Document Control - Northern Devon Healthcare NHS Trust...Lone Working Policy Corporate Governance...

Lone Working Policy

Corporate Governance Lone Working Policy V2.1 07Aug15 of 34

Document Control

Title

Lone Working Policy

Author’s job title Health & Safety Manager

Directorate Commercial Directorate

Department Corporate Governance

Version Date

Issued Status Comment / Changes / Approval

1.0 August 2000

Final Policy approved by Risk Management Committee and by Trust Board. Due for review in September 2009.

1.1 Dec 2009

Revision Policy due for review in September 2008. Policy reviewed and no amendments required to reflect legislative changes. Document Control Report added. Agreement at Health and Safety Committee on 23.12.09 that the review date can be extended until June 2010 to update contents and to transfer to corporate format.

1.2 Feb 2012

Revision Complete re-write of policy to provide a harmonised policy as a result of the merging of Northern Devon Healthcare NHS Trust and NHS Devon community services. A summary of key issues and differences is on page 4. The monitoring section has been strengthened as a result of revised NHSLA requirements.

2.0 Mar 2012

Final Harmonised policy approved by Health and Safety Committee on 22nd March 2012 following consultation.

2.1 July 2015

Revision Dynamic risk assessment definition added, Section 3.3. Dynamic risk assessments added to Sections 5.2 and 5.7. Code of Conduct Leaflet added (Section 6.9).

2.2 Aug 15 Revision Format to new House Style.

Main Contact Health & Safety Manager Suite 1 Munro House North Devon District Hospital Raleigh Park Barnstaple, EX31 4JB

Lead Director Director of Finance and Performance

Superseded Documents Lone Working policy, NDHT (V1.1 2009) Violence and Aggression and Lone Working policy, NHS Devon / Devon Provider Services (v3.0 2010)

Issue Date July 2015

Review Date July 2018

Review Cycle Three years

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Consulted with the following stakeholders:

Health and Safety Committee Members COSHH Working Group DATIX and Incident Manager Deputy Estates Manager, Facilities Dept. Director of Finance and Performance Divisional General Manager - Community Hospitals (Eastern) Fire and Security Advisers Head of Corporate Governance Head of Profession/Assistant Director of Nursing (community and community

hospitals eastern and mid) Head Physiotherapy & Occupational Therapy Health and Safety Committee Health and Social Care Cluster Managers Local Security Management Specialist. Locality Business Manager Moving and Handling Adviser Senior Midwife/Risk Lead Women's Outpatient Services Senior Governance Manager, Compliance Team Specialist Occupational Therapist Unison Conveyor & Staff-side

Approval and Review Process

Health and Safety Committee

Local Archive Reference G:\ PUBLIC\ CORPORATE GOVERNANCE Local Path Policies and Procedures\Corporate Affairs Team\Health and Safety\Lone working Filename Lone Working Policy v2.1 July15.doc

Policy categories for Trust’s internal website (Bob) Health and Safety

Tags for Trust’s internal website (Bob) Lone worker

Lone Working Policy


CONTENTS

Document Control........................................................................................................................ 1

1. Introduction ......................................................................................................................... 4

2. Purpose ................................................................................................................................ 4

3. Definitions............................................................................................................................ 5

4. Responsibilities .................................................................................................................... 7

5. Risk Assessment ................................................................................................................. 11

6. Control Measures ............................................................................................................... 16

7. Incident Reporting .............................................................................................................. 20

8. Training Requirements........................................................................................................ 20

9. Monitoring Compliance with & the Effectiveness of the Policy ............................................. 21

10. References ......................................................................................................................... 22

11. Associated Documentation ................................................................................................. 23

Appendix A: Example Buddy System ........................................................................................... 25

Appendix B: Protecting yourself guidelines ................................................................................. 26

Appendix C: Guidelines .............................................................................................................. 28

Appendix D: Visiting schedule .................................................................................................... 30

Appendix E: Staff member details ............................................................................................... 31

Appendix F: Equality Impact Assessment .................................................................................... 32

Lone Working Policy


1. Introduction

This document sets out Northern Devon Healthcare NHS Trust’s system for lone working. It provides a robust framework to ensure a consistent approach across the whole organisation, and supports the Trust’s statutory duties as set out in the NHS Constitution.

This is a harmonised policy reflecting the incorporation of community services in Exeter, East and Mid Devon with Northern Devon Healthcare NHS Trust in April 2011.

The Trust provides a wide range of local, community, general and specialist services to the residents of Northern and Eastern Devon areas.

In addition to the provision of healthcare and social care services Trust employees may be employed in administrative, catering and hotel services, logistical, maintenance, grounds and gardening work, refurbishment or other construction activities and may travel between sites for work related purposes. Lone working may occur in any of these activities.

2. Purpose

The purpose of this document is to detail the process for

The Health and Safety at Work etc Act 1974; The Management of Health and Safety at Work Regulations 1999; Secretary of State for Health Directions on NHS Security Management

Measures ( 2003, 2004 and as amended 2006); and Secretary of State’s Directions on work to tackle violence against staff and

professionals who work or provide services for the NHS (2003)

The policy applies to all Trust staff who by definition under-take duties as lone workers.

Implementation of this policy will ensure that:

Where it is possible, systems will be adopted to avoid staff working alone; Where this is not possible, staff are made aware of safety issues relating to

working alone; Risk factors which relate to lone workers are addressed through risk

assessment and the implementation of appropriate control measures to ensure lone workers are at no more risk than other workers; and

Appropriate actions are taken in response to incidents resulting in a lone worker sustaining physical or psychological harm.

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3. Definitions

3.1. Lone Worker

Lone workers are those whose activities involve a large percentage of their working time by themselves, out of sight or earshot of others, without close or direct supervision or the benefit of interaction with other workers.

Examples of lone workers, who carry out their work in isolation from others for significant periods, include:

Staff working outside of office hours, for example:

Early morning cleaners; Night porters; or Security staff or those staff who open and close buildings.

Staff working in remote or isolated parts of a building or grounds, for example:

Maintenance staff and contractors; A receptionist working alone in a clinic reception area; or A technician working alone in a laboratory to provide an out-of-hours

service.

Staff working with patients and public, without contact with other workers or supervision for periods of time, for example:

Community nurses, midwives and other health care professionals making home visits; or

Staff dealing with complaints.

Staff that travel alone for significant periods or in circumstances that may give rise to significant risks, for example:

Driving long distances; Making deliveries between Trust sites and other premises; Travelling at night; or Travelling in dangerous conditions.

3.2. Risk

A risk is the likelihood that a hazard will actually cause its adverse effects or harm, together with a measure of the severity or impact (consequences) that this will have. For example:

Lone workers may be at risk of harm should an activity require two persons to complete a task or where the lone worker is in a more vulnerable situation due to the fact they are working alone.

Lone Working Policy


A lone worker may be at risk of psychological stress should unfounded allegations be made against them such as allegations of theft, where they may be working in residencies or someone’s home.

The Trust’s risk management arrangements ensure that clinical and non-clinical risks are managed in the same way.

3.3. Dynamic Risk Assessment

A dynamic risk assessment can be defined as a continuous process of identifying hazards and the risk of them causing harm, and taking steps to eliminate or reduce them in rapidly changing circumstances. Source: NHS Security Management Service “Not Alone” 2009 v2.

3.4. Hazard

A hazard is something (e.g. an object, a property of a substance, a phenomenon or an activity) that can cause adverse effects or harm. For example lone worker conduction a home visit:

Might be entering a hazardous environment if they are required to manage challenging, unpredictable, emotional or disturbed people.

Conditions in the person’s home may be inherently unsafe. For example storage of excessive amounts of combustible materials, patients smoking whilst on oxygen therapy or the presence of unsecured dangerous animals.

3.5. Harm

Harm is defined as “injury (physical or psychological), ill health, suffering, disability, death, loss, damage to property or services.

3.6. Incident

An incident may be defined as ‘any event that has given rise to actual or possible harm such as injury, patient dissatisfaction, property loss or damage’.

3.7. Near miss incident

A near miss is recorded when an incident did not lead to harm but could have. For example: Where a community nurse visits a new patient in their home for the first time and the patient locks the front door behind the nurse entering the home. The nurse may feel vulnerable; however no harm, damage or loss occurred,

3.8. RIDDOR

The Reporting of Injuries, Diseases & Dangerous Occurrences Regulations (RIDDOR) 2013 place a legal duty on the Trust to report certain categories of incident which include:

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Deaths and major injuries (specified injuries); Work related diseases; Dangerous occurrences; and Over seven day injuries (see below) Over seven day injuries are applicable where a person is unable to work as a result of a work related injury for more than seven days (including non-work days). All incidents must be reported using the Trust’s incident reporting systems. See Trust Incident Management Policy. Acts of non-consensual violence to a lone worker resulting in a death, major injury or being unable to work for over seven days are reportable under RIDDOR. Additional guidance on RIDDOR is published on the Trust’s intranet site (BOB).

4. Responsibilities

4.1. Role of Chief Executive

The Chief Executive has overall responsibility for health and safety in Northern Devon Healthcare NHS Trust and must have assurances that there are suitable and sufficient control measures in place to manage hazards and risks associated with lone working.

4.2. Role of Director of Finance and Performance / Security Management Director

The Director of Finance and Performance is the nominated Security Management Director as required by the Secretary of State’s Directions to NHS bodies (see Violence and Aggression Policy) and as such has responsibilities for ensuring appropriate arrangements and control measures are in place to manage risks affecting lone workers such as community staff visiting patients in their own home.

4.3. Role of Executive Directors and Divisional General Managers.

Directors and Divisional General Managers must ensure that an appropriate level of support, guidance and resources are in place to enable line managers to discharge their responsibilities under this policy.

4.4. Role of the Health and Safety Committee

The Health and Safety Committee is a statutory group with membership that includes a non-executive director, clinicians, managers, specialist advisers and health and safety representatives.

http://ndht.ndevon.swest.nhs.uk/policies/?p=6259

http://ndht.ndevon.swest.nhs.uk/?page_id=8043


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The Commercial Director is the Chair of the Trust’s Health and Safety Committee. The Commercial Director is the nominated lead director for health and safety and is accountable to the Chief Executive. Specialist advisers, including the Local Security Management Specialist and Health and Safety Manager, will draw to the attention of the Committee any significant risks relating to lone working activities.

4.5. Role of the Occupational Health Department

The Occupational Health Department will provide support and counselling for staff involved in a Violence and Aggression incident. This can be achieved by referral by line managers or by self-referral. (See Supporting Staff involved in an Incident, Complaint or Claim Policy).

4.6. Role of the Local Security Management Specialist

The Local Security Management Specialist is trained and accredited to lead in all Violence and Aggression management work in line with the requirements of NHS Protect (operating name of the NHS Counter Fraud & Security Management Service). Where such work has implications for lone workers the Local Security Management Specialist is responsible for ensuring: The Trust is informed of guidance and best practice for the

management of lone working provided by organisations such as NHS Protect;

The provision of advice to the Trust on physical security measures, to improve the personal safety of lone workers and make sure that appropriate preventative measures are in place;

Technology which is used to protect lone workers is appropriate, proportionate and meets the needs of the organisation and lone working staff. They should ensure that technology also meets the necessary legal requirements;

In conjunction with the Health and Safety Manager that advice, support and assistance is provided to managers or other staff in the completion or review of lone working risk assessments, actions plans, standard operating procedures and other relevant activities;

Specialist advice and support is provided to the investigation process following reported incidents and making recommendations where appropriate. This may include making recommendations for sanctions to be taken against those who cause harm to staff who work on their own;

Support is provided to staff lone working who are victims from violence and aggression where other resources are not immediately available;

Liaison with external agencies such as the police where appropriate; and



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Where appropriate, advice, support and assistance is provided with regards the appropriate management of care or delivery of services to patients or service users who may be identified on their healthcare records as violent and aggressive. This may include the completion of acceptable behaviour contracts.

4.7. Role of the Health and Safety Manager

The Health and Safety Manager is responsible for: Completing reports to the Health and Safety Executive where an

incident involving a lone worker meets the criteria of the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR);

In conjunction with the Local Security Management Specialist providing advice, support and assistance to managers or other staff in the completion or reviewing of lone working risk assessments, actions plans, standard operating procedures and the like;

Monitoring and reviewing reported Incidents, seeking advice and support from other specialist advisers to ensure appropriate recommendations for actions are taken;

Monitoring the implementation of lone working arrangements as part of the Trust’s health and safety audit programme; and

Signposting staff to the Lone Working Policy and provide core trainers training material content for use at Trust Welcome and refresher training days.

4.8. Role of the Fire and Security Advisors

The Fire and Security Advisors are responsible for: Ensuring the Capital and Information Manager is made aware of any

concerns relating to fire safety and environmental security arrangements which may increase risks to lone workers working in buildings or premises under the Trust’s control; and

Providing advice support and assistance to community based staff that may have concerns relating to fire safety which may increase risks to lone workers working in patients’ homes or other premises not under the Trust’s control.

4.9. Role of Managers, supervisors and team leaders

Managers, supervisors and team leaders are responsible for: Ensuring where possible, that the need for lone working is avoided; Where lone working cannot be avoided, ensuring that robust lone

working arrangements (controls) are implemented and followed by staff, agency and temporary workers, volunteers and contractors under their control, in accordance with the Lone Working Policy and any supporting guidance documents;

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Ensuring that risk assessments and actions plans relating to lone working are completed, monitored and reviewed in accordance with the Trust’s Risk Management Policy;

Supporting staff in the completion of incident reports, including near misses relating to lone working in accordance with the Trust Incident Management Policy;

Ensuring where appropriate that local induction programmes familiarise new staff, agency, temporary workers and volunteers under their control of lone working arrangements applicable to their job role;

Ensuring that employees attend appropriate training according to their level of risk and that employees are provided with suitable and sufficient information and instruction in relation to their job role and the risks that may apply when working alone;

Acting on any concerns raised in relation to lone working arrangements that may affect staff under their control. This includes investigating reported incidents and seeking advice and support from the Local Security Management Specialist, Health and Safety Manager and other specialist advisers subject to the concerns raised by staff; and

Ensuring that they supervise and monitor the implementation of lone working controls and other management systems.

4.10. Role of all staff

All staff who by definition are lone workers are responsible for: Taking reasonable care of their own health and safety and consider how

their acts and omissions may affect their safety as a lone worker. For example, by not putting themselves at undue risk of harm and taking necessary action to minimise the possibility of an incident occurring such as a community nurse withdrawing themselves from a home visit should they feel threatened, or the home environment is unsafe and their immediate safety is at risk. For example a patient refusing to stop smoking whilst on oxygen therapy, even when informed of the risks to themselves and others.

Co-operating with the Trust to enable the Trust to comply with health hand safety duties and report any concerns they may have in relation to lone working arrangements to their line manager;

Attending any relevant training relating to lone working where appropriate for the job role;

Following standard operating procedures, making use of any technology or equipment provided for their safety as a lone worker; and

Reporting at the first available opportunity any incidents, including near miss incidents relating to lone working that occur in connection with work using the Trust’s incident reporting procedures (see Incident Management Policy).

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5. Risk Assessment

Staff who work on their own for significant periods of time may face increased risks, because they do not have immediate support of colleagues or other staff who may be present should an incident occur.

Risk assessments are required to be competed for the management of lone working activities in accordance with the Trust Risk Management Policy.

Risk factors which relate to lone workers must be considered. Proactive measures focus on the identification of potential hazards, predicting likely outcomes and implementing reasonable and appropriate control measures to manage foreseeable risks faced by staff.

Where appropriate and relevant, risk assessments will ensure that systems and procedures for those working on their own will be tailored to suit teams locally and the work activities being undertaken to ensure lone workers are at no more risk than other workers.

5.1. The Hazards of Lone Working

Staff who by definition are lone workers face the same hazards at work as other Trust staff; however for those working alone there may be additional hazards. When assessing the level of risk, it may be identified that a certain task cannot be completed by a lone worker. The risk cannot be reduced to an acceptable level and therefore has to addressed in another way, for example a patient attending an Outpatients Clinic rather than someone completing a home visit on their own.

5.2. Violence and aggression

Violence and aggression is consistently in the top categories of reported incident affecting Trust staff. These include actual physical as well as non-physical harm (see Managing Violence and Aggression Policy)

A lone worker might find themselves in a potentially hazardous environment should they be dealing with challenging, unpredictable, emotional or disturbed people.

Health care professionals delivering a service on a one to one basis that are by definition lone workers may be at greater risk of harm (physical or psychological). Staff may be more vulnerable to violence and aggression incidents and potentially less able to summon help. Factors that may increase the risk of an incident include:

Persons present under the influence of drugs or alcohol; Having to withhold or withdraw a service; The carrying of and /or controlling access to drugs and other medical

supplies;


Lone Working Policy


Handling or carrying cash, valuables, medical supplies or other portable equipment; or

Working in a geographical area where the crime rate is known to be high.

Violence and aggression risks must be considered as part of the lone working risk assessment (see Managing Violence and Aggression Policy).

Community staff such as community nurses are encouraged to make dynamic risk assessments using their clinical judgement balanced against ensuring personal safety. Where considered necessary staff must either cancel or cut short home visits subject to the situation and circumstances.

Any clinical risk affecting patient safety resulting from the decision taken to leave a property must be clearly identified and escalated to the relevant manager e.g. line manager, General Practitioner (GP), Community Services Manager, Senior Clinician on call or the Assistant Director of Nursing as appropriate. This must be documented in the patient’s clinical record. The patient must also be advised where possible, and informed of any actions they might take to reduce any clinical risk.

5.3. Unforeseen circumstances

Wherever possible employees should not be exposed to unforeseen circumstances. All efforts must be taken to identify hazards and risks prior to episodes of lone working and actions put in place to avoid these risks. However it is recognized that this may not be possible on every occasion

For example a physiotherapist completing a home assessment prior to a patient’s discharge from hospital, may not be able to assess the environment they are entering. Risks may include:

Violence and aggression risks as noted in 5.1; The presence of dangerous animals such as an aggressive dog; or Exit routes being unexpectedly blocked.

Under no circumstances must an employee put themselves at risk. If a situation arises that they are unfamiliar with or in which they feel unsafe, they should withdraw and seek further advice and assistance.

5.4. Moving and handling

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For those working on their own the risks of a moving and handling injury may be higher. Standard operating procedures must address the risk and ensure appropriate control measures are in place. This may exclude lone working where the standard operating procedure requires the task to be undertaken by more than one person to safely complete the task. For example, where patients are being cared for in their home and there is a need for hoisting. Patient care plans must take into consideration if it is safe for a member of staff to complete hoisting tasks on their own (See Moving and Handling Policy).

5.5. Fire

Staff working on their own in remote or isolated areas of a site may be at more risk should a fire occur.

Consideration must be given by lone workers to ensure that they can hear alarms, exit safely and call for assistance. Fire risk assessments of Trust premises must take such factors into consideration (see Fire Safety Policy).

Lone workers attending non-Trust controlled premises must make themselves aware of the fire safety management arrangements.

For community staff, supporting information in respect of fire safety in domestic settings and guidance on home oxygen safety have been published on the Trust’s intranet site (BOB).

5.6. Hazardous chemicals and other substances

Some staff working on their own may be required to work with and handle hazardous chemicals or other substances, for example:

A Pathology laboratory technician providing an out of hours service; A Porter conveying substances between sites; or A Community midwife transporting medical gas cylinders.

For community staff, supporting information in respect of the transportation of medical gas cylinders has been published on the Trust’s intranet site (BOB)

Risk assessments must take into consideration any increased risk factors that may affect those working on their own whist handling or dealing with chemicals or other substances (see Control of Substances Hazardous to Health Policy).

5.7. Driving

Staff who travel alone for significant periods or in certain circumstances may face hazards such as:

Vehicle breakdown; Road traffic accident;











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Adverse weather conditions and / or driving at night; Becoming lost in an isolated or unfamiliar area; or Feeling vulnerable or threatened whilst using taxis or public transport.

In emergency situations including severe weather, where community staff undertake home visits or travel between sites, staff safety must be balanced against patient clinical need. Staff are encouraged to make dynamic risk assessments using their clinical judgement balanced against ensuring personal safety regards delaying travel during;

Adverse weather events, Unforeseen circumstances; or Other dangerous situations such as road traffic accidents.

Staff must liaise with their line manager in accordance with buddy systems for support in making alternative arrangements, delaying travel or cancelling the home visit.

Any clinical risk affecting patient safety must be clearly identified and escalated to the relevant manager e.g.; line manager, General Practitioner (GP), Community Services Manager, Senior Clinician on call or the Assistant Director of Nursing as appropriate. This must be documented in the patient’s clinical record. The patient must also be advised where possible, and informed of any actions they might take to reduce any clinical risk.

Consideration should also be given to the risks associated with transporting patients or others without being accompanied by a colleague. A passenger may be a risk because of a medical condition or previous history of violent and aggressive behaviour.

Driving risk assessments must be completed (see Health and Safety Policy).

Supporting information in respect of driving has been published on the Trust’s intranet site (BOB).

5.8. New and inexperienced staff

New and inexperienced staff are generally more at risk than more experienced staff. These risks may be increased when working alone for periods of time without supervision. This may be due to:

Inexperience of the job role and / or lack of familiarity with the environment;

Inexperience and / or maturity to deal with conflict or inappropriate behaviour; or

Lack of knowledge and understanding of standard operating procedures and the reasons for using them.



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Consideration must also be given to temporary, agency or bank staff and their level of experience and training to be able to deal with tasks that require them to work on their own.

Risk assessments must be completed that account for these factors. (See Health and Safety Policy). Inexperience and / or young workers must be provided with adequate levels of supervision, training and support. Upon assessment of risk, they may be excluded from certain tasks.

5.9. Cultural sensitivity

Religious and cultural issues (e.g. gender or ethnicity issues) may exacerbate the risks faced in a lone working situation. It is important that lone workers are made aware of such issues and measures are taken to address issues where identified.

Staff may be subject to verbal abuse and harassment, including racial and personal abuse (see Violence and Aggression Policy).

5.10. Medical and other conditions

Certain groups of staff who are required to work alone may face further challenges these include:

New and expectant mothers; and Those with medical conditions that may affect their ability to work

alone.

Such factors may increase risk such as being taken unwell unexpectedly. This may pose issues in relating to summoning help and the length response time (see New and Expectant Mothers at Work Policy and Health and Safety Policy).

Individual employee risk assessments must be completed and appropriate control measures put in place. The risk assessment must be kept in the employee personal file and the employee provided with a copy.

5.11. Emergency Response

Some activities may result in staff working in particularly remote areas. The length of response times may present particular risks to lone workers. Assessments must consider the provision of:

First aid equipment (see First Aid Policy); or Emergency equipment such as a torch, map and emergency contact

numbers for summoning assistance.

See Appendix C for guidance on using “In Case of Emergency” details (ICE) in mobile phones and other mobile devices.







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6. Control Measures

For the risk assessment process, those responsible for lone workers (see section 4.6) must identify the hazards (see Section 5) and ensure that appropriate and proportionate control measures are implemented for managing foreseeable lone working risks.

Where it is possible, systems should be adopted to avoid staff working alone.

6.1. Appropriate level of control

Low risk

There may be certain work activities that through risk assessment are identified as low risk. For example:

A member of experienced administrative staff, in good health, working on their own during normal daytime hours in a secure building not accessed by patients or the public. Staff from other departments may work out of direct line of sight in adjacent office suites. With reasonable and proportionate control measures in place, lone working would be acceptable in this situation.

High risk

Some activities through risk assessment may be identified as high risk. For example:

There is a history of violence with a service user and their family. Previous incidents have been reported via the Trust’s incident reporting system. For such a high risk scenario, it may not be appropriate for someone to complete a home visit on their own. Consideration must be given to treating the service user away from their home, in a more secure environment. If this is not possible, then it may be appropriate for the visit to be completed by more than one person.

Subject to such high risk circumstances sanctions may be required which could ultimately result in a service being withdrawn (see Violence and Aggression Policy).

6.2. General Practitioner Violent Patient Scheme

To assist in managing risks to lone workers in the Trust the Local Security Management Specialist is notified of all patients placed on the General Practitioner (GP) Violent Patient Scheme due to violent or aggressive behaviour. Information of patients placed on the Violent Patient Scheme is available to staff upon request.

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It may not be appropriate for lone workers to visit patients on the Scheme in their homes, but if there is a clinical need, managers and staff should ensure that an appropriate risk assessment is conducted and the necessary measures are in place beforehand.

Lone working staff may need to come into contact with family members of a patient who is on the Violent Patient Scheme when providing clinical care/treatment. Proper provisions should be made to deal with this situation.

Staff notified of, or who encounter patients on the Violent Patient Scheme should contact the Local Security Management Specialist who will provide staff with advice, support and assistance with regards the management of patients or service users on such schemes.

Through risk assessments the following requirements may be identified:

Security controlled access to healthcare services; or Acceptable behaviour contracts for individual service users.

(See Violence and Aggression Policy).

6.3. Planning Visits

Prior to visiting patients in their home, staff must plan ahead. Issues and actions to consider will include (but not be limited to):

What shared information is available regards the service user or the environment?

Telephoning the patient before visiting will help determine their emotional state, sobriety and mood.

Should there be animosity towards one member of staff, can they be substituted?

Engaging with the patient to agree “ground rules” for visits (See Code of Conduct leaflet). Discuss acceptable behaviour and what is expected during a visit e.g. providing a smoke free room or keeping dogs outside.

6.4. Communication and buddy systems

Systems and procedures are required to ensure that teams are aware of a lone worker’s location and movements. Patient identifiable information must be kept in a secure manner in accordance with the Information Governance and Confidentiality Policies.

Subject to the team and work activities being undertaken this may include:

Leaving a written visiting or task log with a manager or colleague; Maintaining a diary of visits or updating electronic system, that can be

accessed by others; Providing details of the people they will be visiting, including patient

addresses and telephone numbers;



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Recording the anticipated time and duration of work activities or visits; Using a whiteboard or similar in a secure and confidential environment; Maintaining a data base of contact details for lone workers, (including

vehicle details where appropriate) next of kin and other nominated emergency contacts; or.

Operating a buddy system.

Buddy systems enable staff to keep another colleague informed of their movements. These have the advantage of flexibility in as much as the buddy can be kept informed of unplanned changes to the planned schedule of work activities. For example, a community nurse changing the order of home visits due to patient availability or a maintenance worker changing location and work task due to weather conditions.

Buddy systems can provide reassurance to staff working on their own.

For buddy systems to work, teams must ensure that the nominated buddy understands the agreed standard operating procedure and:

Has access to information relating to the movements of the lone worker;

Knows contact details for the lone worker (including vehicle details where appropriate) their next of kin and other nominated emergency contacts;

Agrees with the lone worker timescales within in which contact will be made (check in times), this may include at the start or work, between visits and when returning to base or home when finishing work;

Will attempt to contact the lone worker should they not contact with buddy within timescales as agreed;

Understand the emergency and escalation procedures in place; and Ensures there are contingency arrangements in place for someone else

to take over the role of buddy, for example if the lone working situation extends past the end of the nominated buddy’s shift.

It is essential that systems and procedures are monitored and tested within reasonable timescales.

See Appendix A which provides an example of a buddy system, Appendix D which provides an example of a visit schedule record and also Appendix E which can be used to record community staff emergency contact details.

6.5. Sharing of information

Where legally permissible and in the interests of lone worker safety, information concerning risks posed by individual service users or patients must be communicated within the Trust where it is known that other teams or services also work with the particular service user or patient. Sharing of information must be in accordance with the Information Governance and Confidentiality Policies.


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6.6. Use of technology

Equipment provided for the safety of lone workers may be identified as appropriate for certain groups of staff. This may include:

Mobile phones; Two way radios (walkie-talkies); Lone worker safety devices for community based staff (typically those

who undertake home visits); Personal transmitter alarms linked to locator panels within fixed

buildings; Panic attack alarm systems in treatment or consultation rooms within

fixed buildings; or Personal audible alarms.

It must be noted that lone worker safety devices will not prevent incidents from occurring and are intended as an additional layer of protection and cannot be solely relied upon or be seen to replace existing control measures.

Personal audible alarms are primarily designed to create a distraction, to startle or disorientate to allow a member of staff time to escape from a violent or threatening situation. Such alarms may not be heard by those who could assist and the expected response from use of such alarms must be considered.

Personal transmitter alarms and panic alarm buttons can discretely and in some instances silently raise an alarm. Procedures must be agreed when using such devices to ensure appropriate responses and support is achieved should an alarm be activated.

Lone worker devices, personal transmitter alarms, personal audible alarms, emergency call bell systems and the like must be periodically tested within reasonable timescales that are balanced against the frequency of the work activity or task, the type of technology in use and the level of risk.

6.7. Escalation procedures

Escalation procedures are required to support communication and buddy systems. The procedure outlines who should be notified if a lone worker cannot be contacted within agreed or reasonable timescales. The escalation process must identify suitable contacts appropriate for the team, service or department, for example a line manager, senior manager or the police.

For further guidance on escalation procedures refer to Appendix A.

6.8. Work equipment

Any work equipment provided for a lone working member of staff must be fit for purpose and be suitable and safe for handling and use by a person on their own.

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For example, it would be unsuitable for someone to undertake a task on their own where it is identified that more than one person is needed to operate essential controls for the safe running of the equipment supplied.

6.9. Code of Conduct Leaflet

The Code of Conduct leaflet for staff and patients outlines the codes of conduct expected of all Northern Devon Healthcare NHS staff and also our expectations in relation to patients to enable staff to provide the very best care possible. The leaflet is supported by the Violence and Aggression and Lone Working Policies.

7. Incident Reporting

Incidents relating to lone working (including near misses) that occur must be reported at the first available opportunity using the Trust’s incident reporting procedures (see Incident Management Policy)

The Local Security Management Specialist and Health and Safety Manager, and where appropriate other specialist advisers, will support managers in the follow up and investigation of reported incidents.

The aim of the investigation process is to monitor and learn from incidents, act on findings and implement measures to prevent similar incidents occurring.

Upon investigation certain information in the interests of staff safety may be shared with other Services or Departments and external agencies such as the Police, Security Management Service and the Health and Safety Executive.

8. Training Requirements

All staff who are required to undertake health and safety training related to their lone working activities will be identified through the Trust’s training matrix available via BOB under ‘What training do I need?’. The training matrix will detail:

Staff groups requiring training; Frequency of training; Mode of deliver i.e. e-learning or taught; and Course titles.

Booking for all health and safety training related to lone working activities training will be undertaken through Workforce Development via the Electronic Staff Record. Signed records must be kept of all training undertaken in the Trust. These records will be held centrally and reported Trust wide through Electronic Staff Records. Individuals are encouraged to keep a copy of this in their portfolio.



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On updating the Electronic Staff Record, line managers will be notified of all non-attenders, further detail on booking and reporting processes are contained within Risk Management Training Policy.

8.1. Lone worker safety device training

Certain groups of staff that through risk assessment have been issued with lone worker safety equipment, may receive other specialist training delivered by external trainers in the safe and appropriate use of the technology or equipment provided.

8.2. Conflict resolution training

The Trust requires that all front line staff (those dealing directly with the public) receive the National Syllabus in Conflict Resolution Training. This training is intended to help prevent situations escalating and to diffuse potentially abusive and violent incidents (see Violence & Aggression Policy).

9. Monitoring Compliance with & the Effectiveness of the Policy

9.1. Standards/ Key Performance Indicators

Key performance indicators comprise:

There are no specific key performance indicators for this policy.

9.2. Process for Monitoring Compliance and Effectiveness

Monitoring Arrangements

Compliance of this policy against all minimum requirements in the NHSLA Risk Management Standards will be monitored on a three yearly basis as part of the health and safety audit programme and assessment of complaints and incidents.

Responsibility

The Health and Safety Manager will be responsible for monitoring and reporting to the Health and Safety Committee.

Methodology

Using audit tool attached (see Appendix G).

Reporting Arrangements

The result of the audit will be reviewed by the Health and Safety Committee.

Audit results



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The Corporate Governance Team will develop an action plan to improve compliance and ensure improvements in performance occur. Action plans will be implemented by the Health and Safety Manager in conjunction with the Local Security Management Specialist to ensure learning takes place.

The Health and Safety Manager monitors progress of the action plan via the Trust’s risk management processes. Exceptions will be reported to the Health and Safety Committee. Identified risks related to the non-compliance with this policy through audit will be registered on the Trust’s Corporate Risk Register by the Health and Safety Manager.

Where non-compliance is identified, support and advice will be provided to improve practice.

10. References

10.1. References - Legislation

Health and Safety at Work etc Act 1974

Management of Health and Safety at Work Regulations 1999

Secretary of State for Health Directions on NHS Security Management Measures (2003, 2004 and as amended 2006)

Secretary of State’s Directions on work to tackle violence against staff and professionals who work or provide services for the NHS (2003)

10.2. References – Others

The Health and Safety Executive (HSE) website provides further information and resources: www.hse.gov.uk.

Working alone: Health and safety guidance on the risks of lone working (2009). INDG73 (rev2), published 09/09

Can a person be left alone at their place of work? www.hse.gov.uk/contact/faqs/workalone.htm

Work-Related Violence. Lone worker case studies www.hse.gov.uk/violence/loneworkers.htm

Five steps to risk assessment. INDG 163(rev3) revised 06/11.

The NHS Security Management Service (NHS SMS) website provides further information and resources: www.nhsbsa.nhs.uk.

Not Alone: A Guide for the better protection of lone workers in the NHS. (2009, version 2)

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Developing a policy for the protection of lone workers (2009, version 2)

NHS Employers. (2010). ‘Health and safety essential guide’, “lone working”. NHS Employers website pages. NHS Employers. Available at: www.nhsemployers.org

Royal College of Nursing. RCN lone worker guidance for nursing staff provided at http://www.rcn.org.uk/support/the_working_environment/violence

You’re not alone. Leaflet published June 2007

UNISON. The UNISON website provides further information and resources: www.unison.org.uk

You are not alone. A UNISON guide to lone working in the health service. April 2007

Working Alone. A health and safety guide on lone working for safety representatives. March 2009

10.3. Further Information

The Suzy Lamplugh Trust, a registered charity, is considered a leading authority on personal safety. Further information is available at: www.suzylamplugh.org/

Keeping Safe. Buddy System Guidance leaflet. 2011

Personal Safety in the Workplace. Working Alone. 2011

The Royal Society for the Prevention of Accidents. RoSPA is a registered charity promoting safety and the prevention of accidents. Further information available at

www.rospa.com/

Out of site: Home visitors article. Sept 2008

11. Associated Documentation

Confidentiality Policy; Control of Substances Hazardous to Health Policy; Code of Conduct Leaflet; Fire Safety Policy; First Aid Policy; Health and Safety Policy; Incident Management Policy; Information Governance Policy; Incident Management Policy; Violence and Aggression Policy; Midwives Working Alone – Lone Working Policy; Moving and Handling Policy; New and Expectant Mothers at Work Policy; Risk Management Policy; Risk Management Training Policy; Supporting Staff involved in an Incident, Complaint or Claim Policy





















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Appendix A: Example Buddy System

Example Buddy System & Escalation Procedure, Community Team

This is an example, intended as a guide and to illustrate best practice. It may not suit all situations or work scenarios and can be tailored provided the core principles are maintained.

Home visit required

Pre-shift team planning meeting. Scheduled visits discussed. Buddy agreed for lone worker

Record order of visits, duration and anticipated return time to base. Agree check in times with Buddy

Names, addresses and landline numbers of patients on record at base. Buddy can access records (appendix E).

Change in sequence of visits, delay or incident, keep Buddy informed (check in)

Upon completion of visits, return to or contact base

Community Worker to complete sequence of

home visits as recorded in diary and /or electronic

device

Upon completion of visits, return to / or contact base

Lone worker contact details for home, next of kin and type of car on record (Appendix E)

Check in times exceeded by one hour

1) Buddy attempts contact with lone worker by mobile phone

2) Buddy contacts patients visited on itinerary starting with last visit

Next of kin provided with contact details of base.

3) Buddy contacts lone workers home or nominated next of kin

4) Buddy contacts:

member of the service management team (between 09:00 – 17:00, Mon – Fri)

Trust Director / Senior Manager on call at all other times

Senior manager informed of:

Last known visit and whereabouts

Next scheduled visit and location

Contact and car details for lone worker

Senior manager to re-check steps (1) and (3) and (2) if no response had been gained previously

Senior manager to inform Police

Under no circumstances must anyone put

themselves at risk. If a situation arises that

makes the lone worker feel vulnerable or unsafe they must make excuses to leave immediately and seek further advice and

assistance

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Appendix B: Protecting yourself guidelines

Issues to consider to protect yourself when visiting patients at their home

These guidelines are general, and should be applied as appropriate for different groups of staff. They do not negate the requirement for each department / team to have a fully documented risk assessment for violence and aggression and lone working, but can form part of the control measures to reduce the risk.

It is essential that the following elements are in place for all members of staff working alone in the community, who carry out visits to patients’ homes.

• An itinerary of visits held at an agreed and accessible location such as the work base;

• The itinerary of visits should include as a minimum:

o Name, Address and telephone number of place visited o Name of person visited at that location o Order of visits (as near as possible) o Description of vehicle used and registration number (see Appendix E)

• An agreed contact point and details of how to contact that person(s) (e.g. team leader, colleague, receptionist);

• The contact person should have access to any mobile phone numbers, home numbers, bleep numbers for staff they are covering;

• An agreed contact time or return to base time;

• If no message has been received by the buddy or contact person 1 hour after the agreed contact time, the contact person should follow the agreed escalation procedure; and

• The contact person should be advised of any extra / new visits which were not previously detailed on the itinerary.

Home Visiting Checklist

Have you:

• Got information about the area to be visited and ensure you know exactly where you are going?

• Carefully previewed the day’s visits?

• Scheduled visits to problem areas for particular times of day, such as morning?

• Consider whether to ‘double up’ or take an escort if unsure?

• Given patients’ information about your role and the planned appointment so that they know what to expect?

• Left your itinerary and expected departure/arrival times with your buddy or contact person?

• Told your buddy or contact person about possible changes of plan?

• Asked patients to leave a prominent light on at night to help you find the house?

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• Advised an expected return time or anticipated duration time for the visit / visits?

• Checked that you have all the equipment required for the treatment or procedures to be carried out as this may cause tension?

• Ensured your vehicle has sufficient fuel and is well maintained?

When travelling:

• As far as possible, allow yourself adequate time for the journey so that you are not rushing;

• Drive sensibly to help avoid incidents of road rage. Keep aware of the latest police recommendations regarding road rage. For example, if another driver gets annoyed with you:-

o Do not make gestures; o If you are followed try to get to a location where other people will be around,

such as a petrol station.

• Drive with bags, drugs, documentation and equipment concealed preferably in the boot of car. Ensure they are hidden when you leave 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 well-lit areas at night;

• Avoid as far as possible, waste ground, isolated pathways and subways, particularly at night; and

• Be aware of the nearest place of safety such as shops.

When arriving at a patient’s home:

• Do not enter a location if you are uneasy about your safety;

• Leave the home if you feel unsafe; you can obtain support and re-enter if necessary for patient safety;

• 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;

• Avoid being locked in by patients or other persons;

• Treat patients courteously, remembering that you are a guest in their home; and

• Avoid arguing with a patient or relative who is very unhappy with a service- instead refer them to the PALS or Complaints Service or offer to have those services make contact.

When visits are completed:

• Always return to base or phone in at the end of your visits. If your plans change or you get delayed, phone in to your buddy or contact person to let them know.

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Appendix C: Guidelines

Personal safety when visiting patients at home or working alone

This guidance sets out core personal safety control measures for lone workers visiting patients at home. Not all measures will be appropriate to all clinical services and in some cases there will be a need for control measures to be tailored to the needs of the department and the individual.

General controls

Where home visits are being carried out planned visits must be recorded in a diary or accessible electronic device, list or similar that is accessible to colleagues in event of concern.

Employee details should be kept at the base, including name, home & mobile telephone numbers, next of kin contacts (home / mobile / work). The make, model, registration & colour of the employee’s car should also be recorded. These details should be kept secure but accessible in event of emergency. See Appendix E.

All staff who carry out home visits / community work should carry mobile telephones. Users should programme numbers for the manager, colleagues & emergency services into the telephone.

All staff working directly with the pubic, including reception staff, must attend Conflict Resolution training. Managers must ensure that existing and new staff attend this training.

ICE – In Case of Emergency

Putting the acronym ‘ICE’ (In Case of Emergency) in front of a designated emergency contact in your mobile phone will save crucial time if you become ill or are in an accident and cannot communicate critical information to the emergency services. This is the recognised way of letting the emergency services know who to contact should you be involved in an accident.

Follow these hints to get the best out of ICE

• Make sure the person whose name and number you are giving has agreed to be your ICE partner

• Make sure your ICE contact has a list of people they should contact on your behalf – including your place of work

• Make sure your ICE contact’s number is one that’s easy to contact, for example a home number could be useless in an emergency if the person works full time

• Make sure your ICE contact knows about any medical conditions that could affect your emergency treatment – for example allergies or current medication

• Should your preferred ICE contact be deaf, then type ICETEXT then the name of your contact before saving the number

• For more than one contact use ICE1, ICE2, ICE3 etc*

*If your phone doesn’t show the caller’s name any more this will be because your ICE contact number is a duplicate entry of another contact in your phone book. If you have two numbers the same, your phone won’t know which one to display so it will show just the number. To get round this, simply type a * after the number under your ICE contact. It will still work and will solve the caller – ID problem.

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Visiting Patients in their home

A “Buddy system” is a good practice and appropriate for use where conducting home visits i.e., a colleague knows the time you are due to report back or “check in” by phone to the office or a colleague’s mobile. If unable to obtain a reply your colleague will call you or escalate to the manager as necessary.

In some cases it is helpful to telephone certain patients to assess mood prior to a planned visit. This has proven helpful in cases where a patient uses alcohol or drugs, and can help assess sobriety before the visit.

Consider hazards from dogs, animals and environmental hazards such as faulty wiring or trip hazards in the patient’s home. Staff must leave a situation in which they feel vulnerable and seek assistance from their team leader.

Where there is any history of aggression towards the Trust’s staff or staff are notified of aggression towards other health and social care services involved the situation must be risk assessed with the team leader. Alternatives to home visits may be necessary, such as specific control measures used. The risk assessment should be conducted with advice sought from the Local Security Management Specialist.

Patients with a history of aggression are assessed for inclusion on the Violent Patients Scheme. Patients on the scheme may be seen under controlled circumstances only, including security provision. A list of patients on this scheme is circulated to relevant services. Two way information sharing with health / social care / GP practice colleagues is encouraged where there is any history of aggression or violence. This is acceptable under Information Governance procedures.

Incidents

All incidents of violence or aggression must be reported, via the Trusts incident reporting procedure.

Additional control measures

Staff sometimes feel vulnerable when travelling alone, particularly when working outside ‘office’ hours. Consider the timing of your visits and also where you park your car. Risk assess visits to known high risk areas. Staff visiting patients in evenings / at night should consider their visibility to drivers in the darkness. When parking use maximum available lighting. Ideally park in the direction of intended travel and minimise risk of being ‘blocked in’ by other vehicles. Do not leave valuables or medical supplies on display.

Remember to listen to your instincts. If a situation does not feel safe leave the home and contact your manager for advice.

No staff are expected to put up with abusive or threatening behaviour.

For further information see the Managing Violence and Aggression Policy.

Contact the Local Security Management Specialist if you have any concerns about personal security or if your team needs support to implement these procedures.

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Appendix D: Visiting schedule

Lone Workers Visiting Schedule

Display or keep in a readily accessible area known to all team staff. Display out of public sight.

Staff Member ………………………………………………………Date…………………….

Base …………..…………………………………………………………….……………..……..

Contact Numbers: Mobile…………………………..Home…….…………………………

Description of Vehicle:………………………..………..Registration:…………….….……

Approx. Time Client’s Name/ Meeting

Address Phone Number

Return to base / called in clear

Time

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Appendix E: Staff member details

Lone Worker Staff Member Details

Name …………………………………………………………

Designation (e.g. Community Nurse) ……………………………

Base ………………………………………………….………

Home Address & Telephone ……………………………………..……………………………………………………………

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

Mobile Number(s) …..……………………………………………………………………….

Vehicle details ( Registered Number/make model/colour (circle): hatchback / saloon / estate / convertible / MPV / 4x4 / m/c /other.

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

Does car have a ‘Tracker’ fitted - Yes/No – Company name

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

Next of Kin Name: ………….………………………………………………………………..

Next of Kin Relationship……………………………………………………………………

Mobile Telephone:……………………………………………………………………

Home Telephone:………………………………………………………………….....

Work Telephone: …………………………………………………………………….

Address:……………………………………………………………………………….

Other Relevant Details: ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Signature:……………………………………………………… Date Completed:………………….

This record should be kept in secure and confidential storage but staff must be aware of where stored and how to access in an emergency

Photograph

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Appendix F: Equality Impact Assessment

Table 1: Equality impact Assessment

Group Positive Impact

Negative Impact

No Impact

Comment

Age X

Disability X

Gender X Should in the interest of health and safety gender be identified as a significant issue that is likely to unacceptably increase risks in a lone working situation. It may exclude the person from working on their own (see section 5.9).

Gender Reassignment X

Human Rights (rights to privacy, dignity, liberty and non-degrading treatment), marriage and civil partnership

X

Pregnancy X Should in the interests of health and safety, new and expectant mothers be assessed as being unduly at risk due to for example medical reasons, they may be excluded from working alone (see section 5.11).

Maternity and Breastfeeding

X

Race (ethnic origin) X Should in the interest of health and safety, race be identified as a significant issue that is likely to unacceptably increase risks in a lone working situation. It may exclude the person from working on

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their own (see section 5.10).

Religion (or belief) X

Should in the interest of health and safety, gender be identified as a significant that is likely to unacceptably increase risks in a lone working situation. It may exclude the person from working on their own (see section 5.10).

Sexual Orientation X

Should in the interest of health and safety, sexual orientation be identified as a significant issue that is likely to unacceptably increase risks in a lone working situation. It may exclude the person from working on their own (see section 5.10).

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