Lone Working Procedure - Southern Health NHS … · 1 Lone Working Procedures Version: 2 August...

1 Lone Working Procedures Version: 2 August 2016

SH NCP 24

Lone Working Procedure

(Procedures and Practices to Facilitate the Safety of Lone Workers)

Version: 2

Summary:

Procedures and Practices to Facilitate the Safety of Lone and Remote Workers

Keywords (minimum of 5): (To assist policy search engine)

Security; safety; risk assessment; assault; verbal abuse; violence and aggression; lone working;

Target Audience:

All staff employed by Southern Health NHS Foundation Trust.

Next Review Date: August 2020

Approved & Ratified by:

Health & Safety Forum Date of meeting: 25.7.16

Date issued:

August 2016

Author:

Jan Macavoy (Local Security Management Specialist)

Sponsor:

Paula Anderson Deputy Director of Finance (Security Management Director)


Version Control

Change Record

Date Author Version Page Reason for Change

May 2016 Jan Macavoy V2 1 Change of SMD as sponsor

16 Removal of 2 minute risk assessment and substitution with Role Risk assessment and evaluation tool

29 Inclusion of lone worker device management plan

Reviewers/contributors

Name Position Version Reviewed & Date

David Batchelor Compliance Officer, Quality & Governance

Department V2 20/5/2016

Sharon Gomez Essential Training Lead V2 20/5/2016

Patrick Carroll East ISD Integration & AHP Lead V2 24/5/2016


Contents

Section Page

1 Lone working 4

2 Identification and assessment of potential risks 4

2.1 Identification of risks 4

2.2 Identification of risks for lone workers 4

2.3 Risk Assessment 5

2.4 Managing Risk 5

2.5 Before a home worker visit 6

2.6 Violent Patient Schemes (VPS) 6

2.7 Information Sharing 7

2.8 Low-risk activities 7

2.9 High-risk activities 7

3 Scheduling Visits 7

4 Safety equipment 8

5 Monitoring Lone Worker Movements 8

5.1 Visiting logs and diaries 8

5.2 Lone Worker vehicle details 8

5.3 Maintaining contact with lone workers 9

5.4 Code Words 9

5.5 The Buddy System 10

5.6 Escalation process 10

5.7 Pre-registered calls to Police 10

6 Cultural Sensitivity 11

7 Dealing with animals 11

8 Smoking in the home environment 11

9 Managing conflict and aggression 11

10 Planning your journey 12

10.1 By motor vehicle 12

10.2 Use of taxi’s 13

10.3 Travelling by foot 13

10.4 Travelling for work using public transport 14

11 Lone Working Tools 14

11.1 Lone working devices 14

11.2 Mobile telephone 14

11.3 Personal attack alarms 15

12 Further information and support 15

Appendix 1 Role risk assessment and evaluation tool 16

Appendix 2 Manager’s check list 26

Appendix 3 Community based Lone Worker Form 27

Appendix 4 Lone worker information sheet 28

Appendix 5 Lone worker device – management plan 29


Lone Working Procedure To be read in conjunction with the Security and Management of Violence and Aggression Policy and Procedures.

1. Lone Working

All staff have the potential to be lone or remote workers; however staff performing some

roles will as part of their role have a greater exposure to risk of lone working; consequently all roles must be risk assessed to establish the level of potential risk for staff and to ensure that appropriate measures are in place to keep staff safe and that wherever possible risks associated with lone or remote working are minimised.

All processes must be evaluated for effectiveness and learning shared with all staff.

APPENDIX 1 documents the role risk assessment process and examples of possible measures that can be put in place to protect staff. This list of measures is not exhaustive. Also included is an evaluation checklist. APPENDIX 2 includes a check list for Managers to ensure that their staff are suitably prepared for lone working.

NHS Protect defines lone working as: any situation or location in which someone works without a colleague nearby; or when someone is working out of sight or earshot of another colleague.

The Health and Safety Executive (HSE) defines lone workers as: those who work by themselves without close or direct supervision.

Some SHFT staff may spend a significant time lone working; others may find themselves in a situation where they are for a period of time technically a lone worker. This procedure sets out procedures and guidance designed to keep staff safe.

2. Identification and Assessing of the Potential Risks

2.1 Identification of risks The identification of risks relies on using all available information in relation to lone working

to ensure that the risk of future incidents can be minimised. This includes learning from operational experience of previous incidents and involving feedback from all staff and stakeholders. It is therefore essential that staff are encouraged to report identified risks to managers, as well as ‘near misses’, so that a risk assessment can be carried out, appropriate action taken and control measures put in place. APPENDIX 1 Consideration must also be given to a particular patient or location as some patients and locations will carry a greater risk of incident than others.

2.2 Identification of risk for lone workers The risk identification process should be carried out to identify the risks to lone workers

and any others who may be affected by their work. This information is needed to make


decisions on how to manage those risks and ensure that the action taken is proportionate. Arrangements also need to be made to monitor and review the findings.1 This risk identification should consider:

lone working staff groups exposed to risk

working conditions: normal, abnormal and hazardous conditions, such as dangerous steps, unhygienic or isolated conditions, poor lighting

particular work activities that might present a risk to lone workers, such as prescribers carrying prescription forms and medicines on their person, particularly controlled drugs

staff delivering unwelcome information or bad news: whether they have received suitable and sufficient training to deliver sensitive or bad news and defuse potentially violent situations

the possibility of an increased risk of violence from patients/service users due to alcohol abuse, or drug misuse in relation to their clinical condition or response to treatment, and the risk of violence from their carers or relatives

the lone worker wearing uniforms when visiting certain patients/service users

working in or travelling between certain environments or settings

lone workers carrying equipment that makes them a target for theft or makes them less able to protect themselves

evaluation of capability to undertake lone working – for example, being inexperienced or pregnant, or having a disability.

2.3 Risk Assessment The key to risk assessment is to identify hazards, understand how and why incidents

occur in lone working situations and learn from that understanding to make improvements to controls and systems to reduce the risk to the employee. To achieve this, the following factors should be considered and documented2:

type of incident risk (e.g. physical assault/theft of property or equipment)

frequency/likelihood of incident occurring and having an impact on individuals, resources and delivery of patient care

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

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

the level of concern and rated risk

1 See Management of Health and Safety at Work Regulations 1999

2 For further information, see the Health and Safety Executive’s Five Steps to Risk Assessment:

http://www.hse.gov.uk/risk/fivesteps.htm


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

2.4 Managing Risk Managers are required to implement measures to manage, control and mitigate risks to

lone workers. The levels of follow-up action should be proportionate to the level of concern highlighted in the risk assessment.

These measures should be specific, commensurate with the risk identified, and realistic. Any associated costs need to be included not only in terms of resources and purchasing equipment but also staffing, training and expertise.

Measures might include removing weaknesses or failures that have allowed these

incidents to take place (procedural, systematic or technological), and identifying further training needs of staff in relation to the prevention and management of violence, or other training such as correctly identifying and operating the relevant technology.

2.5 Before a lone worker home visit

Where it is practicable3, a log of known risks should be kept by the department. This should record the location and details of patients/service users/other people that may be visited by staff, where a risk may be present. APPENDIX 3 This log should be kept securely and the information should be accurate and reviewed regularly. It should be available to lone workers to inspect ahead of any visit they make. Consideration should be given to requiring, as part of a lone worker’s job description that they inform their manager or buddy if they have to make a visit to an address or person on that log. Where there are realistic and significant concerns that staff may be faced with violence or aggression and a planned visit to a patient’s home or a scheduled clinic appointment has been made, staff may contact Police by dialling 101 (non-emergency number) and pre-registering their concerns. After the Call Handling Desk staff member has taken sufficient information, staff will be provided with a reference number. In the event of violence or aggression being displayed at the visit or appointment staff should ring 999 and give the call taker the reference number so that a response team can be dispatched promptly.

2.6 Violent Patient Scheme (VPS) NHS Organisations should utilise the violent patient scheme (VPS) to manage the risks to

lone working staff. Close liaison between community nursing teams and GP surgeries is essential in ensuring that appropriate warnings are given in relation to those who are deemed to be violent. It may not be appropriate for lone workers to visit patients on the VPS 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 VPS when providing clinical care/treatment. Proper provisions should be made to deal with this scenario.

3 If staff work from a variety of locations, a written log may be difficult to implement and maintain. Where this is in place,

consideration should be given to placing it in a secure location that is only accessible to managers and lone workers – for example, on the trust intranet or by setting up a group calendar in MS Outlook®


2.7 Information Sharing As part of the risk management processes outlined above, information concerning risks of

individuals and addresses should, where legally permissible, be communicated internally to all relevant staff who may work with the same patients/service users.

Members of any one family may be users of a number of the community services provided

by the Trust and sharing information between services is essential if the safety of all staff involved is to be maintained.

Service/Team managers are to notify other services of high-risk patients/clients, using the most appropriate means (i.e. e-mail) when information needs to be cascaded as quickly as possible or an appropriate notation on the patient’s record.

Wherever possible and legally permissible, the healthcare organisation should also share information on known risks of addresses and associated individuals externally, within the health, social care and other public sectors. This should include social care services, the ambulance service, patient transport services and primary care where applicable. A means of achieving this should be built into a local information sharing protocol. Communication could also be facilitated through existing participation in crime and disorder partnerships, community groups and other health-care organisation forums, and liaison with the police.

2.8 Low-Risk Activities There may be certain scenarios and activities that can be classified through a risk

assessment as low-risk – for example, staff undertaking office work during normal daytime hours. Staff in this situation may be authorised to work alone without the agreement of their line manager. However, risk assessments need to consider not only safety while at work during normal office hours, but also issues of location and timing relating to personal safety (e.g. someone leaving an empty building, alone, at night).

2.9 High-Risk Activities If there is a history of violence and/or the patient/service user, other friends/relatives who

may be present or the location is considered high-risk, the lone worker must be accompanied by at least one colleague or, in some cases, by the police. Consideration should be given to whether the patient/service user should be treated away from their home, at a neutral location such as a clinic, or within a secure environment. (See 5.7 Pre-registered calls)

3. Scheduling Visits Before visiting a location or patient/service user that is a known risk, colleagues who may

have worked alone in the same situation previously should be contacted. This aids communication and informs the action taken to minimise the risks.

If there are known risks associated with a particular location or patient/service user, lone

workers should consider, in consultation with their manager, rescheduling the visit so they can be accompanied by another member of staff or police presence. As part of the risk assessment process, consideration should also be given to whether they should, and can, be treated by attending a clinic or hospital.


If practical, the time of day and day of the week for visits should be varied when visits are frequent.

Where a lone worker has been given personal equipment, such as a mobile phone or a

lone worker device, this is safety protective personal equipment supplied in support of providing a safe working environment as required by health and safety legislation. All due care should be taken by the lone worker to maintain the equipment in good working order and ensure it is fully charged and ready to use.

4. Safety Equipment As part of the planning process, equipment that may be required to promote a safe visit

should be assessed. This might include a torch, map of the local area, telephone numbers for emergencies (including local police and ambulance service), a first aid kit, etc. Managers should also consider the use of lone worker devices. [See 11.1]

All staff should be aware of the use of 112 as an alternative to 999 in order to request

emergency assistance. 112 is the European Emergency Number and can use any network regardless of your service provider which is helpful if you are in an area where there is poor or no signal coverage. Calls to this number can be located, generally within 2 seconds of the call being received.

5. Monitoring Lone Worker Movements Lone workers should always ensure that someone else (a manager or appropriate

colleague) is aware of their movements. This means providing them with the address of where they will be working, details of the people they will be working with or visiting, telephone numbers if known and expected arrival and departure times.

5.1 Visiting Logs and Diaries

Lone workers should leave a written visiting log, containing a diary of visits, with a manager and colleague(s). This information must be kept confidential. Details can be left on a whiteboard or similar, if it is in a secure office to which neither patients/service users nor members of the public have access and is not overlooked through windows. An example of a suitable template is included in APPENDIX 3

Arrangements should be in place to ensure that if a colleague with whom details have been left leaves work, they will pass the details to another colleague who will check that the lone worker arrives back at their office/base or has safely completed their duties. For office-based staff, if details have been left on a whiteboard, they must not be erased until it has been confirmed that the lone worker has returned safely or completed their duties for that day.

5.2 Lone worker vehicle details

Details of vehicles used by lone workers should also be left with a manager or colleague, for example, registration number, make, model and colour. This information will help Police or Rescue teams locate the staff member in the event of any emergency. Details should be checked on a regular basis to ensure it is up to date. APPENDIX 4


5.3 Maintaining contact with lone workers

Procedures should also be in place to ensure that the lone worker is in regular contact with their manager or relevant colleague, particularly if they are delayed or have to cancel an appointment.

Where there is genuine concern, as a result of a lone worker failing to attend a visit or an

arranged meeting within an agreed time, or to make contact as agreed, the manager should use the information provided in the log to locate them and ascertain whether they turned up for previous appointments that day. Depending on the circumstances and whether contact through normal means (mobile phone, pager, etc) can be made; the manager or colleague should involve the police, if necessary.

If it is thought that the lone worker may be at risk, it is important that matters are dealt with

quickly, after considering all the available facts. If police involvement is needed, they should be given full access to information held and personnel who may hold it, if that information might help trace the lone worker and provide a fuller assessment of any risks they may be facing.

It is essential that contact and escalation arrangements, once in place, are adhered to.

Many such procedures fail simply because staff members forget to make the necessary call when they finish their shift. The result is unnecessary escalation and expense, which undermines the integrity of the process. Also once a period of time has elapsed following non-contact, then the escalation process must be activated to prevent delay in seeking help.

5.4 Code Words

Code words can be used to alert a colleague that a staff member is anxious about their safety or under duress. Usually code words take the form of a statement or question that would not appear to be out of context to the situation. They must have been pre-agreed by all team members and each team member will understand that when the words are used, that closed questions should be asked to enable the staff member who is with the patient to seek assistance; but without escalating any aggression. For example, a lone worker may be being held at a patient’s home against their wishes. The staff member should explain that they have to telephone their base under the pretext of checking the patient’s notes or to advise that they will be late for their next appointment. When speaking to their colleagues they can then use the following code words “I am at Mr John Smith’s house at [patient’s address]; I need you to check his red folder and tell me what medication he should be having.” “I am at Mr John Smith’s house at [patient’s address]; can you advise my next patient Sally O’Sullivan that I am running late? Using these forms of words the staff member has said where s/he is and who s/he is seeing – use of the code word “red folder” or “Sally O’Sullivan” should prompt the colleagues response “do you need help”; “do you need the police?” “Is it an emergency?” For code words to be effective it is important that they are simple and that all staff recognise that they are a sign that a member of staff feels at risk and in need of help. They can also be used in joint visits where one staff member senses possible danger to which their colleague seems unaware.


5.5 “The Buddy System” It is essential that lone workers keep in contact with colleagues and ensure that they make

another colleague aware of their movements. This can be done by implementing management procedures such as the ‘buddy system’.

To operate the buddy system, an organisation must ensure that a lone worker nominates a buddy. This is a person who is their nominated contact for the period in which they will be working alone.

The nominated buddy will:

be fully aware of the movements of the lone worker

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

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

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

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

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

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

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

5.6 Escalation Process All services must operate an escalation procedure, outlining who should be notified if a

lone worker cannot be contacted or if they fail to contact the relevant individual within agreed or reasonable timescales. The escalation process should include risk assessment and identification of contact points at appropriate stages, including a line manager, senior manager and, ultimately, the police. Any individual nominated as an escalation point should be fully aware of their role and its responsibilities and should not delay escalating concerns once a specified period of time where contact has not been made has elapsed.

5.7 Pre-registered calls to Police

Where there are realistic and significant concerns that staff may be faced with violence or aggression and a planned visit to a patient’s home or a scheduled clinic appointment has been made, staff may contact Hampshire Police by dialling 101 (non-emergency number) and pre-registering their concerns. After the Call Handling Desk staff member has taken sufficient information, staff will be provided with a reference number. In the event of violence or aggression being displayed at the visit or appointment staff should ring 999 and give the call taker the reference number so that a response team can be dispatched promptly.


6. Cultural Sensitivity Staff members must be aware of cultural and gender issues before entering a lone worker

situation, to avoid the possibility of escalating a challenging or sensitive situation. 7. Dealing with animals

Staff must consider the potential risks posed by household pets when conducting home visits. Considerations will of course involve safety, allergies and infection control. There is a danger with dogs that any intrusive treatment given to their owner, may be wrongfully be perceived to be an attack on the owner resulting in the dog feeling the need to protect them. This may result in a member of staff being attacked. Where animals are present and the staff member is concerned for any of the above reasons, a polite request should be made for the animal to be placed in a different room. If the resident/owner is not content with this request and has had the clinical and personal safety issues explained in a calm manner and if appropriate the visit should be abandoned and reported in accordance with the risk reporting policy. Every opportunity should be taken to negotiate with the patient/service user to have the animal put in a different room prior to the visit. Given that appointment times are not always given for home visits it may be helpful to offer to ring the patient service user prior to arrival so that they may put the animal in a different room.

8. Smoking in the home environment Staff members are entitled to a smoke-free environment when at work and this includes a patient’s home when they are receiving home visits. Requesting patients/service users or relatives or friends who may be present to stop smoking can be a highly contentious issue and a possible cause of aggression. Where the patient service user refuses to stop smoking then it may be appropriate to terminate the visit; however consideration must be given to the reason for the visit and whether if treatment or care is not delivered, the impact on the patient’s health and well-being. Some patients may not have the capacity to understand the need for a smoke free environment and not-smoking may trigger aggression. Every opportunity should be taken to negotiate with the patient/service user. Given that appointment times are not always given for home visits it may be helpful to offer to ring the patient service user approximately 20 minutes before the planned visit. This will enable them to finish any cigarette, put it out and if possible open windows for ventilation. If a patient is smoking and using oxygen, then staff must insist that they cease smoking immediately.

9. Managing Conflict and Aggression

It is important that staff employ the skills and techniques that form the core of the various training workshops to recognise potential warning or danger signs; diffuse the situation


where possible and if necessary remove themselves from potentially violent or dangerous situations.

9.1 Dynamic Risk Assessment The importance of dynamic assessment is that it enables lone workers to anticipate and

recognise the early warning signs of suspected risks and enables safe early interventions to minimise or negate the risk to themselves and others. It recognises that situations change rapidly as do associated risks and that dynamic risk assessment should be an ongoing process.

Dynamic risk assessments should be conducted as necessary in the circumstances in

place at the time. The process involves: • The assessment of risk in dynamic situations is undertaken before, during and after a

home visit, potentially hazardous appointment or working period. • The benefits of proceeding with a task must be weighed carefully against the adverse

risk posed to the lone worker • What sets DRA apart from systematic risk assessment is that it is applied in situations

where:

- there are unpredictable/unforeseen risks - the risk environment rapidly changes - the individual can make a risk judgement based on the situation and current

circumstances

10. Planning Your Journey 10.1 By motor vehicle

Lone working staff should ensure that they know where they are going, plan their route and always carry a map. Satellite navigation systems are excellent tools; however in built up areas GPS connections may be lost or poor.

When working in evenings/nights staff members should ensure that they park in a well-lit area, as close to the patient’s door as possible, facing in the direction in which they will leave. Staff should where possible reverse onto a patient’s drive; however should be aware that this may result in being blocked in.

If an area is known to be unsafe, a decision will need to be made by the line manager and staff member on the safety of the visit and an appropriate plan implemented. Care should also be parked when parking in residential areas as neighbours can be territorial over parking near their home. Where this is the case warning notes should be provided to reduce the likelihood of staff being subjected to aggression.

Staff members in uniform should keep their uniform out of sight as much as possible and keep any equipment locked safely in your boot as this may make them a target. All personal belongings are to be kept out of sight. It is preferable to lock items in the boot prior to arrival at your destination; putting items in the boot on arrival can draw attention to the fact that valuables are stored in the boot, increasing the risks.


Staff members should carry their car keys in their hand when leaving the premises, in order to avoid looking for them outside, which could compromise personal safety.

The inside of the car and area around the car should be checked for possible intruders before entering.

Once inside the car, all doors should be locked, especially when travelling at slow speed, at traffic lights or known danger areas.

Lone Workers should not unlock or wind car windows down to talk to people you do not know, even if they may be in distress or requiring help; they should stop in a safe place as soon as practicable and call the emergency services as appropriate.

Staff should not display signs such as ‘nurse on call’ as this may encourage thieves to break into the vehicle.

The Health and Safety Executive’s safe driver programmes advise that lone workers should reverse into car parking spaces so that, if attacked, the door can be used as a barrier.

If being followed, or if in doubt as to whether they are being followed, lone workers should drive to the nearest police station or manned lit building such as a petrol station, to request assistance. Whilst using a mobile phone when driving is an offence, the police have advised that if a person is fearful for their safety and being followed then they would consider this an appropriate method of summoning assistance.

If a lone worker uses their own vehicle, then it should be properly maintained. Importantly it should include what safeguards to make when driving alone and how to handle a situation where the vehicle breaks down or is involved in an accident.

10.2 Use of taxis

The Trust does not advocate the use of taxis or private hire vehicles for use by lone workers. Where there is an operational requirement for such transport to be used, lone workers are only use reputable licensed companies and they should book in advance. Private hire cabs should not be used, other than licensed or registered hackney carriages.

Staff members should avoid displaying uniform or equipment which would identify them as health workers. They should ensure that they remain in possession of all equipment and records and they do not leave any in the vehicle on exiting it.

10.3 Travelling by foot

Where staff need to take part of their journey by foot they should always endeavour to use well lit paths and pavements. They should avoid unoccupied/populated areas and should ensure that their colleagues are aware of the route being taken prior to the journey.

Staff members need to be aware of the areas that they are working in and plan their journey accordingly. Uniforms should be covered up and equipment and other items should be kept to a minimum. In the event of a situation where a staff member has concern for their safety, they should head for the nearest public area (Shop, Petrol Station, Police station; etc.) If possible look out for street CCTV cameras and try and remain in view of these.


10.4 Travelling for work using public transport

Where it is necessary to utilise public transport, staff members should prepare for their journey by ensuring they know the routes and times of buses/trains etc. They should stick to using larger stations and bus stops in busy areas.

11. Lone Working Tools 11.1 Lone working devices It is essential to recognise that lone worker devices will not prevent incidents from

occurring. They will not make people invincible, nor should they be used in a way that could be seen to intimidate, harass or coerce someone. However, if used correctly in conjunction with robust procedures, they will enhance the protection of lone workers. Lone workers should still exercise caution even if equipped with such devices and continue to use the dynamic risk assessment process. Finally, lone workers should remember that a device will only be useful if checked regularly, properly maintained and kept fully charged.

The use of such devices can send a strong deterrent message to potential offenders. They

may also improve the feeling of confidence amongst NHS staff, helping to reduce the fear of crime. However, physical security measures in the absence of appropriate policies, procedures, and training to prevent and manage violence may create a false sense of security. It is therefore important to ensure that robust policies and procedures are available to work in conjunction with such devices. The LSMS will work with managers to secure competitive rates and support from a LWD provider so purchases of such devices should be done in conjunction with the LSMS.

If a lone worker protection device is misused frequently or maliciously, the matter should

be referred to the LSMS for investigation, the results of which may result in disciplinary action being taken.

Where lone worker devices are issued, staff members are to be fully trained in their use prior to deployment. Where teams invest in lone worker devices to protect their staff, robust arrangements must be in place to ensure that they are suitably updated to ensure that escalation details are current otherwise in the event of an incident there may be a delay in providing support to affected staff. APPENDIX 5 sets out how lone worker devices should be managed by services who have purchased them.

11.2 Mobile telephone

Lone workers will inevitably carry mobile phones and they should always check the signal strength before entering a lone working situation. A mobile phone should never be relied on as the only means of communication. Lone workers should tell their manager or a colleague about any visit in advance, including its location and nature, and when they expect to arrive and leave. Afterwards, they should let their manager or colleague know that they are safe.

If provided, a mobile phone should always be kept as fully charged as possible.


All staff should be aware of the use of 112 as an alternative to 999 in order to request emergency assistance. 112 is the European Emergency Number and can use any network regardless of your service provider which is helpful if you are in an area where there is poor or no signal coverage. Calls to this number can be located, generally within 2 seconds of the call being received.

The lone worker should ensure they can use the mobile phone properly, by familiarising themselves with the handset and instruction manual.

Emergency contacts should be kept on speed dial.

The phone should be kept nearby and never left unattended.

Lone workers should be sensitive to the fact that using a mobile phone could escalate an aggressive situation.

In some circumstances, agreed ‘code’ words or phrases should be used to help lone workers convey the nature of the threat to their managers or colleagues so that they can provide the appropriate response, such as involving the police. The decision to use code words or phrases should give due consideration to the ability of a member of staff to recall and use them in a highly stressful situation.

A mobile phone could also be a target for thieves. Care should be taken to use it as discreetly as possible, while remaining aware of risks and keeping it within reach at all times.

Staff members are reminded that it is against the law to use a mobile phone whilst driving. 11.3 Personal attack alarms

Personal attack or shriek alarms can be used to attract attention and summon assistance. Care needs to be exercised as these alarms can escalate a situation.

12. Further information and support For additional support for the protection of lone or remote workers please contact the SHFT LSMS, for contact details see the SHFT intranet. The Suzy Lamplugh Trust is a charity which focusses on the protection of lone workers and is a further valuable source of advice and guidance.


APPENDIX 1

LONE WORKING ROLE RISK ASSESSMENS AND PROCEDURAL EVALUATION

Background This appendix to the Lone Working Procedures should be read in conjunction with the Management of Security and Violence and Aggression Policy and Procedures. Ensuring that those who work alone or remotely are adequately protected is a priority for the organisation. The NHS Protect Standards for Providers requires that each organisation assesses the risks to its lone workers, including the risk of violence. It takes steps to avoid or control the risks and these measures are regularly and soundly monitored, reviewed and evaluated for their effectiveness. This appendix sets out how:

Each role should be assessed and summarises the various processes and procedures that can be put in place to reduce and minimise the likelihood of violence and aggression.

Processes and procedures are reviewed and evaluated for effectiveness.

Processes and procedures are shared across teams and the wider organisation to ensure organisational learning and best practice. Broadly roles fall into 5 categories; however the location and type of service provided may increase the likelihood and consequence of aggression; for example, while all staff working in mental health wards are likely to be subjected to violence and aggression; those working in a PICU may find that their patients are younger and more physically able and as such the consequences of any assault may be more severe. Each role must have a role risk assessment conducted to ensure that every action is taken to mitigate the risk of violence and aggression and to keep staff safe.

Process The risk assessment process follows the 5 x 5 risk management matrix agreed as part of SHFT Risk Management Strategy and Policy. It is important to recognise that risk assessments may be dynamic and that additional control measures may need to be implemented where a higher risk is identified; for example a patient or their relative has been identified that poses a specific risk to staff. In documenting risk assessments it is important to ensure that intelligence is gathered from as may appropriate sources as possible as this may help to inform our response to the given risk. Staff should keep in mind working closely with other NHS providers, Local Authority teams and care agencies – when sharing information, staff must always follow Information Governance guidance and best practice to avoid DPA breach.


In all situations, recommended control measures should be implemented and shared with all affected staff. Managers should make sure that lone working and buddying procedures are discussed at team meetings to ensure that all staff follow agreed actions. In particular, where “code words” are used managers must ensure that all staff are familiar with the words used; their purpose and the agreed response. At least annually, managers should conduct a review to evaluate the effectiveness of the procedure, or procedures adopted. In multi-disciplinary teams, there may be a blend of processes and procedures. The review must be documented and shared with the team. This review will be assessed as part of the workplace Health, Safety and Security Assessment [HSSA]i.

Role Risk Assessments

This assessment must be undertaken for any activity deemed to present a significant risk to employees.

Trivial risks or those associated with every day life do not been to be included, unless they are compounded by the work activity.

The assessment should be reviewed by department safety representatives and included within the Business Unit’s Risk Register where scores are 8 or above.

The hierarchy of controls must be used when considering the Risk Reduction Plan, i.e. avoid if possible, assess those activities that cannot be avoided, reduce the level of risk to the lowest level reasonably practicable ergonomically, by the provision of equipment, information, instruction & training, signage, etc.

Very Low = Risk is very well managed; Low = Risk is adequately managed, although improvements may be possible to reduce the risk further; Moderate = Risk is NOT adequately managed, a detailed risk reduction plan must be completed; High = The Risk is NOT managed and could present a significant risk to SHNS. The activity should be suspended until a detailed assessment has been undertaken and a Risk Reduction Plan developed and implemented.

Ratings Action 1-3: Low Risk Local managers should manage low risks by maintaining routine procedures and taking proportionate action to implement any additional new control measures to reduce risk where possible. Local Managers must escalate higher levels of risk 4-6: Moderate Risk

Likelihood

Severity

1 2 3 4 5

Extremely unlikely

Unlikely Possible Likely Almost Certain

5 Catastrophic 5 10 15 20 25

4 Major 4 8 12 16 20

3 Moderate 3 6 9 12 15

2 Minor 2 4 6 8 10

1 Negligible 1 2 3 4 5


Service Managers must ensure that an action plan is identified to reduce risk and entered on local risk register. Managers must escalate higher levels of risk 8-12: High Risk Senior Management action plan must be specified for high risks. Appropriate management assurance must evidence and control the risk assessment, and oversee the action plan to reduce the risk. The head of service is generally responsible for this level of risk, ensuring that the risk is placed on divisional and corporate risk registers. High levels of risk must be escalated to an Associate Director 15-25: Extreme Risk Executive management is required to ensure immediate action, in line with the context of the risk. Associate Directors will be responsible for this level of risk and the action plans. However the Executive Director must be over see the progress. The Head of Risk Management, who will ensure the risk, is captured Corporate Risk Register as required.


Generic Role Risk Assessments [Keep in mind that some situations and circumstances may increase the risk to staff members for a specific activity and this must be assessed separately.]

Ref No

Group Affected Activity Hazard/Risk Existing Control Measures

Degree of Risk Additional Actions Required

to Reduce the Level of Risk

Residual Risk

L I R L I R

1.0

Corporate

Executive & Directors/Service Line Managers/Clinical Governance Leads

As per job role Hazard:

Challenging patients; service users and external stakeholders

Lone working

Travelling from site to site

All Corporate Policies in particular:

Lone working procedures

Management of Violence and Aggression Policy and Procedures

Travel and Subsistence Policy

1 3 3

Risk:

Potential for violence and aggression

Risk of breakdown


Ref No

Group Affected

Activity Hazard/Risk Existing Control Measures



Residual Risk

L I R L I R

2.0

Support – H&S, Security, Fire, Estates, Facilities, administrators

[his list is not exhaustive]



Lone working






2 3 6

Where appropriate PPE [Lone Worker device] Robust buddying arrangements] Training: CRT Breakaway techniques

1 3 3 Risk:


Risk of breakdown


Ref No




Residual Risk

L I R L I R

3.0

Clinical/therapy – clinic based



Lone working

Travelling from site to site; risk of breakdown

Risk:






Environmental controls/potential security presence

Patient history

CRT

Breakaway techniques

2 3 6

Where appropriate PPE [Lone Worker device] Panic Alarms Robust buddying arrangements including use of code words

1 3 3


Ref No




Residual Risk

L I R L I R

4.0

Clinical/therapy – ward based



Lone working






Environmental controls/potential security presence

Close proximity of other staff

Patient history including personalised care plan

Training

CRT/PRISS


2 3 6

Educational campaigns Review of incidents to determine RCA and effectiveness of control measures inclusive of formal patients written agreements

1 3 3

Risk:


Risk of breakdown


Ref No




Residual Risk

L I R L I R

5.0

Clinical/therapy – community based



Lone working

Travelling from site to site;

Risk:


Risk of breakdown





Robust buddying arrangements

Patient history including personalised care plan

Information sharing

Local knowledge of area and possible risks

Training

CRT


2 3 6

Where appropriate PPE [Lone Worker device] Increased staff presence where appropriate Liaison with other supporting agencies or providers e.g.LA Review of incidents to determine RCA and effectiveness of control measures inclusive of formal patients written agreements Potential of seeing patient in clinic setting

1 3 3

NOTE: The list of existing control measures and additional actions required is not exhaustive and local arrangements may include further actions. Signed ………………………………………………….. Signed ……………………………………………… Print Name …………………………………………….. Print Name ………………………………………… (Person Undertaking Inspection) (Manager) Date completed…………………………………………..


Risk Assessment Evaluation Team Service manager

Location Period under review

Brief summary of patient group and associated risks

Lone Working Process[es] [Please document all processes and procedures that are used by the team.]

Review Who conducted the review? [Name of staff member[s]]

When was the review conducted?

How was the review conducted?

Review findings [Document the number of staff who were able to be contacted and if they were where they should have been; who was unable to be contacted; escalation processes are appropriate and all contact details including make and model of car are accurate. Where LWDs are in use,


review usage as recorded on the web portal.]

Recommendations for improvement

Where risks have been identified and appropriate mitigation cannot be identified or implemented - risks have been documented on departmental risk register and escalated in accordance with Risk Management Strategy and Policy.

Escalated by: Date:

Action plan in place: Review date:

Review findings and recommendations for improvement shared with the team and implemented

Date shared: Date implemented:

Documented in team meeting minutes.

Date of meeting:

Summary By continually reviewing processes and assessing risks to staff, SHFT aims to keep those who work alone or remotely safe. Furthermore our goal is to work closely with our partnership agencies and organisations to ensure that all intelligence that could be considered during part of the assessment process is available to support a robust risk assessment process. This is of significant importance when managing patients [or their relatives] where the use of violence or aggression is a likelihood or certainty.


APPENDIX 2 Manager’s Check List

Are your staff –

issued with all relevant policies and procedures relating to lone working staff?

trained in appropriate strategies for the prevention and management of violence (in particular, have they received conflict resolution training)?

given all information about the potential risks for aggression and violence in relation to patients/service users and the appropriate measures needed to control these risks?

issued with appropriate safety equipment and the procedures for maintaining such equipment?

trained to be able to confidently use a device and familiar with the support service systems in place before being issued with it?

aware of how to report an incident and of the need to report all incidents when they occur?

issued with the necessary contacts for post-incident support? Are they –

aware of the importance of doing proper planning before a visit, being aware of the risks and doing all they can to ensure their own safety in advance of a visit?

aware of the importance of leaving an itinerary of movements with their line manager and/or appropriate colleagues?

aware of the need to keep in regular contact with appropriate colleagues and, where relevant, their nominated ‘buddy’?

aware of the need to carry out continual dynamic risk assessments during a visit and take an appropriate course of action?

aware of how to obtain support and advice from management in and outside of normal working hours?

aware that they should never put themselves or colleagues in any danger and if they feel threatened should withdraw immediately?

Do they –

appreciate the organisation’s commitment to and support for the protection of lone workers and the measures that have been put in place to protect them?

appreciate that they have their own responsibilities for their own safety?

appreciate the circumstances under which visits should be terminated?

appreciate the requirements for reporting incidents of aggression and violence?

understand the support made available to lone workers by the trust, especially post- incident support and the mechanism to access such support?


APPENDIX 3

Community Based Lone Worker Form

Name of lone worker: Mobile No

Home address

Home Tel No: Car Registration:

Date of Visits:

Patient visits in order:

Patient name: Tel No:

Patient address:


Patient address:


Patient address:


Patient address:


Patient address:


APPENDIX 4 LONE WORKER INFORMATION SHEET

Team:___________________________________________________________

Name Make of Vehicle Registration Colour Work Mobile No.

Personal Mobile No.

Home Address and Phone No.

Emergency Contact Name, Home and Mobile No.

Appendix 4


APPENDIX 5

Lone Worker Device – Management Plan

1. INTRODUCTION & PURPOSE 1.1 Service Managers within Southern Health Foundation Trust have purchased lone worker

devices for use by their teams to be used by lone workers where robust buddy systems cannot be put in place to protect staff. The devices are quite simply an effective way of ensuring that staff who work alone or remotely are able to ensure that in the event of an emergency and where their safety is at risk, they can call for support.

1.2 Lone worker devices are considered to be personal protective equipment as they have been issued to keep staff safe and must be used at all times, not just when risk has been identified.

2. SCOPE & DEFINITIONS SCOPE 2.1 This document applies to all directly and indirectly employed staff within SHFT Trust and

other persons working within the organisation in line with SHFT Trust’s Equal Opportunities Document.

DEFINITIONS

2.2 Lone worker - NHS Protect defines lone working as: any situation or location in which someone works without a colleague nearby; or when someone is working out of sight or earshot of another colleague.

The Health and Safety Executive (HSE) defines lone workers as: those who work by themselves without close or direct supervision.

2.3 Alarm Response Centre [ARC] – the call centre that receives and responds to alarm calls;

which includes summoning support from the emergency services.

3. PROCESS/REQUIREMENTS 3.1 The device uses telephony and satellite navigation and once an alarm is triggered, a call is

received by Alarm Response Centre [ARC]. The ARC call handler will identify the position of the device by using GPS and will listen to the conversation that is taking place between the member of staff and the aggressor. Where it appears that intervention is required then the ARC will call the police using 999 and send them to the address where the device is traced to. If the staff member appears to be managing the situation, then the call handler will continue to listen to ensure that either, the situation is brought to a safe conclusion or if the situation escalates further, that assistance is summoned.

3.2 The device can also be “woken up” if switched off and its location identified. This function will be valuable if there are concerns over the whereabouts of a staff member. Local administrators will have the ability telephone the lone worker provider’s helpdesk and ask for a staff member to be located.


4. ROLES & RESPONSIBILITIES 4.1 Service Managers will be responsible for:

Ensuring that all staff members use the device for the purpose that it is intended and to keep themselves safe. Make maximum use of the device and not only use it when there is a known risk of aggression Local Administrators maintain up to date records of staff contact and escalation details; ensure that staff use the devices that is allocated to them and where pooled, a record is maintained of who is using the device at any given time. Monitor usage reports to establish details of staff who are not using the devices and ascertain the reasons; for example a lack of understanding about how the device works. Check activation and charging reports for non-compliance.

4.2 Local Administrators will be responsible for [Appendix 1]: Day to day management of the devices at local team level Liaising with LWD provider over a request to locate a staff member who is considered

missing Ensure that staff who have been allocated devices are suitable trained and familiar

with the device and how it works Ensuring that devices are appropriately allocated and recorded on the LWD web portal Ensuring that staff review their escalation details and that they are correct Extracting management data from the LWD web portal to ensure that staff who have

been allocated devices are making maximum usage Staff regularly carry out activation tests

4.3 Staff - staff who have been issued with a device, either personally or as a member of a

pool of staff who share the device, have a responsibility to: Ensure that the device is used in accordance with the manufacturers guidance Keep the device fully charged Use the device to protect themselves when lone working or at any other time when

they may be at risk Carry out activation tests Notify the local administrator if personal details or escalation details change

5. TRAINING 5.1 Training for using the device and administration processes and procedures are available

through the provider, usually via a web portal.

5.2 SHFT Trust recognises the importance of appropriate training for staff and all users will be encouraged to refresh their understanding over usage of the device by reviewing the training video.

6. EQUALITY IMPACT ASSESSMENT AND MENTAL CAPACITY 6.1 This procedure has no negative impact on any group or groups of staff.


Appendix 1 Local Administrator’s Monthly Check List

Action Intention Check devices allocated to team are correctly recorded on Skyguard web-portal

To ensure that staff are using the correct device so that in the event of an alarm being triggered the escalation processes will be correct

Ensuring that staff review their escalation details and that they are correct

To ensure that in the event of an alarm being triggered to escalation details on the web portal are correct and relevant staff and management advised

Extracting management data from the Skyguard web portal to ensure that staff who have been allocated devices are making maximum usage

To ensure that all staff are suing their devices to provide protection when lone working and that devices are being charged

Check staff regularly carry out activation tests

To ensure that staff are fully conversant with the device and how it operates

i Health, Safety and Security Improvement Plan is the Southern Health NHS Foundation Trust cyclical Health, Safety and Security Assessment and audit programme to support safer working procedures in the workplace.

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