdrawal or other substance withdrawal

Anger can be due to: humiliation rejection interpersonal deregulation feelings of being ignored


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concerns or request dismissed

Stress can be due to: grief e.g. to potential or perceived loss frustration/helplessness pain both acute and chronic agitation secondary to depression inadequate finances side effects from medications which cause neurological agitation dependency and withdrawal

Diminished capacity to self-regulate emotional wellbeing can be due to: disrupted sensory process


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CHHS18/074

Attachment 3: Instruction Regarding Infectious Status

Hospitals are to give written instructions and training on hygiene techniques and infection to employees who may be liable to work in infectious areas. Such instructions should be given to existing employees as soon as possible and to new employees at the point of engagement.

In addition, supporting oral instructions should be given to relevant employees whenever a patient is admitted to hospital with a suspect or confirmed infectious condition and to those employees who work regularly in designated infectious areas.

Medical Officer, Nursing, Midwifery, Clinicians, Allied Health Professionals must give instructions to employees in relation to the infectious status of a patient/area before an employee/s has any interaction with such patient/area. Example: Wards Persons to be given oral instructions before transportation of patient from one area to another or before assisting with lifting and showering.

The instructions given to employees should be in such a manner as to remove any fears that the employees may have, and to give them an understanding of the methods of the spread of disease.

The instructions should include the following subject matters:1. Mode of transmission

a) Droplet infectionb) Faecal-oral routec) Bloodd) Fomitese) Discharges –Secretionsf) Urine

2. Disease not transmissible from person to persona) Degree of communicabilityb) Period of communicabilityc) Personal hygiened) Protective clothinge) Barrier nursingf) Immunity – naturally acquired; - immunisation;g) Cleaning methods which minimise spread of infection


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