Violence and Aggression Policy Version 7.2

Tackling Violence & Aggression

EQUALITY IMPACT The Trust strives to ensure equality of opportunity for all both as a major employer and as a provider of health care. This policy has therefore been equality impact assessed by the Trust Internal Safeguarding Group to ensure fairness and consistency for all those covered by it regardless of their individual differences, and the results are shown in Appendix 14. Version: Authorised by: Date authorised: Next review date: Document author:

7.2 Trust Internal Safeguarding Group 23rd September 2016 September 2018 Head of Security

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

VERSION CONTROL SCHEDULE violence & aggression policy Version : 7.2 – Final Version Number 3.1 (final) 1

Issue Date Month Year Oct 2005

2

Nov 2005

3

Feb 2007

4

7th October 2008

4.1

5th March 2009

4.2

27th January 2010

5.0

1st April 2010

Revisions from previous issue Original issue. Approved by Trust Executive Group Amendments made following guidance from NHS SMS and HSE Amended following review by Security Management Group and Risk Management Committee. Amended to ensure compliance with NHSLA level 3. Changes include: More defined responsibilities i.e. who will monitor the policy and who they report to. Actions following an incident Monitoring Alerts Post Incident Review Ensuring compliance. Further amendments were made following review by TEG, they included formatting More definitions Changes to Trust Logo Amended to detail changes to how alerts are entered onto Lorenzo for V&A”. Amendments approved by the Security Management Group on the 18th February – Ratified by the Risk Management Committee on the 5th March 2009. Amended to ensure compliance with NHSLA level 3. Changes include: Adding the requirement to undertake risk assessment. The addition of sub headings for training and appendices detailing Training needs analysis (TNA) Conflict Resolution Training. Inclusion of additional sub heading for Physical Intervention. Ratified by Risk Management Committee

VERSION 7.2 September 2016

Page 2 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

5.1

23rd July 2010

Re-defined training needs analysis (Appendix 6)

6.0

5th July

Ratified by the Risk Management Committee with the following comments: Section 3 – Include contractors/temporary staff 5.2 – Change form Director of Planning & Performance to Director of Human Resources Amended 20.4 to read: Physical Restraint will only be carried out by Security staff who have received appropriate training in the Maybo Level Added 20.5: The clinical staff upon request must take the lead and advise the security staff accordingly.

7.0

22nd August 2014

5.2 – Change from Director of Human Resources to Directr of Estate and Facilities 5.3 – Changed Risk Management to Quality & Governanace department Amended 8.1 to read: This may include occassions when the assault was unintentional due to patient’s clinical condition. Such incidents should be recorded in the patient’s clinical notes to ensure staff are made aware. Remove 10.1 The Security Manager will record the assault on to the Physical assault Reporting System (PARS) Removed section under 14.4 and 15.4 as Medway is no longer used. Procedures for entering onto Medway are as follows: During normal working hours: Staff member to telephone Security Manager, or send email to dedicated

VERSION 7.2 September 2016

Page 3 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

email address [email protected], accessible to Security Manager  Security Manager to assess/investigate as necessary and decide whether request is valid.  If yes, Security Manager to email or telephone IT Service Desk with details, including the period of the alert.  IT Service Desk to log the call, allocate to System Management Team.  System Management Team to pick up the call, add the alert to the record  System Management Team to notify Security Manager when alert is expiring.  Security Manager to review and decide on cancellation or continuation, and notify System Management Team.  System Management Team to action Security Manager decision. Out of hours:  Staff member to ring IT Service Desk, which will divert to the IT person on call  IT on call to add the alert as requested, and email [email protected] to notify this fact.  Security Manager to review next working day and either confirm or give other instructions to SMT re this alert. 7.1 7.2

27/09/2016

Removed some of the definitions 4.3 onwards Approved in its current version by the Trust Internal Safeguarding Group, however the policy does require amending to incorporate Community Services. Follwing which the Policy will be reviewed and ratified as version

VERSION 7.2 September 2016

Page 4 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

8. New Trust Logo added and replaced Trust name

VERSION 7.2 September 2016

Page 5 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

TABLE OF CONTENTS 1. INTRODUCTION ................................................................................................. 7 2. AIM ...................................................................................................................... 7 3. SCOPE ................................................................................................................ 8 4. DEFINITIONS ...................................................................................................... 8 5. DUTIES ............................................................................................................... 8 6. POLICY STATEMENT....................................................................................... 10 7. Requirement to undertake Risk Assessment..................................................... 10 8. THE PROCEDURE FOR REPORTING PHYSICAL AND NON- PHYSICAL ASSAULTS ............................................................................................................... 10 9. RESPONSE BY LINE MANAGER FOLLOWING ASSAULT ON MEMBER OF STAFF ...................................................................................................................... 11 10. SPECIFIC ACTIONS FOLLOWING REPORT OF ASSAULT ......................... 11 11. INVESTIGATION ............................................................................................ 12 12. ACTIONS TO BE TAKEN FOLLOWING REPORT OF NON- PHYSICAL ASSAULT BY A VISITOR (i.e. non-Patient or non-Staff member)............................ 12 13. ACTIONS TO BE TAKEN FOLLOWING REPORT OF NON-PHYSICAL ASSAULT BY A PATIENT ........................................................................................ 13 14. VERBAL WARNINGS ..................................................................................... 13 15. WRITTEN WARNING ..................................................................................... 14 16. FINAL WRITTEN WARNING .......................................................................... 15 17. WITHHOLDING OF TREATMENT ................................................................. 16 18. LORENZO ALERTS ....................................................................................... 17 19. FURTHER ACTION FOLLOWING A PHYSICAL ASSAULT .......................... 17 20. PHYSICAL INTERVENTION .......................................................................... 17 21. POLICY DEVELOPMENT & CONSULTATION .............................................. 18 22. Training............................................................................................................ 18 23. IMPLEMENTATION ........................................................................................ 19 24. MONITORING ................................................................................................ 20 25. REFERENCES ............................................................................................... 21 26. BIBLIOGRAPHY ............................................................................................. 21 27. APPENDICES................................................................................................. 21 28. REVIEW ......................................................................................................... 21 Appendix 1................................................................................................................ 22 Appendix 2 ............................................................................................................ 24 Appendix 3 ............................................................................................................ 26 Appendix 4 ............................................................................................................ 28 Appendix 5 ............................................................................................................ 29 Appendix 6 ............................................................................................................ 31 Appendix 7 ............................................................................................................ 33 Appendix 8 ............................................................................................................ 34 Appendix 9 ............................................................................................................ 35 Appendix 10 .......................................................................................................... 37 Appendix 11 .......................................................................................................... 38 Appendix 12 .......................................................................................................... 41 Appendix 13 .......................................................................................................... 43

VERSION 7.2 September 2016

Page 6 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

1.

INTRODUCTION

1.1

The Trust will not tolerate any form of violence or aggression, including verbal abuse against its staff, visitors, or patients. In order to deal with the problem effectively, it is vital that all incidents are reported and formally recorded. Any resulting action taken by the Trust will vary according to individual circumstances. This may range from immediate removal and arrest of offenders by the Police, to the issuing of informal or formal warnings, or in extreme cases may include the exclusion from treatment other than immediate emergency care. The Trust recognises that training of staff is fundamental to the effective operation of this policy, and that employees will be required to attend appropriate training relative to the degree of risk faced within their working environment.

1.2

The Trust recognises that the Management of Violence and aggression by patients, particularly behaviour that is due the patient’s clinical condition, should be managed following the advice of Senior Medical staff, Line Mangers and Mental Health Specialists, as appropriate. Therefore such behaviour would be managed according to the ‘Managing Clinically Related Challenging Behaviour Policy.

1.3

This policy should be read in conjunction with the following:      

Managing Clinically Related Challenging Behaviour Policy Place of Safety Policy Deprivation of Liberties (DOLS) Supporting Staff Policy Lone Worker Policy Use of Restrictive Physical Intervention Policy

2.

AIM

2.1

The aim of this policy is to ensure that all staff are aware of the local requirements for managing and reporting violence and aggression.

2.2

The policy outlines procedures for dealing with physical and non-physical assaults and includes preventative measures for tackling Violence and Aggression.

2.3

The Policy details how the Trust will ensure that staff have the right to work, and patients the right to be treated, free from fear of assault and abuse in an environment that is safe and secure.

VERSION 7.2 September 2016

Page 7 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

3.

SCOPE

3.1

This policy applies to all staff, (including contractors, agency, and temporary), patients and visitors who work or use Tameside & Glossop Integrated Care NHS Foundation Trust

3.2

The policy is concerned with violent and aggressive behaviour, both physical and verbal, towards employees of Tameside & Glossop Integrated Care NHS Foundation Trust from patients, relatives, visitors or other members of the public. Incidents of violence and aggression between staff are to be reported separately - see Trust’s Harassment at Work Policy

4.

DEFINITIONS

4.1

Physical Assault The intentional application of force to the person of another without lawful justification, resulting in physical injury or personal discomfort

4.2

Non-Physical Assault The use of inappropriate words or behaviour causing distress and/or constituting harassment

5.

DUTIES

5.1

Chief Executive  The Chief Executive is responsible for the provision of appropriate policies and procedures for all aspects of health and safety at work, and the management of security rests initially with the Trust Board (Health & Safety at Work Act 1974), Secretary of State Directions (Statutory Instrument 3039/2002). For foundation trusts, these arrangements are replicated under schedule 13 of the standard NHS contract. Directions outline the responsibilities of NHS bodies to manage security and provide a safe and secure environment for staff, patients and visitors.  Additionally, the Chief Executive will ensure through the line management structure that these policies and procedures are applied fully and consistently and that all employees are aware of the standards and behaviours required within them.  The Chief Executive has overall responsibility for ensuring that adequate arrangements are in place for the management of Security and that a system is in place for monitoring, reviewing, and updating these arrangements.

VERSION 7.2 September 2016

Page 8 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

5.2

Violence and Aggression Policy

Director of Estate & Facilities (SMD)  The Director of Estate and Facilities is the Director nominated as the Security Management Director (SMD) with responsibility for Security Management

5.3

Head of Security (LSMS) The Head of Security will:  Ensure the provision of training, guidance, and support to Line Managers on the operation of this policy.  Ensure that queries in relation to this policy at a local level as required.  Ensure that procedures are in place to accurately record all relevant Information relating to incidents involving physical and non-physical assault.  Ensure that full co-operation is given to the Police in respect of an investigation and any subsequent action, including ensuring access to personnel, premises and records whether electronic or otherwise which may be considered relevant to the investigation.

5.4

Managers  Managers have a responsibility to support staff involved in incidents of violence and aggression.  Managers will ensure that risk assessments take account of the risk of violence to staff and ensure that appropriate systems are in place to protect the safety of individuals.  Managers will liaise with Risk management Department and Security Department as appropriate when a violent or aggressive incident occurs.  Managers will ensure that all staff have access to appropriate training, and that the training is recorded on the Trust’s OLM system.

5.5

Employees.  All Trust employees must conform to this policy and report any incidents of violence or aggression to both the Security Department and via the Trust’s Risk Management incident reporting form.

VERSION 7.2 September 2016

Page 9 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

6.

POLICY STATEMENT

6.1

Tameside & Glossop Integrated Care NHS Foundation Trust will not tolerate any aggressive, abusive, or violent behaviour towards employees engaged in their lawful duties. Violent or abusive behaviour will not be tolerated and decisive action will be taken to protect staff, patients and visitors.

6.2

The Trust is committed to providing a safe and secure environment and anti social behaviour of any kind will not be tolerated.

6.3

The Trust is committed to supporting criminal proceedings and redress, and where appropriate will apply sanctions to withdraw healthcare services to the perpetrator if employees are subjected to unwarranted and unsolicited antisocial behaviour and/or abuse.

7.

REQUIREMENT TO UNDERTAKE RISK ASSESSMENT

7.1

Each Ward/Department is required to carry out their own risk assessment for the management of violence and aggression for their particular area based on the generic assessment tool. (Appendix 11). Risks must be added to the divisional risk register and managed locally.

7.2

As a result of the local violence and aggression risk assessment, appropriate Risk Action Plans should be developed where appropriate.

7.3

Lone Workers who may be exposed to violence or aggression must complete a lone worker risk assessment using the guidance provided in the Lone worker policy.

8.

THE PROCEDURE FOR REPORTING PHYSICAL AND NONPHYSICAL ASSAULTS

8.1

It is primarily the responsibility of the victim(s) involved in an incident to report the incident as soon as practicable to:  The Security Department  Line Manager/team leader  Complete Trust Incident Form  The Police, where it is deemed appropriate, after consultation with the Trust Security Manager. Exception - Some incidents do not necessarily have to be reported to the Police except where the following applies: In those cases where the First On-call, having made the necessary enquiries chooses not to report the matter to the Police. This may

VERSION 7.2 September 2016

Page 10 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

include occasions when the assault was unintentional due to the patient’s clinical condition. Such incidents should be recorded in the patient’s clinical notes to ensure staff are made aware. 8.2

All sections of the Incident Report should be completed fully, accurately, and as close to the time of incident as possible by the victim(s). Where necessary, additional records should be made and retained, and if possible any objects or equipment involved in the incident, taken out of use pending further investigation.

8.3

See Appendix 7 for flowchart

9.

RESPONSE BY LINE MANAGER FOLLOWING ASSAULT ON MEMBER OF STAFF

9.1

Remove victim from immediate vicinity of where the assault took place to gauge how they are feeling and offer support.

9.2

Identify whether victim requires medical treatment (i.e. referral to the Emergency Department or Occupational Health Department) and if they are fit to resume their duties, or need to be sent home.

9.3

Assist victim to complete Risk Management Incident Form, or complete form on their behalf if they are unable to do so.

9.4

Complete Post Incident Review form (Appendix 9)

9.5

Prior to resuming duty conduct a “Return to Work” interview in order to ensure that the member of staff is sufficiently recovered from the incident to resume normal duties.

9.6

Ensure that member of staff has access to counselling if required.

9.7

Carefully consider the working conditions of the victim, and determine whether any changes are required, such as:   

Relocation of the individual Restructuring of the individual’s working day Provision of support from colleagues.

9.8

See Appendix 8 for flowchart and Post Incident Review Form)

10.

SPECIFIC ACTIONS FOLLOWING REPORT OF ASSAULT

VERSION 7.2 September 2016

Page 11 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

10.1 If Police attend an incident it is important to obtain the investigating officer’s details, ascertain what action is to be taken against the assailant, and inform the Head of Security. 10.2 If the matter has been considered under the exception above and is reported to the Police, the Police should be provided with information concerning the assailant’s clinical condition by the Nurse in charge of the Patient’s care, if this is regarded as a relevant factor. 10.3 Where the victim does not wish to pursue the matter, the Trust will consider whether it would be in the wider interest of the Trust to take action, as failure to do so could compromise the safety of personnel, if there was a recurrence. The decision to take action without the support of the victim should only be taken after considering all available evidence and the advice of NHS Protect. 10.4 Risk Assessments must be updated following any identified risks contributing to the cause of the incident. 10.5

See Appendix 8

11.

INVESTIGATION

11.1 Following a physical or non-physical assault against a member of staff, the Security Manager will:  In all instances (whether a Police prosecution is in process or not), consider, in conjunction with the relevant staff and representatives, what preventative action, if any, should be taken to reduce further or related incidents.  Keep the victim fully informed of the progress of any investigation or action taken and offer full support and counselling.

12.

ACTIONS TO BE TAKEN FOLLOWING REPORT OF NONPHYSICAL ASSAULT BY A VISITOR (I.E. NON-PATIENT OR NON-STAFF MEMBER)

12.1

Visitors who use abuse or threatening behaviour will be asked to stop and offered the opportunity to explain their actions

12.2 Continued failure to comply with the required standard of behaviour will result in Security staff being called to remove the offending individuals from Trust property. 12.3 Any persons behaving unlawfully will be reported to the Police.

VERSION 7.2 September 2016

Page 12 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

13.

ACTIONS TO BE TAKEN FOLLOWING REPORT OF NONPHYSICAL ASSAULT BY A PATIENT

13.1

A range of measures are available depending on the severity of the assault including:  Verbal warnings  Written warnings  Withholding treatment  Civil injunctions and Anti-Social Behaviour Orders (ASBO’s).  Restraining Orders  Criminal prosecution.

13.2

A verbal warning would precede a Written Warning, and this would precede withholding of treatment, although there is no requirement to escalate the response in any particular order if the situation warrants immediate action.

13.3

Depending on the individual circumstances and seriousness of each case, the options outlined above can be taken in conjunction with one another or in isolation. (see Appendix 5 for types of Assault)

14.

VERBAL WARNINGS

14.1

Verbal warnings are often an effective method of addressing unacceptable behaviour with a view to achieving realistic and workable solutions.

14.2

They will be given by the Ward Manager or member of staff responsible for the department. The warning should (where practicable) be in private and when all parties involved are composed.

14.3

The verbal warning should be recorded onto the Trust’s Incident form, and all relevant staff should be made aware of the verbal warning issued.

14.4

The verbal warning should be entered onto Lorenzo as an alert. The alert will remain on Lorenzo for the duration of the verbal warning. A period of 6 months is considered by the Trust to be a reasonable period of time for the warning to remain active. Appropriate systems must be in place to flag up removal of the warning upon expiry.

VERSION 7.2 September 2016

Page 13 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

14.5

Violence and Aggression Policy

The aim of the verbal warning process is twofold:  To ascertain the reason for the behaviour as a means of preventing further incidents or reducing the risk of recurrence.  To ensure that the patient, relative or visitor is aware of the consequences of further unacceptable behaviour.

14.6

It is important that patients, relatives, and visitors are dealt with in a demonstrably fair and objective manner. However, whilst staff have a duty of care, this does not include accepting abusive behaviour. Every attempt should be made to de-escalate a potentially abusive situation. Where deescalation fails, the patient, relative or visitor should be warned of the consequences of future unacceptable behaviour.

14.7

Verbal warnings will not always be appropriate and should only be attempted when it is safe to do so with relevant and appropriate staff present (including security staff if necessary).

14.8

Where the process has no affect and unacceptable behaviour continues, alternative action must be considered.

15.

WRITTEN WARNING

15.1

Written warnings should be considered to address unacceptable behaviour from patients, relatives or visitors either when verbal warnings have failed, or as an immediate intervention depending on the circumstances. The written warning is an agreement between parties aimed at addressing and preventing the recurrence of unacceptable behaviour.

15.2

The written warning will be issued by the Ward Manager or member of staff responsible for the department following consultation with all relevant parties (i.e. the offender’s GP, Consultant, Matron, Social Services, Director of Service Improvement & Planning, Security Manager)

15.3

The written warning should be recorded onto the Trust’s Incident form, and all relevant staff should be made aware of the written warning issued.

15.4

The written warning should be entered onto Lorenzo as an alert and should state “written warning for V&A”. The alert will remain on Lorenzo for the duration of the written warning. A period of 6 months is considered by the Trust to be a reasonable period of time for the warning to remain active. Appropriate systems must be in place to flag up removal of the warning upon expiry.

15.5

The written warning should specify the reasons for issue with a view to

VERSION 7.2 September 2016

Page 14 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

obtaining an improvement in future behaviour. 15.6

The terms of the written warning should be outlined formally in a letter to the offender. (See Appendix 1 for template), and a copy signed by the offender and retained by the Trust. If the unacceptable behaviour ceases, it may be appropriate to acknowledge this in a further letter to the perpetrator, to encourage continued good behaviour.

15.7

Where Director of Operations and Performance having consulted with relevant staff and obtained clinical advice has concluded that the incident was clinically induced, (i.e. underlying clinical condition), and where a written warning could adversely affect the patient’s well-being or recovery. However, the presence of a underlying clinical condition should not prevent appropriate action being taken.

15.8

For offenders under 16 years of age, other than in exceptional circumstances, a written warning to the child’s parent(s) or guardian(s) may be appropriate.

16.

FINAL WRITTEN WARNING

16.1 It is recommended that a final written warning should be issued prior to withholding of treatment being instigated. A final written warning will be signed by the Chief Executive only (or in the absence of the Chief Executive by the Director of Operations and Performance) and must be copied to the patient’s Consultant and GP. The Chief Executive or Director of Operations and Performance will only issue a final warning letter after taking the advice of the Medical Director or the Director of Nursing. The written warning will: 

explain the reasons why withholding of treatment is being considered (including relevant information, dates and times of incidents);



explain that the behaviour demonstrated is unacceptable;



explain the appropriate sanctions which apply to violent or abusive patients;



detail the mechanism for seeking a review of the issue, e.g. via local patient complaints procedures;



be recorded onto the Trusts Incident form, and all relevant staff made aware of the warning.



be entered onto Lorenzo as an alert and should state “final written warning for V&A”. The alert will remain on Lorenzo for the duration of the Warning. A period of 6 months is considered by the Trust to be a reasonable period

VERSION 7.2 September 2016

Page 15 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

of time for the warning to remain active. Appropriate systems must be in place to flag up removal of the warning upon expiry.

17.

WITHHOLDING OF TREATMENT

17.1

Any decision to withhold treatment must be based on accurate clinical assessment and the advice of the patient’s Consultant or a senior member of the medical team (on call team for Out of Hours) on a case by case basis. Under no circumstances should it be inferred to a patient that treatment may be withheld without appropriate consultation taking place. The withholding of treatment should always be seen as a last resort.

17.2

There may be instances of serious assault when the Trust, having obtained legal advice, can decide to withhold treatment immediately.

17.3

Where it has been decided that a patient is to be excluded from Trust premises and treatment withheld, a written explanation for the exclusion will be issued by the Chief Executive / Director of Operations and Performance.

17.4

The letter will be signed by the Chief Executive, and copied to the Security Manager, the patient’s Consultant, and GP. A copy should also be retained on the patient’s medical records. A sample letter is contained in Appendix 3

17.5

Once the patient has been advised that treatment is to be withheld they must be escorted from Trust premises by Security staff, and the patient’s next of kin advised.

17.6

A detailed record of the rationale for exclusion and of alternative arrangements for care should be maintained in the patient’s medical notes.

17.7

The withholding of treatment should be recorded onto the Trust’s Incident form, and all relevant staff informed. The withholding of treatment should be entered onto Lorenzo as an alert and should state “withholding treatment for V&A”. The alert will remain on Lorenzo for the duration of the sanction.

17.8

Withholding treatment is time limited and must be for no more than 2 months, after which the situation will be reviewed. Appropriate systems must be in place to flag up removal upon expiry.

17.9

If an excluded patient requires emergency treatment, this will be given and, if necessary, security will be asked to attend.

17.10 The need for security presence should be decided in conjunction with the nurse or consultant in charge of the patient’s care and the Security Manager. VERSION 7.2 September 2016

Page 16 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

18.

LORENZO ALERTS

18.1

Ensure that alerts are entered on to Lorenzo in accordance with instructions detailed in points 13, 14, 15 & 16 above.

18.2

Ensure alerts are recorded in the patient’s casenotes

18.3

Refer to Patient Alerts Policy for further guidance.

19.

FURTHER ACTION FOLLOWING A PHYSICAL ASSAULT

19.1

The Security Manager will arrange for an acknowledgement to be sent to the person assaulted to ensure that any necessary support (i.e. counselling) is offered. The acknowledgement will be issued by the Security Manager. The acknowledgement will state that appropriate action will be taken, that they will be kept informed of the progress and outcome of the investigation. It will also include details of how, when and where the Security Manager can be contacted. A recommended format is contained within Appendix 4.

19.2

Once all actions, both criminal and/or civil have been completed, the Security Manager will ensure that the Trust Incident Form is updated. Any action taken and warning letters issued, including withholding treatment or removal from practitioners list will also be recorded.

19.3

If the patient is violent and aggressive due to a transient clinical condition the incident should not be recorded onto Lorenzo, but should be included in the patient’s clinical notes to ensure that staff are aware of the patient’s clinical condition.

20.

PHYSICAL INTERVENTION

20.1

The term physical intervention refers to Control and Restraint, Safe Holding, and Breakaway. Physical Interventions must only be used as a last resort and when all other measures (including de-escalation) have been unsuccessful, and the situation is deteriorating. Consideration must be given to the overall context of care; therefore staff must take into account the detrimental effect the use of Physical Interventions may have to all involved individuals. The decision to use a physical intervention must take into account the circumstances associated with the behaviour and be based upon an assessment of the risks associated with the intervention compared with the risks of not employing a physical intervention. Physical Restraint will only be carried out by Security staff who have received appropriate training in the Maybo Level 4 Physical Intervention

20.2

20.3

20.4

VERSION 7.2 September 2016

Page 17 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

20.5

The clinical staff upon request must take the lead and advise the security staff accordingly.

21.

POLICY DEVELOPMENT & CONSULTATION

21.1

This policy was first authorised by the Trust Executive Group in October 2005, having been developed using guidance from NHS Protect Service publications  Tackling Violence against staff – Explanatory Notes (Updated March 2007)  Non Physical Assault - Explanatory Notes

21.2

The draft policy was circulated to the:  Security Management Group  Risk Management Committee  Human Resources Policy Development Group  Joint Negotiation & Consultation Committee (now known as the staff Parnership Forum) Their comments are incorporated into this policy

21.3

Following an assault on three members of staff by a Patient in July 2005, the NHS Protect, and the Health & Safety Executive carried out an investigation into the Trusts responses, and their recommendations following the investigation are incorporated into this policy.

21.4

Reviewed by the Security Management Group and Risk Management in February 2007

21.5

Policy amended to include a Post Incident Review, as part of the Line Managers responsibilities following an assault on a member of staff. The updated policy has been reviewed and ratified by the Risk Management Committee in August 2008

22.

TRAINING

22.1 The Trust recognises that training of staff is fundamental to the effective operation of this policy, and that employees will be required to attend appropriate training relative to the degree of risk faced within their working environment. 22.2 The Trust provides Conflict Resolution Training to ensure that staff are provided with the appropriate skills necessary for the management of violence and aggression. 22.3 As a minimum requirement all front line staff must undertake Conflict Resolution Training. The course follows a national syllabus which will enable VERSION 7.2 September 2016

Page 18 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

staff to recognise triggers and diffuse potentially violent/aggressive situations. (See appendix 6 for Training Needs Analysis) 22.4 In addition Managing Unintentional Aggressive Patients Policy is available on TIS website. Security Officers will carry out restraints (and we would not expect nursing staff to be restraining patients), however officers do need support from clinical staff for carrying out observations, assisting where necessary. 22.5 The training requirements of this policy are described in Trusts Mandatory Training and Induction Policy. The requirements include:  Identification of relevant staff groups  Frequency of training  Attendance and follow up of non attendance  Monitoring of compliance and the process the organisation will follow should gaps in compliance be identified 22.6 Follow up of non attendance is described as follows 

In the event of an individual cancelling, sending apologies or failing to attend any (Risk Management /Health and Safety) mandatory event (– see individual TNA’s in Mandatory and Induction Policy), a subsequent date will be offered. Following any subsequent non-attendance, the ET&D Department will record the individual as “Never Attended” and this will be reported monthly to the Divisional Management Team (DMT) by the Human Resource (HR) Managers, for action or inclusion on the Divisional Risk Register and reported on the Risk Management Report to the Trust Board. For ongoing monitoring a quarterly ESR/OLM Litigation Authority, Mandatory Training Compliance report will be published for heads of departments on the Trust G Drive G:\Trust General Data Area\Trust Mandatory Training

23.

IMPLEMENTATION

23.1

General Awareness of the policy is promoted to staff during Trust monthly inductions and also during monthly Conflict Resolution Training sessions

23.2 Violence and Aggression information and advice is included in Security Awareness Week, an annual event held over a five day period at the Trust 23.3 This policy is implemented throughout the Trust and is available on the Trust website.

VERSION 7.2 September 2016

Page 19 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

24.

Violence and Aggression Policy

MONITORING

The monitoring of this policy is defined in the matrix below Where monitoring has identified deficiencies, appropriate recommendations and action plans will be developed and changes implemented accordingly. Progress will be reported to the Security Management Group. Minimum policy requirement to be monitored

Process monitoring audit

Duties

for e.g.

Responsible individual/ group/ committee

Frequency of monitoring

Responsible individual/ group/ committee for review of results

Responsible individual/ group/ committee for development of action plan

Responsible individual/ group/ committee for monitoring of action plan

Annual monitoring report including audit and review s

Trust Security Manager

Annual

Security Management Group / Health & safety Group

Security Management Group / Health & safety Group

Security Management Group / Health & safety Group

Requirement to undertake appropriate risk assessments for the prevention and management of violence and aggression

Annual Audit of risk assessment summary to be included in annual monitoring report

Trust Security Manager

Annual

Security Management Group / Health & safety Group

Security Management Group / Health & safety Group

Security Management Group / Health & safety Group

Arrangements for ensuring the safety of lone workers

Annual Audit of risk assessment summary to be included in annual monitoring report

Trust Security Manager

Annual

Security Management Group / Health & safety Group

Security Management Group / Health & safety Group

Security Management Group Health & safety Group

Organisation’s expectations in relation to staff training, as identified in the training needs analysis

Annual review of training records summary to be included in annual monitoring report

Trust Security Manager

Annual

Security Management Group / Health & safety Group

Security Management Group / Health & safety Group

Security Management Group / Health & safety Group

Health and Safety Assistant

VERSION 7.2 September 2016

Page 20 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

25.

REFERENCES

25.1

The NHS Protect (formerly NHS Security Management) Explanatory Notes for  Tackling Violence against staff www.cfsms.nhs.uk/doc/sms.general/Tackling_violence_against_staff_2 007.pdf  Non Physical Assault - Explanatory Notes www.cfsms.nhs.uk/doc/sms.general/non.physical.assault.notes.pdf

26.

BIBLIOGRAPHY

26.1

Not applicable

27.

APPENDICES

27.1

The following appendices are attached to support the policy: Appendix 1 Appendix 2 Appendix 3 Appendix 4 Appendix 5 Appendix 6 Appendix 7 Appendix 8 Appendix 9 Appendix 10 Appendix 11 Appendix 12

28.

Written Warning Final Warning Withholding of Treatment Security Manager – Report of Physical Assault letter Types of Physical & Non - Assaults Training needs analysis (TNA) Conflict Resolution Training Procedure for reporting Physical and Non-Physical Assaults Flowchart Response by Line Manager following a Physical Assault Flowchart & Post Incident Review Non Clinical Physical Assaults Flowchart Violence & Aggression Questionnaire Generic Risk Assessment Tool Analysis of Effects Assessment

REVIEW

28.1 This policy will be formally reviewed in 2 years, or earlier depending on the results of monitoring, changes in legislation, recommendations from National bodies, or as a result of incident or incident, complaints or claims data analysis or investigation.

VERSION 7.2 September 2016

Page 21 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

APPENDIX 1

Tameside & Glossop Integrated Care NHS Foundation Trust Fountain Street Ashton-Under-Lyne Lancashire OL6 9RW Tel: 0161 922 6000 Dear The Trust has evidence which suggests on the you used/threatened unlawful violence/acted in an anti-social manner to a member of NHS staff/whilst on NHS premises (delete as applicable). Behaviour such as this is unacceptable and will not be tolerated. This Trust is firmly of the view that all those who work in or provide services to the NHS have the right to do so without fear of violence or abuse. I would urge you to consider your behaviour when attending the, in the future and comply with the following conditions: If you fail to act in accordance with these conditions and continue to demonstrate what we consider to be unacceptable behaviour, will have no choice but to take one of the following actions: (to be adjusted as appropriate); 

The matter will be reported to the police with a view to this Trust supporting a criminal prosecution by the Crown Prosecution Service.



The matter will be reported to the NHS Protect Service Legal Protection Unit with a view to this Trust supporting criminal or civil proceedings or other sanctions. Any legal costs incurred will be sought from yourself.



Consideration will be given to obtaining a civil injunction in the appropriate terms. Any legal costs incurred will be sought from yourself.

I enclose two copies of this letter for your attention, I would be grateful if you could sign one copy, acknowledging your agreement with these conditions and return it to me in the envelope provided. In the event that I receive no reply within the next fourteen days, it shall be presumed that you agree with the conditions contained herein.

VERSION 7.2 September 2016

Page 22 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

I hope that you should find these conditions acceptable. However, if you do not agree with the details contained in this letter about your alleged behaviour or feel that this action is unwarranted, please contact in writing < insert details of local complaints procedure> who will review the decision in light of your account of the incident(s). A copy of this letter will be kept with your Medical Records. Yours sincerely,

Signed by senior staff member

Date

I, accept the conditions listed above and agree to abide by them accordingly. Signed

Date

VERSION 7.2 September 2016

Page 23 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

Appendix 2

Tameside & Glossop Integrated Care NHS Foundation Trust Fountain Street Ashton-Under-Lyne Lancashire OL6 9RW Tel: 0161 922 6000 Dear FINAL WARNING I am writing to you concerning an incident that occurred on at . The Trust has evidence which suggests that you used / threatened unlawful violence / acted in an anti-social manner to a member of NHS staff / whilst on NHS premises (delete as applicable). Behaviour such as this is unacceptable and will not be tolerated. This Trust is firmly of the view that all those who work in or provide services to the NHS have the right to do so without fear of violence or abuse. This has been made clear to you in . A copy of this Trusts Tackling Violence & Aggression policy on the withholding of treatment from patients is enclosed for your attention. If you act in accordance with what this Trust considers to be acceptable behaviour, your care will not be affected. However, if there is a repetition of your unacceptable behaviour, this warning will remain on your medical records for a period of one year from the date of issue and will be taken into consideration with one or more of the following actions: (to be adjusted as appropriate) 

The withdrawal of NHS Care and Treatment, subject to clinical advice.



The matter will be reported to the Police with a view to this Trust supporting a criminal prosecution by the Crown Prosecution Service.



The matter will be reported to the NHS Protect Service Legal Protection Unit with a view to this Trust supporting criminal or civil proceedings or other sanctions. Any legal costs incurred will be sought from yourself.

VERSION 7.2 September 2016

Page 24 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST



Violence and Aggression Policy

Consideration will be given to obtaining a civil injunction in the appropriate terms. Any legal costs incurred will be sought from yourself.

In considering withholding treatment this Trust considers cases on an individual basis to ensure that the need to protect staff is balanced against the need to provide health care to patients. An exclusion from NHS premises would mean that you would not receive care at this Trust and (title, i.e. clinician) would make alternative arrangement for you to receive treatment elsewhere. If you consider that your alleged behaviour has been misrepresented or that this action is unwarranted please contact in writing who will review this decision in the light of your account of the incident(s). A copy of this letter has been issued to your GP and consultant. A copy of this letter will also be kept with your Medical Records.

Yours sincerely,

Chief Executive

Date

VERSION 7.2 September 2016

Page 25 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

Appendix 3

Tameside & Glossop Integrated Care NHS Foundation Trust Fountain Street Ashton-Under-Lyne Lancashire OL6 9RW Tel: 0161 922 6000

Dear Withholding of Treatment I am writing to you concerning an incident that occurred on at . The Trust has evidence which suggests that you used / threatened unlawful violence / acted in an anti-social manner to a member of NHS staff / whilst on NHS premises (delete as applicable) Behaviour such as this is unacceptable and will not be tolerated. This Trust is firmly of the view that all those who work in or provide services to the NHS have the right to do so without fear of violence or abuse. A copy of this Trusts policy Tackling Violence & Aggression on the withholding of treatment from patients is enclosed for your attention. Following a number of warnings where this has been made clear to you, and following clinical assessment and appropriate consultation, it has been decided that you should be excluded from the Trust premises. The period of this exclusion is and comes into effect from the date of this letter. As part of this exclusion notice you are not to attend the Trust premises at any time except: 

in a medical emergency; or



Where you are invited to attend as a pre-arranged appointment.

Contravention of this notice will result in one or more of the following actions being taken (to be adjusted as appropriate):

VERSION 7.2 September 2016

Page 26 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

  

Violence and Aggression Policy

Consideration will be given to obtaining a civil injunction in the appropriate terms. Any legal costs incurred will be sought from yourself. The matter will be reported to the Police with a view to this Trust supporting a criminal prosecution by the Crown Prosecution Service The matter will be reported to the NHS Protect Legal Protection Unit with a view to this Trust supporting criminal or civil proceedings or other sanctions. Any legal costs incurred will be sought from yourself.

During the period of your exclusion the following arrangement must be followed in order for you to receive treatment . In considering withholding treatment this Trust considers cases on their individual merits to ensure that the need to protect staff is balanced against the need to provide health care to individuals. If you consider that your alleged behaviour has been misrepresented or that this action is unwarranted, please contact in writing who will review this decision in the light of your account of the incident(s). A copy of this letter has been issued to your GP and Consultant. A copy of this letter will also be kept with your Medical Records.

Yours sincerely,

Chief Executive

Date

VERSION 7.2 September 2016

Page 27 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

Appendix 4

Tameside & Glossop Integrated Care NHS Foundation Trust Fountain Street Ashton-Under-Lyne Lancashire OL6 9RW Tel: 0161 922 6000 Dear Report of a Physical Assault I understand that you were physically assaulted on [Enter Date] during the course of your duties. I am sorry to hear about this. The Trust is determined to tackle all forms of anti-social behaviour and, in particular, where trust staff are abused and/or assaulted. Tameside & Glossop Integrated Care NHS Foundation Trust will ensure that where a member of staff reports a physical assault: 

it is properly followed up by the police;



where the police do not take action, the assault is investigated to see whether appropriate action can be taken against the offender;

Furthermore the Trust and the NHS Protect are committed to ensuring that you receive any support and guidance that may be needed following this incident. As the Local Security Management Specialist for this Trust, I will be monitoring any police action taken in your case. Where it is necessary, I shall explore with your consent and the support of Tameside & Glossop Integrated Care NHS Foundation Trust, what alternative or additional action can be taken. Please do not hesitate to contact me should you have any questions or concerns. Yours sincerely

Security Manager

VERSION 7.2 September 2016

Page 28 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

Appendix 5 Types of Physical & Non – Physical Assaults Background Incidents of Physical and Non-Physical assault against NHS staff and professionals constitute the vast majority of violent incidents reported. This policy has been developed to enable the Trust to tackle assaults in a consistent yet flexible framework. The policy also provides guidance to assist the Trust in the development and implementation of procedures to effectively tackle assaults on staff by patients, relatives, and visitors in accordance with new requirements introduced by the Secretary of State Directions and existing obligations under Health and Safety legislation. Types of Physical Assaults These include any hurt or injury calculated to interfere with a person’s health and comfort, such as:  Slapping with open hand  Punching  Kicking  Grabbing  Spitting  Pinching  Pulling Hair

Types of Non-Physical Assaults Non-Physical Assaults include:  offensive language, verbal abuse and swearing which prevents staff from carrying out their duties or makes them feel unsafe;  loud and intrusive conversation;  unwanted or abusive remarks;  negative, malicious or stereotypical comments;  invasion of personal space;  brandishing of objects or weapons:

VERSION 7.2 September 2016

Page 29 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

 near misses i.e. unsuccessful physical assaults:  offensive gestures;  threats or risk of serious injury to members of staff, other patients or visitors;  bullying, victimisation or intimidation;  stalking;  spitting;  alcohol or drug fuelled abuse;  unreasonable behaviour and non-cooperation such as repeated disregard of hospital visiting hours; or  Any of the above linked to destruction of or damage to property. It is important to remember that such behaviour can be either in person, by telephone, letter or e-mail or other forms of communication such as graffiti on NHS property. The appropriate and proportionate response to incidents will depend on individual circumstances. The Trust will ensure that all front-line staff receive Conflict Resolution Training by March 2008 to help prevent situations escalating and to diffused wherever possible (see Appendix 6 for Conflict Resolution Training content). It is also essential that staff are aware of reporting procedures for nonphysical assaults and are fully supported in doing so.

VERSION 7.2 September 2016

Page 30 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

Appendix 6

Training needs analysis (TNA) Conflict Resolution Training It is a National requirement that all front-line staff in the NHS receive Conflict Resolution Training. The course has been designed for all frontline NHS staff and professionals whose work brings them into contact with members of the public. Staff may be exposed to situations that may become volatile and confrontational, resulting in violence and abuse. Training should be undertaken every three years. To ensure that the courses are filled it is essential that: 

Managers identify relevant staff for training during PDR session



Staff are booked onto courses as soon as possible



Staff are released to attend the courses onto which they are booked



New starters employed in the areas specified below are booked onto a course by their Line Manager as soon as possible after commencing employment

Conflict Resolution Training consists of a standard national syllabus for NHS staff in non-physical intervention techniques and managing and de-escalating potentially violent incidents within the work environment. At the end of the course delegates will be able to:          

Describe common causes of conflict Describe the two forms of 'communication' Give examples of how communication can break down Explain 3 examples of communication models that can assist in conflict resolution Describe patterns of behaviour that may be encountered during different interactions Give examples of the different warning and danger signs Give examples of impact factors Describe the use of distance when dealing with conflict Explain the use of 'reasonable force' as it applies to conflict resolution Describe different methods for dealing with possible conflict situations

The Trust provides half-day training courses – for further information contact ET&D Reception on ext 4203 or email: [email protected] VERSION 7.2 September 2016

Page 31 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

Training Needs Analysis All staff: Basic awareness (workbook based) annually Conflict Resolution half day session mandatory for A&E, Wards, Outpatients, MAAU. Other areas by manager nomination. Update to be completed every 4 years.

VERSION 7.2 September 2016

Page 32 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

Appendix 7 PROCEDURE FOR REPORTING PHYSICAL & NON-PHYSICAL ASSAULTS (In all situations, you must complete the Trust’s Incident Report Form)

WHAT TO DO Non-Physical Abuse by Visitors

Non-Physical Abuse by Patients

Physical Abuse

1. Quiet Word

1. Quiet Word

1. Contact Security ext. 6688

2. Verbal Warning

2.Verbal Warning By Ward Manager or Senior Staff

2. Report to Police – 0161 872 5050

3. Have offender removed Call Security on ext. 6688 or Emergency 2222

3. Written Warning By Ward Manager or Senior Staff

3. Inform Line Manager

4. Request Police assistance If necessary 0161 872 5050

4. Final Written Warning Issued by Chief Executive / Director of Clinical Services

4. See Appendix 8 Non Clinical Physical Assaults Flowchart

5. Withhold Treatment Issued by Chief Executive / Director of Clinical Services

VERSION 7.2 September 2016

Page 33 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

Appendix 8

Immediate Action

Prior to Staff Member resuming duty

Remove member of staff to safety

Carry Out Return to Work interview – Use form found in Attendance Management Policy

Gauge how they are feeling and offer support

Ensure that member of staff has access to Counselling if required

If member of staff requires medical treatment refer to A/A or Occupational Health

Assist Member of staff to Complete Risk Management Incident Form

Complete on their behalf if unable to do so.

VERSION 7.2 September 2016

Page 34 of 47 Check the Intranet for the latest version

Once Staff Member has returned to Work Ask relevant colleagues to provide additional support, including restructuring of work

Ensure that member of staff is not exposed to potential violent/aggressive situations.

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

Appendix 9

Physical Assault Post Incident Review Date____________________

Ref Number_____________________

Details of the perpetrator of the incident_________________________________ Incident Date____________________

Location____________________

Names of Staff involved in Incident (including job title)

Circumstances prior to Incident

Incident - What happened, actual facts?

Any Triggers to be taken into consideration?  Environment

 Staff

 Time delays

 other  Medication

Comment……………………………………………………………………………………………..

Subsequent Actions (responses to incident)  Removed member of staff to safety  Gauged feeling and offered support  Assessed/offered medical treatment or referral to Occupational Health  Assisted member of staff to complete Trust incident form  Security attended?  Police attended? VERSION 7.2 September 2016

Page 35 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

Current risks? (if any)  To Patient ……………………………………………………………………………………… ………………………………………………………………………………………  To Staff

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

 To Trust

………………………………………………………………………………………

  

No. of staff involved in incident No. staff on duty in dept. /ward No. of patients in dept. /ward

Detail numbers of staff involved in incident as categorised below: Security



Nurse



Doctor



Other



Have all staff involved in the incident received the following training: Conflict Resolution training Yes/No Control and Restraint Yes/No  Care Plan up to date at time of incident?  Care plan update following incident? By whom______________________  Risk Assessment up to date at time incident?  Risk assessment updated following incident? By whom______________________ Were policy and procedures followed?

Yes/No

If not, comment.___________________________________________________ Security Manager Action Physical Assault Report System completed



Conduct Letter issued  Security Review completed



Further Recommendations of Reviewer Name of Reviewer (please print Signature of Reviewer Date:

VERSION 7.2 September 2016

Page 36 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

Appendix 10

Non Clinical Physical Assault Occurs Flowchart WHAT TO DO Inform Police

Complete PARS Form

Police Investigation

No Police Investigation

LSMS Investigation Commences (Case Management File Opened) LPU/ASMS Advice Available

Pars Referral

LPU Advice CPS Consultation

Prosecution File Completed Where Police/CPS do not progress case, return to LPU for potential private prosecution

Suspect either

Cautioned or No Further Action

NHS Protect LPU

Charged

Court Outcome Reported to SMS

VERSION 7.2 September 2016

Summons Issued

Page 37 of 47 Check the Intranet for the latest version

No Further Action

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

Appendix 11

Violence and Aggression Questionnaire Incident Number……………….. Incident Date……………………….. Incident Time………………………. Incident Location…………………. Patient/Staff/Public Verbal / Physical Intentional / Unintentional Telephone / Face to Face

1. Was the incident managed locally by yourself? YES/NO 2. Was your manager/colleague involved in managing the incident? YES/NO 3. Was the patient/public/staff counselled as to their behavior? YES/NO 4. Who undertook this role (circle correct answer)        

You Colleague of same grade Senior Colleague/Ward, Dept Manager Matron Medical Staff Security DNM Other please state………………………………………………………….N/A

5. Did you feel that this was effective? VERSION 7.2 September 2016

Page 38 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

YES/NO/N/A If not why not …………………………………………………………………………………………………. …………………………………………………………………………………………………………… ……..

6. If the patient/public/staff was not counselled do you think that they should have been? YES/NO/N/A 7. Were the relatives of the patient informed of the patient's actions? KNOW/N/A

YES/NO/DONT

8. If not did you feel that they should have been?

YES/NO/N/A

9. Were security involved in the incident?

YES/NO

10. Did you feel the actions of security were?  Appropriate  Timely

YES/NO/N/A YES/NO/N/A

If not please clarify………………………………………………………………………………………………. 11. If security were not involved do you feel that they should have been? YES/NO 12. Was the Matron / Manager informed/involved in the incident? YES/NO/N/A 13. Was the intervention of the Matron/Manager  Appropriate YES/NO/N/A  Timely YES/NO/N/A 14. Did the Matron / Manager follow the steps as outlined in the Trust’s Tackling Violence & Aggression Policy? YES/NO/N/A 15. If the Matron / Manager was not involved did you feel they should have been? YES/NO/N/A 16. Were the police involved in the incident? YES/NO 17. If not did you feel that they should have been? YES/NO/N/A VERSION 7.2 September 2016

Page 39 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

18. Have you had conflict resolution training ? YES/NO 19. Did you receive a debriefing session from anyone following the incident? YES/NO 20. If yes who undertook this ……………………………………………………………… 21. If not do you think this would have been beneficial ………………………………… YES/NO 22. Were you a lone worker at the time of the incident? YES/NO/N/A 23. If yes are you aware of the lone worker policy and of the requirement for risk assessment? YES/NO/N/A 24. If yes - Do you know if a risk assessment has been carried out regarding lone worker ? YES/NO/N/A 25. Do you have any suggestions as to how this incident could have been managed better? ………………………………………………………………………………………………………… …………………………………………………………………………………………………………

VERSION 7.2 September 2016

Page 40 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

Appendix 12

Risk Assessment Record Division/ Directorate……………………………………………………... Ward/ Department………………………………………………………… Risk Identified:

Risk of violence or aggression from a patient

Description Of Risk: (i.e. what could go wrong, who may be affected, organisational / financial implications)  Physical and psychological injury  Staff absence/ sick leave  Low moral  Stress/anxiety  Disturbance and disruption to care of other patients  Inadequate care to the patient causing the V&A Level of Risk:

Corporate

Noncorporate

Risk Type: (please tick)

Clinical

NonClinical

(please tick) Manual Handling

Manual Handling

(patient)

(inanimate)

Controls in place: (e.g. consider, equipment, staffing, environment, policy/procedure, training, documentation)  Conflict resolution training  Trust’s Violence and Aggression policy.  Use of Lorenzo and medical record alerts  Incident reporting procedure.  Adequate clinical environment: lighting, physical space, privacy and dignity, unimpeded observation, consistent inpatient team.  Appropriate training and levels of staff to nurse patients who display V&A behaviour.  Ward alarm / panic systems.  Access to security assistance  Identify trigger factors and early warning signs of disturbed / violent behaviour  Identify clinical variables., e.g. medical factors such as medication or abnormal bloods, misuse of substances / alcohol/ drugs, symptoms of schizophrenia or mania, agitation or excitement, anti-social or explosive disorders.  Clear staff handover and good documentation is required when there is potential patient V&A or disruptive behaviour. Identify any gaps in control:

VERSION 7.2 September 2016

Page 41 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Effectiveness of controls: (please tick)

Adequate

Current Risk Grading: (indicate appropriate number) Risk Rating = (insert score in box)

High 15-25

Moderate 8-12

Violence and Aggression Policy

Limited

Poor

Severity

Likelihood

Low 4-6

Very Low 1-3

Name of Assessor(s): Signature of Assessor(s):

Date:

Name of Manager: Signature of Manager:

Date:

Risk Treatment / Action Plan Risk Identified:

Risk of violence or aggression from a patient

Ref:

What is being done about the risk? (please tick below) Eliminate

Transfer

Reduce

Accept

(all or part)

Actions planned to reduce / prevent risk: (e.g. change in practice, physical systems) Proposed Action

Resource Requirements

Target Risk Grading: (indicate appropriate number) Target Risk Rating = (insert score in box) Review Frequency: (please tick)

High 15-25

Responsibilities

Quarterly

Weekly

Annually

Target Date for Completion

Severity

Likelihood

Low 4-6

Very Low 1-3

Moderate 8-12

Daily

Timing

Next Review Date:

Annual

Monthly

Completed by:

Date:

Date Implemented:

VERSION 7.2 September 2016

Page 42 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

Appendix 13 Analysis of Effects Assessment (AoE) Title of Policy: Violence & Aggression Policy Short description of Policy

The aim of this policy is to ensure that all staff are aware of the local requirements for managing and reporting violence and aggression.

Date of assessment: 27/09/16

Person responsible for assessment:

Steve Peet, Head of Facilities

Is this a proposed new policy/proposal?

No

Is this a review of an existing policy/proposal? Yes 1. Who is responsible for the policy/proposal? (Consider the following; i.

Who is accountable?

ii.

Who implements it?

iii.

Who is responsible for policing/monitoring?

Trust Internal Safeguarding Group Steven Peet Security Management Group

iv. Who enforces the policy?)

VERSION 7.2 September 2016

Page 43 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

2. Who are the main stakeholders in relation to the policy/proposal?

Violence and Aggression Policy

This policy was approved by the Trust Internal Safeguarding Group

(Consider the following; i.

Who needs to be consulted / informed about the policy/proposal?

ii.

Who is the policy/proposal intended to involve in the wider sense? For example; Staff/professionals, the public/community…

3. What outcomes are expected / desired from this policy/proposal?

The policy outlines procedures for dealing with physical and non-physical assaults and includes preventative measures for tackling Violence and Aggression.

(Consider the following;

The Policy details how the Trust will ensure that staff have the right to work, and patients the right to be treated, free from fear of assault and abuse in an environment that is safe and secure.

i.

Who will benefit from this policy/proposal and in what way will they benefit?

ii.

Does the policy/proposal explicitly involve the elimination of inequality, or the promotion of equality?)

VERSION 7.2 September 2016

Page 44 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

4. The following section requires you to assess the likely negative impact and positive impact of your policy/proposal on the nine Protected Characteristics as defined by the Equality Act as follows. Please support any answers with evidence. Protected Answers to: Characteristics What likely adverse impact will this Policy / Service have on the public or staff, giving particular regard to potential impacts negative and positive in relation to:

Evidence:

a. Race

The promotion of this policy will raise awareness to staff of their responsibilities.

Positive

(What is your evidence for this answer? Consider; both quantitative and qualitative existing data.)

This policy applies to all those employed by and / or using the Tameside Hospital NHS Foundation Trust site, including volunteers, students and contractors Positive

As above

Positive

As above

Positive

As above

b. Disability

c. Sex

d. Religion and belief

VERSION 7.2 September 2016

Page 45 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

Positive

As above

Positive

As above

Positive

As above

Positive

As above

Positive

As above

Positive

As above

Positive

As above

e. Sexual orientation

f.

Age

g. Carers

h. Gender Reassignment

i. Marriage & Civil Partnership

j. Pregnancy & Maternity K. Human Rights

5. Is there any further evidence / data that you would consider relevant or necessary in order to answer the above question? If so, please detail. *

Not applicable

6. Are any of the above impacts (detailed in 4a – K) justifiable, valid or

None

VERSION 7.2 September 2016

Page 46 of 47 Check the Intranet for the latest version

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Violence and Aggression Policy

legal? Please explain?

7. Is this policy/proposal missing a valid opportunity to promote equality of opportunity for one or more of the groups (see 4a) concerned? Please expand.

Not applicable

8. Based on the above, do you consider that this policy/proposal now requires a full impact assessment?

Yes – outlines employee/management responsibilities in the policy.

Signed (Responsible Manager for Policy/proposal)……………………… Date………………………………………………………….

VERSION 7.2 September 2016

Page 47 of 47 Check the Intranet for the latest version