Transcript Independent mental capacity advocates

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STAFF BRIEFING
An overview of essential processes and policies
This document contains
1) An overview of the key points within essential processes and policies
2) Useful contacts for each area
3) Signposts to additional policy information on the intranet
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Question 1 : Are we safe?
Mental Capacity Act
Independent Mental Capacity Advocates
Safeguarding Adults
Safeguarding Children
Infection Control
Cleanliness
Medicine Safety
Monitoring Drug Fridge Temperatures
Health and Safety
Waste Management
Medical Equipment
Safe Staffing
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Mental Capacity Act
Summary
• The Mental Capacity Act applies to everyone who works with people who lack
capacity
• Provides a statutory framework to empower & protect people who may lack capacity
to make some decisions for themselves (e.g. dementia, learning disabilities, mental
health, stroke/head injuries)
• Enables them as far as possible to make appropriate decisions on their own behalf
• Protects the rights of those who make decisions on their behalf (health workers and
care workers)
• It’s purpose is to provide clarity and safeguards around the research in relation to
those who lack capacity
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Mental Capacity Act
Five core principles
• All decisions about mental capacity should be guided by five core principles:
• Assume a person has capacity unless otherwise indicated
• All practicable steps must be taken to help person make a decision
• A person is not to be treated as unable to make a decision merely because it is an
unwise decision
• Any act/decision taken on behalf of someone must be in their best interest
• Always consider the least restrictive option/intervention.
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Mental Capacity Act
The Act clarifies…
• What “lack of capacity” is:
• A person lacks capacity in relation to a matter if at the material time he/she is
unable to make a decision for himself in relation to the matter because of an
impairment of the mind
• The impairment may be temporary or permanent
• How to assess capacity:
• Assume a person has capacity unless otherwise indicated i.e. start from a
presumption of capacity then take into account the person’s behaviour, their
circumstances and any concerns raised by others
• Assessment of capacity should be specific to the decision to be made at a
particular time
• Avoid assumptions by reference to age or appearance, or aspects of behaviour
which could lead to unjustified assumptions
• Staff always document and keep records of any assessment.
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Mental Capacity Act
• Assessment of a person’s capacity must consider the following factors:
• Can they understand the information
• Are they able to retain the information
• Are they able to use or weigh that information as part of the decision making
process
• Can they then communicate their decision
• Who assesses capacity?
• The person delivering the care or treatment is responsible for assessing capacity
in relation to the care or treatment proposed - this includes healthcare staff,
social care staff, family, unpaid carers.
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Mental Capacity Act
Best interests
• Where a patient has been assessed as lacking capacity to make a particular decision,
the decision-maker has to act in the patient’s “best interests”
• The Act does not define “best interests” but provides a checklist – detailed on the next
slide
• There is a duty under the Act to consult with the carer, interested party, persons
holding powers of attorney, etc. before a best interest decision is made
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Mental Capacity Act
Best interests checklist
• Avoid assumptions about the patient’s best interests merely on the basis of age,
appearance, condition or behaviour
• Consider a patient’s own wishes, feelings, beliefs & values and written statements
made when they had capacity
• Take account of views of family and carers or Independent Mental Capacity Caldicott
(See IMCA slides)
• Can the decision be put off until the patient regains capacity?
• Demonstrate that you have carefully assessed any conflicting evidence or views
• Provide clear, objective reasons as to why you are acting in the patient’s best interests
• Take the less restrictive alternative or intervention.
For more information contact safeguarding lead David Flood on ext 1624 (Bleep: 8031)
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Independent mental capacity advocates
(IMCA)
• There is a legal duty for an Independent mental capacity advocates (IMCA) to be
instructed where:
• There is a decision to be made regarding SMT or accommodation
• The person has been deemed not to have capacity to make that decision
• The person has no close family or friends who are appropriate or practical to
consult
• Urgent decisions (“life or limb”) should not be delayed.
• The IMCA does not:
• Assess capacity
• Make the best interest decision
• Mediate between family and professionals
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Independent mental capacity advocates
Free service – St George’s uses Voiceability - Hotline - 0845 0175 198
What do IMCAs do?
• Represent and support the person in relation to their “best interests”
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Find out the views, feelings and beliefs of the person.
Make sure that the person can participate in the decision-making process
Obtain & evaluate information
Look at other courses of action
Consider seeking a further medical opinion if necessary
• Check the Mental Capacity Act principles and best interests process are being
followed
• Prepare a report, which the decision-maker has a legal duty to consider.
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Safeguarding Adults
Everyone’s responsibility
All staff should:
• Be able to recognise abuse and neglect
• Know what action to take if they have a concern about an adult
• Know where and from whom to access support and advice
• Know how to access the safeguarding adults site on the intranet (documentation,
information, training)
• Be confident about information sharing
• Understand that they have a duty to report concerns.
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Safeguarding Adults
It’s your responsibility
What to do if you have a concern? – Five Rs
• Recognise signs or symptoms of abuse or neglect
• Respond - Listen and reassure - Think safety first
• Report – Datix and inform your line manager
• Record and document evidence
• Refer to safeguarding lead/social services
Please do not ignore the situation.
Safeguarding adult lead is David Flood - ext 1624 (Bleep: 8031)
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Safeguarding Adults
Signs / symptoms
• Unexplained injuries – bruises, fractures or burns
• Think history – Any inconsistencies? Unusual sites?
• Behaviour – passive, stressed/agitated, check with family/carers (if appropriate)
• Neglect – malnutrition, pressure ulcers, isolation, home environment, hygiene, access to
services
• Financial – basic needs not being met, unpaid bills
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Safeguarding Children
Everyone’s responsibility
All staff should:
• Be able to recognise abuse and neglect
• Know what action to take if they have a concern about a child or young person (under
18 years)
• Know what action to take if they have concerns about an adult who is a parent or carer
• Know where and from whom to access support and advice
• Know how to access the safeguarding children section on the intranet (documentation,
information, training)
• Be confident about information sharing
• Understand that they have a duty to report concerns.
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Safeguarding Children
Recognition of abuse and neglect
Physical abuse
• Bruises, burns, fractures, - does the injury fit the history and the child’s
developmental stage?
Neglect
• The persistent concerns...
• Unkempt, dirty, hungry, inappropriate clothing, DNA’s, untreated medical conditions,
poor school attendance, developmental delay...
Emotional abuse
• Withdrawn, behavioural issues, low self esteem, soiling, wetting, parents who are
negative/critical
• Includes impact of domestic abuse
Sexual abuse
• Sexualised behaviour, language, soiling, wetting, physical signs
• Sexual exploitation.
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Safeguarding children
Be aware
• The adult issues that may present concerns for
children in their care and what to do
• Domestic violence, drugs and alcohol, mental health
issues, chronic health issues, learning disability,
criminal behaviour all increase the risk to children
• The level of training you require, depends on how
often you are in contact with children
• Have access to key documents – available via the
intranet under procedural documents
• How to contact social services
• A critical policy for paediatric staff to understand
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People who can help:
• Dr Sarah Thurlbeck
x3648 (named Dr)
•Geraldine Fraher x 5237
(named nurse acute
paediatrics)
•Caroline Beazley
(named nurse)
•Marion Louki x0700
(named midwife)
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Infection Prevention and Control
Single-use items
• Single-use items should be used once and discarded. Do not re-use single items
• Discard all other unused items in a pack e.g. mouth care packs and NG syringes
• Look for this symbol on packaging for single-use items
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Infection Prevention and Control
Re-usable items
Re-usable items must be adequately reprocessed between each patient
There are three levels of decontamination
• Cleaning
• physical removal (blood, faeces, etc) and many micro-organisms with detergent
• mattresses, bedside lockers
• Disinfection
• reduces the number of micro-organisms to a safe level, spores are not usually
destroyed
• endoscopes, bedpans, commodes, crockery
• Sterilisation
• removes or destroys all micro-organisms, including spores
• surgical instruments
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Infection Prevention and Control
Further inspection
• The Infection Control Manual and infection control pages are available on the intranet
• The Infection Control Nurses are available
• Monday to Friday 08:30 to 17:30 via Bleep 6798
• Office 08:30 - 16:30: ext. 2459
• For urgent calls out of these hours please contact the on-call microbiologist via the
switchboard
• Each ward has in infection control notice board – is your board up to date?
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Infection Prevention and Control
Keeping clean and clutter free
• Ensure the Know your Responsibilities – posters are displayed on the wards to inform all who does what
for cleaning- including how often areas are cleaned.
• Ensure you know to contact the helpdesk and how to report cleaning and estates concerns and how to
escalate.
• Ext 4444 (4438/7 out of hours) for Estates and Cleaning in Atkinson Morley Wing
• Ext 4000 (bleep 7888 out of hours) for all patient’s meals across all areas and ext 4000 for all cleaning
across the rest of the Trust (SGH) (bleep 7888 out of hours)
• Ext 1234 Trust estates team (all non AMW areas at SGH) bleep 6407 emergency engineer bleep out of
hours.
• Do you know who your cleaning supervisor is / the names of your cleaning team on the area? If not find
out
• Ensure you have your latest cleaning audits up on the Infection Control notice board. Did your staff
accompany the audit team and sign off the audit ?
• Remember to check the bed area once a deep clean has been completed to ensure that this is
satisfactory before the next admission and that this has been noted.
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Infection Prevention and Control
Caring for the environment top tips
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Cleanliness
NHS Standards and responsibilities
• Current standards 2007 National Standards – 49 elements and 2009 NHS
Cleaning Manual
• Specific Risk Categories depending on levels of infection e.g. Wards - High
risk
• The higher the risk the more frequent the cleaning and the more frequent
the auditing
• Nursing /cleaning staff areas of responsibility
• Duties outlined in SLA/posters in ward areas
• Infectious cleans guidance on intranet
• Cleaning of Body Fluids
• See Infection Control policies
• Use neat Milton or Haztabs
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Caring for the Environment - Top Tips
• Have your staff had waste management training ? Ensure that all staff understand the
different types of waste and ensure that this is being carried out correctly.
• Remember to look up as well as down when reviewing your environment.
• Ensure staff have been trained on how to clean equipment – drip stands, commodes, BP
machines, resus trolleys, raised seats, clinical storage racks, pc’s keyboards and screens,
mattresses, body fluids.
• Linen – ensure that this area is separate from other items and that it is clean and tidy –
always reject linen if not up to standard.
• Are all gel/soap dispensers/toilet paper/hand towels/aprons full all the time ?
• Curtains are changed every 6 months in addition to the changing of these after patients
have left the Trust. These records are kept with the cleaning teams.
• Further support can be given by contacting the Facilities teams via ext 1234 or on bleeps
7159 / 7664 or on ext 0058.
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National colour coding scheme for hospital cleaning
materials and equipment
• All NHS organisations should
adopt the colour code (right) for
cleaning materials.
• All cleaning items, for example,
cloths, (reusable and disposable)
mops, buckets, aprons and gloves
should be colour coded.
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Medicine Safety
• Ensure you have read and understood the relevant sections of the medicines policy
and know how to access it
• Never administer anything you are not confident about or assessed as competent to
do. If not sure speak to your named pharmacist
• Never give any medicine (or undertake any procedure) without confirming the
patient’s identity
• Ensure all medicines are always locked away and not left on lockers or in the open
• Ensure all cupboards, fridges, PODs and trolleys are locked and the keys are with a
registered nurse or midwife
• Do not administer and leave medicines with patients to take later, this must be
observed (may be different for some in offender healthcare)
• Ensure that if any medicines are omitted this is documented clearly with reasons
• Ensure you attend all regular updates and relevant training
• Please ensure you report and record all near misses or errors on Datix and tell your
manager
• Make sure allergies are clearly documented on prescription charts
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Monitoring Drug and Fridge Temperatures
Previous CQC inspection highlighted drug and fridge temperatures as a risk
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CQC said - “Patients were not protected against the risks associated with medicines because the
temperatures of medicines storage areas on some wards were not monitored consistently.”
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Key points
– Ensure all drug fridges must have a calibrated thermometer to monitor minimum and maximum
temperatures
– Clinical areas must use the trust approved temperature monitoring log form
– Drug fridges must be monitored on a daily basis
– Any deviation in drug fridge temperature must be acted upon, following the temperature
deviation procedure
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Since August 2013, a Trust-wide Drug Fridge Thermometer Calibration Service has been rolled out
– Calibrated thermometers have been purchased and installed in clinical areas for monitoring of
minimum and maximum temperatures
– Policies are available on the intranet, Pharmacy Department page, for drug fridge temperature
monitoring, temperature deviation and for defrosting drug fridges. See link:
http://stginet/Units%20and%http://stginet/Units%20and%20Departments/Pharmacy/Fridge%20
Monitoring.aspx
– Key clinical staff have been trained on the fridge thermometer calibration process and monitoring
requirements.
For further training please contact [email protected] or [email protected]
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Health and Safety
Managing health and safety and risk assessments
A Risk Assessment – The process of identifying risks to and from an activity and assessing the
potential impact of each risk (CQC Guidance Essential standards of Quality and Safety 2009)
• The Management of Health and Safety at Work Regulations (1999) state:
• Every employer shall make a suitable and sufficient assessment of the risks to the health
and safety of employees to which they are exposed to at work (staff, volunteers)
• The risks to the health and safety of people not in their employment (Patients, Visitors etc)
• Only trained and competent people should carry out a risk assessment, for training or guidance
please refer to the Risk management policy or contact:
• The risk management department ext 4054 or 4966 or The Health and Safety department
ext 3309 or 4043
• Examples of patient specific risk assessments: VTE, SBAR, EWS, pressure ulcers and falls
• Examples of non-patient specific risk assessments: manual handling, fire, emergency evacuation,
environmental.
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Health and Safety
How to carry out a risk assessment
• Identify the hazards - consider human, environmental and emergency factors
• Consider who may be harmed and how - consider patients, staff, visitors and anyone
else who may be in the area. Also consider personal factors like age, medication,
medical conditions
• Evaluate the risks and decide on risk control measures - Use the relevant risk scoring
matrix to score the risk and decide on the control measures required to reduce the risk
to an acceptable level
• Record the findings - To demonstrate that the assessment has been carried out and to
instruct other members of staff on the required control measures
• Review and update - risk assessments must be reviewed at time intervals relevant to
the assessment. If anything changes in regards to the patient, the control measures
required or the environment, then this must be recorded in the risk assessment.
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Waste Management
Correct waste segregation
Infectious clinical waste
Domestic waste
Clinical waste for incineration
Recycling
Sharps bins in caddies
with lids of same colour
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Waste Management
Correct waste segregation
Pedal bins
The pedal bins used in clinical areas should be
rust-free and clean. Silent-closing, rigid body bins
can be obtained from EHP via Agresso. For 70 litre
rigid body bins the product code is HSBM1030SC,
when ordering please state colour required. For the
disposal of old bins please contact Waste Manager.
For further advice contact the
Waste Manager on x3169
Clinical Waste
Sharps bins
Sharps bins should:
1. Have the lid firmly attached
2. Not be filled above the line
3. Not to be used when ¾ full
4. Have the label completed to show where and when used
5. Contain only sharp objects, which should be placed into a
sharps bin as soon as they have been used
6. Always be mounted on a bracket, available from Waste
Manager, or in POUD tray.
Domestic Waste
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Medical Equipment
• Medical Equipment must be:
• Safe: Properly maintained and used correctly
• Suitable for its purpose
• Available
• Support is from Medical Physics and Clinical Engineering Department
Practice Nurse Educators and the Procurement Department
• Policies
• Medical Devices Management and Use policy
• Medical Devices Training Policy
• Procurement policy
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Medical Equipment
• Only use equipment you are competent to use. Request training as required
• Only use equipment that you are sure is fit for the purpose (that is, the correct
equipment and accessories to perform the task)
• Ensure any equipment checks required are carried out
• Report any faults or concerns about equipment function to Medical Physics, and take
equipment out of use
• Report any safety incident involving equipment, and take the equipment out of use (&
save all consumables for investigation).
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Medical Equipment
• Only use ‘Know how’ to borrow from the equipment library
• Return equipment to the equipment library when finished with – someone else will
need it
• ‘Know how’ to request pressure relieving mattresses including out of hours.
• Assess and return pressure relieving mattresses not required – someone else needs
one
• Assess whether any lack of equipment is detrimental to patient outcomes. Make
senior staff aware of any lack. Budget holders to manage locally bought equipment,
and to present capital equipment requests to their division
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Safe staffing
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The Trust has a duty to ensure staffing levels are sufficient to maintain safety,
minimise risks to patients and provide quality care. Nurse staffing levels make a
difference to patient outcomes, patient experience, quality of care and the
efficiency of care delivery (all staff should read the safe staffing policy).
We should work towards having the right staff with the right skills in the right
place at the right time with the right leadership.
Safe staffing can be defined as whether staff can safely:
• Complete vital signs observations - (especially post-operatively, and 1:1 ‘specials’)
• Assist patients with nutrition
• Assist patients with hydration (drinks and intravenous or nasogastric fluids)
• Care for pressure areas
• Administer drugs and and oxygen therapy
• Take their statutory rest breaks
• Complete risk assessments for new patients including PUP and MUST.
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Safe Staffing – top 10 tips
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Each unit, ward, department and community service will have an agreed number of
Nurses, Midwives and Health Care Assistants for each shift of the 24-hour day – ensure
you know what these numbers are.
The duty roster should be planned in advance with the aim to provide the best possible
nursing skill mix
Safe staffing relies on good management of your rota. Ensure that all permanent staff
hours are used. Ensure everyone on short or long term sickness is managed with the aim
of getting them back to work as quickly as possible
Gaps in the nursing numbers due to vacancy or sickness may be covered by bank staff or
agency staff (refer to your locally agreed procedure for authorisation)
Assess your patient acuity/dependency at handover and ensure you have sufficient staff
to cover the required work for the shift. Review your skill mix and ensure staff are
allocated appropriately to cover the nursing workload
If you have a concern, talk to your Matron / Head of Nursing. If they are unable to assist,
ensure your Divisional Director of Nursing (DDNG) is contacted. They are expected to
liaise with other senior staff in the organisation to provide a solution
Be clear about what you can and cannot do. Have precise information on staff numbers,
skill mix, patient dependency and the definition of safe staffing (above) to support your
case for more staff or other interventions (eg. Stopping admissions or transfers for two
hours). Be clear about what you could stop and for how long (eg. Escorts).
Once your concerns have been highlighted and acted upon, record your staffing situation
before 10am using the real time RaTE system.
Remember that any change to staffing or dependency can affect staffing for the following
24 hour period. Ensure a plan is in place to respond to this.
DO NOT BE AFRAID TO CHALLENGE IF YOUR WARD IS UNSAFE