Enhanced Care Policy for Adult Patients V1 Jan 2017
Enhanced Care Policy for Adult Patients
If being read as a paper copy, please refer to Trust intranet to ensure this is the current version
Document Reference: LGT/CN020 Version: 1.0 Date Effective: March 2017 Author: Senior Matron Nursing Development Manager Responsible Director: Selina Trueman Deputy Nurse Director Consultation: Heads of Nursing Matrons Ward Managers Patient Safeguarding Lead Approved By and Date: Heads of Nursing Meeting January 2017 Ratified By and Date: Workforce and Education Committee 19th January 2017
Target Audience: All clinical staff involved in management and care of adult patients Equality Impact Assessment: No inequalities highlighted Review Date: January 2020
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Review and Amendment Log
Version Date Author Type of change Summary of Change(s) New cross-site This policy aims to outline the care and 1.0 Nov 2016 Policy for LGT management of patients requiring
enhanced care. It is the first version of a new policy cross site.
Dissemination Plan
Audience Method Paper or Responsible Staff Electronic Member Raising Awareness: Doctors, nurses, Electronic Nursing Development physiotherapists, Place on Trust intranet and email the Manager locum staff, link to All Users. bank/agency staff, Senior Matron AEM, volunteers Include in Trust wide electronic weekly UHL bulletin
Email to all Divisional Governance Teams and Clinical Directors to request they inform their staff
Email to AHP leads
Email to Nurse Bank for information to be disseminated to all nurse bank staff
Include in ‘Just 5’ communication to all clinical areas
Documentation: Documents will be accessible through Electronic Nursing Development the trust procurement process Manager
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Content
Section Heading Page 1 Introduction 4 2 Purpose and Scope 4 3 Types of Enhanced Care 5 4 Roles and Responsibilities 6 5 Assessment Process and the Identification of the Enhanced 8 Care required 6 Involvement of Carers and Relatives 9 7 Cohorting of Patients requiring Enhanced Care 9 8 Actions to be taken prior to commencing Enhanced Care 10 9 Deprivation of Liberty 12 10 Incident Reporting 13 11 Escalation process when Enhanced Care is requested but not 13 provided 12 Procedure for undertaking enhanced care 13 13 Evaluation, review of plan and reassessment 14 14 Discontinuing Enhanced Care 15 15 Training 15 16 Monitoring Compliance 16 17 References 16 18 Associated Documents 16
Appendices 1 Working Together Leaflet 18 2 Assessment Tool for Enhanced Care 20 3 Intervention Check List 22 4 Observation Chart 24 5 Cohort Nurse Guidance 25 6 Activity Record 26 7 Enhanced Care Flow Chart 27 8 Equality Impact Assessment 28
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1.0 Introduction
This guideline is based on National Guidance for patient observation issued by the National Institute for Health and Clinical Excellence (2007) that was used as part of the Trust Improvement Planning Project. The following policy is therefore an amalgamation of best practice, ensuring it reflects Trust priorities and local issues
The Trust has stated that it is committed to improving standards of care by delivery of service that is of the highest quality possible. This includes ensuring there is a system of monitoring in place applicable to patients needs and responsive to alterations in risk, whilst being cost effective and efficient. Nurse staffing ratios/establishments have traditionally reflected bed occupancy not dependency or acuity of patients. Levels of observation may have an impact on the standard staffing and skill mix numbers and require extra controls, reporting and additional staffing.
Many different terms are used to describe the use of additional staff to maintain patient safety, for example, specialling, enhanced observations, one to one care, constant or close observation/supervision. This policy will use the term Enhanced Care to maintain consistency.
2.0 Purpose and Scope
2.1 Purpose
To ensure that patients requiring enhanced care have the appropriate level of care, supervision and observation provided to them that is based upon an assessment of risk.
Enhanced care is an integral part of a patient’s care plan, to ensure the monitoring of the patients behaviour and mental state, and identify factors that may exacerbate or inhibit challenging behaviours whilst at the same time fostering a positive therapeutic relationship and using the least restrictive means to maintain safety.
Enhanced care should never interfere or compromise any planned treatment or therapy for a patient.
This document provides guidance on how the need for Enhanced Care should be identified, implemented and evaluated to ensure that safe and effective care is provided to all patients assessed as needing enhanced care.
2.2 Scope
This policy will apply to all adult inpatient groups across the organisation. The policy applies to all staff working across Lewisham and Greenwich NHS Trust in all locations, including temporary employees, agency staff, bank workers, contractors, locum staff, carers, volunteers, visitors/family members and any other person who may be affected by its undertaking.
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In terms of context, some patients during their time at hospital may require a temporary period in which they received enhanced care to maintain their safety or the safety of others.
3.0 Types of Enhanced Care
The decision to implement enhanced care is made following a holistic risk and multidisciplinary assessment of the patient’s physical and psychological state as well as social and environmental factors at that moment in time. This needs to be clearly documented with the rationale for the type of observation clearly stated and an appropriate observer identified.
The observer must satisfy themselves that the individual they are observing is safe and appears free from harm to self and others. It is not sufficient when undertaking observations to merely record that an individual has been seen or watched.
3.1 General Observation (Routine Care)
This is the minimum acceptable level of observation for all inpatients. The location of all patients should be known to staff, but not all patients need to be kept within sight. At least once a shift a nurse should sit down and talk to each patient to assess their health and wellbeing. At the beginning and end of every nursing shift, the whereabouts and general condition of all patients should be part of the handover.
3.2 Intermittent observation (Green)
This means that the patient must be observed at specific intervals agreed by the Nurse-in- charge and where possible agreed in collaboration with the patient/carers /family as appropriate. This type of support is indicated where there is some form of identified need for enhanced care (but there is not an acute or overt risk of harm to self or others) and the patient is deemed safe between checks or has capacity to summon support where necessary.
It is anticipated that intermittent observation will only be used for a limited period of time. The time frames decided by the team must be specified and clearly recorded, as well as realistic and achievable for the staff involved.
3.3 Within eye sight (Amber)
The patient must be visible and under constant, uninterrupted supervision of the observer. Within line of sight should place staff close enough to respond immediately should an incident occur or be likely to occur. There may be occasions for some degree of privacy (e.g. use of bathroom/toilet/when visitors present), though this must be clearly stated in the care plan.
A regular summary of the patient’s condition, care and treatment must be entered on the evaluation. This must include changes in mental health, physical, psychological and social
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behaviour, pertinent development and significant events. This level may include cohorting or 15 minute observations.
Environmental factors should be considered to maintain patient safety, (e.g. removing equipment/instruments that may be used to cause harm to self or others, positioning of furniture to reduce falls, consideration of noise/lighting levels).
3.4 Continuous observation (Arm’s length)(Red)
The patient must be subject to close proximity, constant, uninterrupted observation. Actual distance or proximity must be determined by an assessment of the patient’s condition. Following an assessment, the patient may be allowed some degree of privacy (e.g. use of bathroom/toilet/when visitors present), though this must be clearly stated in the care plan. Continuous observation can include one to one care.
Such patients include those who have been assessed at high risk and with whom all other interventions have failed. This includes patients who are cognitively unwell and those who are at risk due to high acuity of need.
4.0 Roles and Responsibilities
4.1 Director of Nursing and Clinical Quality/ Deputy Director of Nursing/Head of Nursing
Responsible for the overall safe and supportive care of the patients in the Trust Responsible for the implementation and monitoring of the policy
4.2 Matrons
Review on a daily basis every patient receiving enhanced care to ensure that the risk identified in the individual risk assessment still applies and if the enhanced care is still required Provide leadership for delivery of the implementation of the guidance in their area of responsibility Ensure implementation in a timely manner of action plans devised following environmental and patient risk assessments
4.3 Nurse in Charge
Complete an individual risk assessment taking into account staffing skill mix, current patient acuity on the ward and patient risk Coordinating the multidisciplinary team assessments which will determine the type of enhanced care required Ensure that the individual delegated to undertake enhanced care has the appropriate skills/training
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Ensure staff carry out risk/care assessments which are kept up to date, are acted upon and escalated when appropriate Ensure that the member of staff undertaking the enhanced care is provided with a full handover on the patient’s condition and the rationale for this type of care Ensure that support and assistance from other members of the team are available as required Ensure that nursing documentation is completed and any incident/concern is reported as necessary via the Trust reporting system Ensure that the patient understands why enhanced care is being given. If they do not have capacity, it is essential that relatives and carers are kept informed Ensure that the patient/relatives/carers are involved with the decision making as appropriate Ensure that staff providing enhanced care are aware that where the needs of the patient are being met, they may also be asked to assist with other patient care as required. See 4.6 and 11 Ensure that enhanced care is recorded, detailing all interventions undertaken with the patient. This should be used as part of the assessment to determine if enhanced care is still required Review the clinical condition of the patient and need to remain on enhanced care Establish a rota for staff who have been identified to carry out the task of enhanced care duties over the course of a span of duty period Communicate to all staff on duty which patients are subject to enhanced care and what type of observation they require Ensure that those undertaking enhanced care are offered breaks at regular intervals Ensure that all staff attend the handover for the shift to enable them to work across the ward if needed and be aware of potential risks identified Ensure that the roster accurately reflects the request for extra staff where appropriate, to undertake enhanced care Ensure that any relatives/carers involved in a patient’s care are briefed of what tasks they can/cannot do
4.4 Ward Team/ Ward Nurse
Where the decision to implement enhanced care is taken, this must be made by using the appropriate risk/care assessments. The multidisciplinary team must be informed and where possible be part of the assessment and decision making process. When patients are transferred to the care of another provider, the nurse in charge must ensure that the receiving area is aware of the needs of the patient. Internal movement may require temporarily deploying staff to undertake direct observations in another ward/department Ensure that the patient’s need for Enhanced Care is reviewed daily
4.5 Observer (member of staff, volunteer or carer/relative)
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Aware of the scope of enhanced care activities and are aware of procedure for undertaking enhanced care Undertake the delegated enhanced care and any interventions in accordance with this guidance utilising the relevant documentation Must hand over information pertaining to the care of patients when one observer is replaced with another Be aware of the patient including their history, background, specific risk factors and current care plan Be familiar with the ward/department, its policies and procedures, and potential risks in the environment Consider approaches/interventions that have been effective for the patient in similar situations in the past, such as distraction, diversion and de-escalation techniques (see section 11)
5.0 Assessment processes and the identification of Enhanced care required
The primary purpose of any planned enhanced care is to either:
a) Ensure the safety of the person receiving enhanced care b) Ensure the safety of others from the person receiving enhanced care c) In some circumstances, both of the above
The type of enhanced care must be as a result of the risk assessment tools, for example, falls risk assessment and the assessment tool for enhanced care
On admission, each patient will be assessed by medical and registered nursing staff. All patients identified as having potential enhanced care needs will have a full assessment carried out using the Lewisham and Greenwich NHS Trust (LGT) Assessment Tool for Enhanced care (Appendix 2). An initial checklist of actions will be completed that will guide the registered nurse to identify the type of enhanced care best for the patient. This tool is not designed to override professional clinical judgement but rather support this.
This assessment tool will be kept in the patient nursing records. An individualised care plan should be instigated (blank care plan in patient assessment book 2), using the LGT Intervention Check List as a guide (Appendix 3), and observations recorded on the LGT Enhanced Care observation chart (Appendix 4).
As with all care, a multi-disciplinary team approach must be taken.
Where the patient has mental capacity, an agreement with the patient should be sought; the reasons behind any enhanced care and/or limits should be explained to the patient, carers and relatives in terms and methods compatible with their understanding. Where the patient lacks capacity, decisions should be made in their best interests in discussion with the multidisciplinary team and relatives/carers.
The reason for the type of enhanced care and when the next review is due will be specified in the care plan. This should be reviewed every 24 hours by the Nurse in Charge in
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conjunction with the Matron to determine if enhanced care remains appropriate. This must be recorded within the patient’s nursing notes
Types of enhanced care to be used should distinguish between those necessary when the patient is awake and those required when they are asleep.
The contemporaneous care plan should clearly indicate the specified type of enhanced care is being carried out.
Along with other important aspects of care, the type of observation the patient is receiving must be communicated at each handover of staff in order to promote continuity of care.
6.0 Involvement of carers and relatives
All relatives should be given a copy of the ‘Working Together’ Leaflet for information and guidance on enhanced care (Appendix 1). Prior to carers/relatives undertaking enhanced care there should be a discussion with them by a registered nurse around expectations and any limits for both the patient and carer/relative with regards to tasks they may undertake and whether an initial assessment is required, for example moving and handling, ability of carer, or clinical tasks such as NG tube feeding/dressings. Relatives and carers should be kept informed and involved in all aspects of care planning and supported to provide enhanced care at the level they feel comfortable with. Carers and relatives play an important role in the process of information gathering and assessment. They should be kept informed of changes in the type of enhanced care required and be offered explanations about the reasons for enhanced care Carers and relatives who know the patient well and are aware of the patient’s risks and needs can, at times, help and may on occasions be more appropriate than the professional staff to provide enhanced care depending on their own and patient wishes If a carer or relative undertakes the role of proving enhanced care, it remains the responsibility of the professional staff to ensure the patient’s safety is maintained. Carers/relatives must be informed of the type of enhanced care identified, and the level of information required from them to enable the staff member to complete the care plan during their period of observation. Carers/relatives must be informed who to report to when concerns arise, when leaving the patient/ward, as well as being offered the opportunity to take regularly breaks It must never be assumed that the carer/relatives will undertake the role of providing enhanced care. It is important to note that this may not always be appropriate based on the reason for enhanced care.
7.0 Cohorting of patients requiring enhanced care
If more than one patient requires enhanced care, the nurse-in-charge should consider cohorting such patients in single sex bays. This allows one member of the nursing team to
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provide enhanced care to more than one patient if appropriate. When caring for patients in cohorted bays the following needs to happen:
A cohort bay poster placed outside the bay to inform all staff and visitors of the enhanced care needs of that group of patients
Cohort bay badges and lanyards must be used. A member of staff must remain in the bay at all times; if they need to leave then they can only do so once the Cohort Badge has been passed to another member of staff who will remain in that bay until relieved
The cohort nurse should be given the Cohort Nurse guidance (Appendix 5)
8.0 Actions to be taken prior to commencing enhanced care
Where enhanced care is required, nursing staff must ensure that consideration is based on the following general principles:
8.1 Consent and capacity
All patients are presumed to have the capacity to give or refuse consent unless there is reason to believe otherwise. Capacity is ‘decision specific’. If it is suspected that a patient may lack capacity to consent to a specific decision a mental capacity assessment must be undertaken; this should be for every decision that needs to be made. The Trust’s mental capacity assessment form should be used as this contains the pathway that clinical staff must follow in order to comply with the Mental Capacity Act 2005 (form available on Trust intranet).
Where a patient lacks capacity, care and treatment must be planned in their best interests in discussion with the multi-disciplinary team and those close to the patient. If the Trust’s mental capacity assessment form is not used, all clinical documents must include information detailing the assessment process and how it was concluded that the patient lacks capacity.
Where possible, patients should be given a choice as to the gender of the staff providing enhanced care, particularly at night.
8.2 Environment
Factors relating to an individual’s surroundings should be risk assessed. Consideration should be given to where the patient is located on the ward as well as other factors such as clutter
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8.3 Consideration of day/night/weekend/weekday
Patients on any type of enhanced care must have a complete multi-disciplinary review of their enhanced care needs on a Friday for action over the weekend period. This should be clearly documented in the patient’s care plan.
Staff should continue to review the enhanced care provided at each handover throughout the weekend as per the patient’s weekday observation care plan to ensure that the type of enhanced care is appropriate. In some instances it may be necessary for the patient to continue to receive enhanced care throughout the weekend or bank holidays with review by the multi-disciplinary team on the first normal working day.
In terms of night observations, once a patient’s sleeping routine has been established, staff should aim to complete the data collection/care assessment forms in relation to enhanced care and prepare for when the patient is awake.
8.4 Communication
It is essential that all members of the multidisciplinary team are aware of which patients require enhanced care and the type required. Patients should be informed of the type of enhanced care that is being put in place for them, the reasons for this and any expectations of them. Effective engagement with patients and their relative/carer underpins effective enhanced care. Communication can only take place with the relative/carer if a patient with mental capacity has given permission.
Shift handovers are a particularly vulnerable time in relation to enhanced care delivery as there is the potential for increased risk of harm and reduced patient safety caused by misunderstanding or lack of communication. Staff should follow relevant communication and handover guidelines.
Any person joining a shift outside of handover times must report to the nurse in charge who must ensure that they understand their responsibilities if they have been identified to act as an observer and will be carrying out enhanced care. The nurse in charge remains responsible for ensuring the correct employment checks have been made for non- substantive staff.
8.5 Documentation
Following a full MDT assessment and the identification of the need for enhanced care using the LGT Assessment Tool for Enhanced Care (Appendix 2), an Enhanced care activity record (Appendix 6) must be completed for every patient. This can be used for all types of enhanced care and includes space for recording the date/time, location, activity, mental and physical state of the patient. Additional information pertaining to more specific requirement can be sought from the patient’s care plan. Patients receiving regular observations will have their interventions record on the LGT Enhanced Care observation sheet (Appendix 4). If a patient requires one to one enhanced care, this should be clearly documented in the patient’s medical notes by the matron.
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8.6 Care Planning
A patient must have a specific care plan that details the type of enhanced care required. Care plans must include the following:
The reason why a patient requires a particular type of enhanced care and under what specific circumstances it can be increased/decreased Details of what is expected of staff/volunteer/family member/carer, particularly when providing enhanced care The amount of privacy a patient may have, if appropriate Details of what is expected of staffing providing other care The specific requirements of the observer Any specific activity that is likely to increase or decrease the patient’s agitation/behaviour and level of risk
Blank care plans can be found in the patient assessment book 2.
8.7 Specialist Input
Staff may seek assistance from specialist medical teams and specialist nurses as appropriate e.g. Adult Mental Health Liaison Team, Clinical Psychology Team, Adult Safeguarding or Learning Disability, Dementia Nurse, Outreach Team, appropriate Clinical Nurse Specialist.
If such assistance is sought, it is the Nurse in Charge’s responsibility to alert the specialists as appropriate. This will allow for development of a condition-specific nursing care plan and enhanced care staff for example RMN, RN, HCA and ensure that the individual undertaking the enhanced care receives pertinent information and training as required.
8.8 Cover
Requests for staff to provide enhanced care for further time periods should be undertaken via the matron through the Trust’s roster system, including specific requirements such as gender and/or RMN in order to identify cover for forthcoming shifts. Additional staff will only be requested once all assessments are completed with clear interventions tried and outcomes recorded. When requesting additional staff, the reason for the request must be highlighted on E roster and clearly documented in the patient’s medical notes to allow for accurate tracking of this data.
This will be done using the term ‘enhanced care’ or ‘high patient acuity’ that then allows for additional staff to be booked but redeployed in the ward as identified to best meet all patient needs.
9.0 Deprivation of Liberty
If a patient requires enhanced care, such as cohort care or one to one care and the patient has been assessed as lacking the mental capacity in regards to their care and/or treatment,
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consideration should be given as to whether the restrictions in place require a deprivation of liberty safeguard (DOLS). The Adults Safeguarding Team can advise whether or not a DOLS application is required. All patients with a DOLS in place must be regularly reviewed under the terms of the legislation. For further information and contact details, please refer to the Lewisham and Greenwich Safeguarding Adults at Risk policy and procedure.
10.0 Incident Reporting
Staff must report and record incidents arising during periods of enhanced care in line with the Lewisham Greenwich NHS Trust Incident Reporting policy and procedure.
11.0 Escalation process when enhanced care is requested but not provided
When requesting further staff to undertake enhanced care, the Nurse-in-charge must alert the Matron to discuss availability of internal staff. If none are available, the nurse-in-charge should check staff bank services.
The Nurse-in-charge with support from the Matron should explore other resources including decisions to move staff from other areas based on the least risk. An action plan should be developed, implemented and evaluated for such cases. In such cases regular routine observations need to take place using the enhanced care observation form to maintain safety as much as possible.
If no further staff are available to provide the agreed planned enhanced care, an incident report form must be completed to clearly document that enhanced care was requested but unavailable. This form should also include the impact of not providing the enhanced care and the mitigation that was used to maintain patient safety.
12.0 Procedure for undertaking enhanced care
The registered nurse in charge of the ward must ensure that all people undertaking enhanced care (observer), whether lay or professional, are given guidance about the role and expectations of tasks required. When non clinical staff are carrying out enhanced care duties they should not be involved in other duties in the clinical environment
The observer must be aware of the patient, including their history, background, specific risk factors and current care plan. The observer should be familiar with the ward/department, its policies and procedures, and potential risks in the environment The observer should consider approaches/interventions that have been effective for the patient in similar situations in the past, such as distraction, diversion and de-escalation techniques. Enhanced care gives staff the opportunity to interact, in a therapeutic way, with the patient Observers should recognise their own limitations and call for assistance when appropriate
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The length of time an observer provides enhanced care can be exhausting for both staff and patient, therefore should ideally be limited to a 2 hour period but not exceed a continuous 4 hour period unless therapeutically beneficial to the patient and with consideration of the welfare of observer. During breaks from providing enhanced care, the observer (if a member of staff) should be deployed into other work in the ward environment. It may be beneficial for the observer to engage with the patient by undertaking a number of activities. These could include the following (though not exhaustive):
Reading a newspaper Walking around the ward Completing a Moving from bed to chair Cognitive Physical crossword/quizzes Moving legs and arms in bed activity Activity Completing a jigsaw Reaching for items on the table Reading a book together Talking about current Encourage to shower, assisting affairs where necessary Talking about families Brushing teeth in the morning Talking about hobbies and Personal and before bed Social interests Hygiene Washing hands before meals Brushing hair Assisting with shaving Changing clothes and bedding Although important for Listening to music recuperation, this should Looking at pictures not happen all day, but Reading a story instead reflect the patient’s Rest Calming normal resting patterns. This should help keep the patient in a routine following discharge.
13.0 Evaluation, review of plan and reassessment
Enhanced care for any patient must be reviewed on an ongoing basis and reviewed at the start and finish of each shift by the nurse-in-charge, and be dependent on the patient’s individual needs.
The nurse-in-charge must review patients on enhanced care daily, using the enhanced care assessment tool.
The nurse-in-charge will decide whether the type of observation should be stopped, maintained, increased or decreased. The records of observation will be used as part of the process for this review by the matron and therefore must reflect the patient’s activity, mental state and presentation to enable the staffing plan to be properly assessed.
Evaluation, review and re-assessment of the documented information and patient’s condition will help to justify the type of enhanced care required. Collectively this information will also help to identify the number of patients receiving enhanced care during a particular period,
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the amount of enhanced care being provided, as well as an audit trail of evidence as to the reasons behind why a patient receives enhanced care.
14.0 Discontinuing enhanced care
When it is deemed no longer necessary to provide enhanced care, the decision to discontinue and who has contributed to making that decision needs to be clearly documented in the patient’s medical notes by the registered nurse allocated to care for the patient. This decision can be made at any time seven days a week 24 hours a day.
Documentation must adhere to the following standards:
Date and time decision made Role and printed name of person making the decision Reason for discontinuing enhanced care
If the patient was at risk of self-harm, a psychiatric assessment should be performed before enhanced care is discontinued. A referral would be made to the psychiatric team for review.
If enhanced care was provided for confusion, agitation, behaviour (aggressive, trying to leave the ward) and/or physical symptoms (unsteady risk of falls), then consideration should be given to patients previous condition and the time of day once the patient’s condition improves.
15.0 Training
It is the responsibility of nurse in charge to identify and respond to any identified training needs.
Ideally the Trust will endeavour that all staff, family members, carers or volunteers receive the appropriate training. Components of adequate training include:
Risk Assessment Duty of care suitable to their role Behaviour and expectation Management and engagement of patients at risk of harming self and others Incident reporting and procedures Engaging with the patient
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LGT Consent to Examination or Treatment policy V1 Dec 2015
Corporate & Local Induction Policy and Procedure V4 April 2014
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Enhanced Care Policy for Adult Patients V1 Jan 2017 Appendix 2
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Enhanced Care – Intervention check list for Matron, Ward Sister or Nurse in Charge:
1. Use this tool as a check list each time you are considering using Enhanced Care interventions. If patient is identified as needing Enhanced Care, complete the assessment tool for enhanced care and discuss with matron 2. Remember – this is an intervention check list - it does not replace clinical judgement, and all patients identified must be discussed with your ward Sister/ Charge manager and/or Matron who may decide to implement 1:1 enhanced care or de-escalate 3. RMNs should always be considered if the patient is sectioned under the mental health act 4. In certain circumstances where a patient scores ‘Green or Amber’ the ‘Red’ category 1:1 enhanced care may still be appropriate (such as an isolated patient with a tracheostomy) – discuss with your Matron, Senior Matron, HoN for advice 5. Out of hours – assessment, implementation and de-escalation of enhanced care is the responsibility of the nurse-in-charge. The Site Team are on hand for advice and support as required. 6. Remember to consider DOLs applications (or mental health assessment) in cases where an individual may be at risk, or their liberty may be restricted by the use of enhanced care– contact the Safeguarding, Mental Health, Disability Lead or Site Team for advice
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Enhanced Care Policy for Adult Patients V1 Jan 2017 Appendix 4
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Appendix 5
Enhanced Care Policy for Adult Patients V1 Jan 2017
Appendix 6
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Appendix 7 Enhanced Care Policy for Adult Patients V1 Jan 2017
Enhanced Care Policy for Adult Patients V1 Jan 2017 Appendix 8
EQUALITY IMPACT ANALYSIS - PART 1 – INITIAL SCREENING
1. Name of the policy being assessed? Enhanced Care for Adult Patients 2. Names of persons responsible for carrying out the Selina Trueman assessment?
3. Describe the main aim, objective and intended To ensure pro-active outcomes of the policy. You should be clear about management of patients the policy proposal: what do you hope to achieve by requiring enhanced care thus it? Who will benefit from it? ensuring that the appropriate level of care, supervision and observation is available to them. 4. Who does this policy involve and affect? Applicable to all trust employees Consider both the internal and external aspects e.g. who will implement this and who might it affect e.g. patients, users, employees. etc.
5. Is there reason to believe that the policy could NO have a negative impact on a specific group or groups?
6. Which protected characteristic groups may be disadvantaged / experience negative impact? Age NO Disability NO Gender Re-assignment NO Pregnancy/maternity NO Race NO Religion/Belief NO Sex NO Sexual Orientation NO Marriage & Civil Partnership NO Other (e.g. refugees, behavioural difficulties) NO NO 7. What research data / evidence do you have and None how has this been collected? Some Substantial
8. Have you engaged and consulted those people YES (If ‘YES’, please give who might be affected by the policy? details of those involved) Ward staff: Matrons/Sisters/Charge Nurses Heads of Nursing Patient Safeguarding Lead 9. If the policy positively promotes equality please Equally applicable to all trust explain how employees
10. From the screening process do you consider the Medium positive policy will have a positive or negative impact on equality groups? Please rate the level of impact* and The policy is equally applicable summarise the reason for your decision. to all trust employees and its implementation will ensure the safety of patients requiring enhanced care
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*Positive: High/Medium/Low (High - highly likely to promote equality of opportunity and good relations; Medium - moderately likely to promote; Low - unlikely to promote *Negative: High/Medium/Low (High - highly likely to have a negative impact on equality of opportunity and good relations; Medium - moderately likely to have; Low – likely to have little impact) *Neutral: High - highly likely to have neither a positive nor a negative impact.
Date completed: Print names: Selina Trueman
*If the screening process has shown potential for a high negative impact you will need to carry out a full equality impact assessment (part 2) – see Workforce and Education area of Trust intranet or contact Fay Blackwood
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