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Newcastle Safeguarding Adults Boardi

Newcastle Safeguarding Adults Board

Safeguarding Adults and Skin Damage Protocol

Newcastle Safeguarding Adults Board Launched September 2009 Review July 2010

Newcastle Safeguarding Adults Boardii

Safeguarding Adults and Skin Damage Protocol 1

Contents

Deciding whether to refer to the Newcastle Safeguarding Adults Procedures 3

Initial Assessment 5

Appendix 1 When should the development of a pressure ulcer

(or other skin damage) lead to a referral through the

Newcastle Safeguarding Adults Procedures? 6

Appendix 2 Report to be completed when determining if development of

skin damage should lead to a referral through the Newcastle Safeguarding

Adults Procedures 7

Appendix 3 Body maps – male 11

Appendix 4 Body maps – female 12

Appendix 5 Suggested structure for Investigatory Reports 17

Newcastle Safeguarding Adults Board2


Deciding whether to refer to the Newcastle Safeguarding Adults Procedures

Aim of Protocol and IntroductionThis is a city wide protocol which provides guidance for staff1 in all sectors in Newcastle who are concerned that a pressure ulcer (or other forms of skin damage2) may have arisen as a result of poor practice or neglect and therefore have to decide whether to make a referral via the Newcastle Policy and Procedures for Safeguarding Adults. A flow diagram outlining the key elements of the protocol can be found in Appendix 1.

Neglect is the deliberate withholding OR unintentional failure to provide appropriate and adequate care and support, where this has resulted in, or is highly likely to result in preventable skin damage.

All cases of actual or suspected neglect should be referred through the safeguarding procedures. Although not all poor practice is neglect, some may be. Poor practice may also need to be reported through the safeguarding procedures, to ensure areas of concern are appropriately addressed.

Skin damage has a number of causes, some relating to the individual patient3, such as poor medical condition and others relating to external factors such as poor nursing care, lack of resources e.g. equipment, staffing.

When a member of staff identifies safeguarding concerns about skin damage, an initial assessment must be carried out, involving at least two members of staff, one of whom must be a practising Registered Nurse (RN). The second person could either be the line manager of the person who raises concerns, or in a senior position. This assessment must be documented on the report form in Appendix 2. Advice in completing the form can be obtained from a Tissue Viability Nurse.

1 The term staff is used to refer to employees from all sectors.2 Skin damage includes: pressure ulcers, skin tears, grazes, bruises etc. 3 The term patient has been used throughout – however this also refers to residents in

care homes and those living in their own homes.


If necessary an alert (using form SAMA1) must then be made to Adult and Culture Services Directorate. The safeguarding alert should be made by contacting one of the following:

• The relevant Adult Services Team Manager – when patient / service user is known to Adult Services and has an allocated social worker/ care manager.

• The Hospital Social Work Team Manager – when patient / service user is in hospital.

• The Adult Social Care Direct team (based at Shieldfield) when the alleged abuse has taken place in a care home4 or if you are unsure who else to contact.

• The Emergency Duty Team (based at Civic Centre) for alerts being made out of working hours

Staff should also refer to:

• the Newcastle Policy and Procedures on Safeguarding Adults

• their own organisation’s policies and procedures on pressure ulcers

• other relevant local and national guidelines, protocols and policies e.g. NICE Guidance, incident reporting policies.

Appendix 5 contains a suggested structure for an investigatory report. The decision as to whether there should be an investigation is made at the Safeguarding Adults Strategy Meeting. These Strategy meetings are convened in response to individual cases.

4 If alleged abuse has occured in a care home the Care Quality Commission (CQC) must be informed


Initial Assessment

The assessment must consider five key questions:

Has there been rapid onset and/or deterioration of skin integrity?1.

Has there been a recent change in medical condition e.g. skin or wound 2. infection, other infection, pyrexia, anaemia, end of life care that could have contributed to a sudden deterioration of skin condition?

Have reasonable steps been taken to prevent skin damage3. 5?

Is the level of damage to the skin disproportionate to the patient’s risk status 4. for skin damage? E.g. Low risk of skin damage with extensive injury.

Is there evidence of poor practice or neglect? 5.

Photographic evidence to support the report should be provided wherever possible. Consent for this should be sought. The photographs must record the size of the wound.

Is the patient a vulnerable adult?Consider the definition of vulnerability contained in the Newcastle Safeguarding Adults Policy and Procedures. A vulnerable adult is defined as an adult who ‘is or maybe eligible for community care services and whose independence and wellbeing would be at risk if they did not receive appropriate health and social care support.’

Those in care homes who are ‘self funders’ should also be referred through the Safeguarding Adults Procedures, despite the fact that they are not ‘eligible for community services’ as such.

References Department of Health (2003) Essence of care service user focused benchmarks for •clinical governance April 2003

National Institute for Health and Clinical Excellence (2005) Guidance for the prevention •and treatment of pressure ulcers September 2005

5 The NICE Guidelines should be used as a basis for deciding whether reasonable steps have been taken.


Appendix 1 When should the development of a pressure ulcer (or other skin damage) lead to a referral through the Newcastle Safeguarding Adults Procedures?

.

Concern is raised that a person has skin damage

Is the person vulnerable according to the definition in the Safeguarding Adults Procedures, or a ‘self funder’?

Complete an assessment – two people to answer the 5 initial assessment questions – document assessment on Report Form in Appendix 2.

Refer to Safeguarding by contacting the appropriate person by telephone (Adult and Culture Services) and completing the multi -agency alert form (SAMA1).

Do not refer to Safeguarding. Action any other recommendations identified on Report Form.

Decide whether to refer through Safeguarding Procedures (based on responses to 5 key questions). If unsure as to whether to make a referral – contact the Safeguarding Adults Unit at Shieldfield for advice.


Appendix 2 Report to be completed when determining if development of skin damage should lead to a referral through the Newcastle Safeguarding Adults Procedures

Two assessors must sign this form. At least one of them must be a Registered Nurse (RN).

Please attach completed form to the Multi-agency Alert Form (SAMA1)

The content of this report is confidential. It is part of the Newcastle Procedures for Safeguarding Vulnerable Adults and should be shared as part of the procedures, in the best interests of the vulnerable adult.

Name of patient/service user

Normal address of patient/service user

DOB

Hospital number/NHS number

Place of current care

Previous place of care (if appropriate)

GP or Consultant

Synopsis:

Report prepared by:

At the request of:

Date of report:

Purpose of report:

Main findings:

Documentation available at time of reporting (please list):


1. Has there been rapid onset and / or deterioration of skin integrity?

Yes No

If yes, describe as objectively as possible:

2. Has there been a recent change in medical condition e.g. infection, pyrexia, anaemia, end of life care, that could have contributed to skin damage?

Yes No

If so, have a reassessment of risk and additional measures been implemented?

Yes No

Give details:

3. Have reasonable steps been taken to prevent skin damage?

Yes No

a. List what steps have been taken to prevent skin damage:

b. List any reasonable steps you would have expected, but that have not been taken:


4. Is the level of damage to skin disproportionate to the patient’s risk status for pressure ulcer development? E.g. low risk – but extensive injury.

Yes No

If yes, please explain:

5. Is there evidence of poor practice or neglect?

Yes No

a. List evidence of poor practice:

b. List evidence of neglect:

Rationale for referral / non referral:

Recommendations (to include decision as to whether a safeguarding adults alert should / should not be made):


Any other recommendations:

Details of two members of staff contributing to this assessment:

Name:

Title:

Place of work:

Qualifications:

Signed:

Print name:

Date:

Name:

Title:

Place of work:

Qualifications:

Signed:

Print name:

Date:


Appendix 3 Body maps – male

Body maps should be used to record skin damage and can be applied as evidence if necessary at a later date. If two workers observed the skin damage they should both sign the body map.

Name of service user

Date of birth

Date of worker(s) witnessed the skin damage

Time the worker(s) witnessed the skin damage

Name of worker Name of worker

Job Title Job Title

Signature Signature


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APPENDIX 3

Body maps – male



Date of birth



Name of worker

Name of worker


Appendix 4 Body maps – female



Date of birth



Name of worker Name of worker

Job Title Job Title

Signature Signature


10

Job Title

Job Title

Signature

Signature

Body maps – female



Date of birth

Date of worker(s) witnessed the

Time the worker(s) witnessed the


10

Job Title

Job Title

Signature

Signature

Body maps – female



Date of birth

Date of worker(s) witnessed the

Time the worker(s) witnessed the


Appendix 4 Safeguarding adults Multi-agency Alert Form

Reference: SAMA1This form is to be used to notify Adult and Culture Services Directorate / Adult Social Care Direct Team of any suspected or actual instances of abuse.

Phone 0191 278 8377 (8.00am – 6pm) or 0191 232 8520 after 6.00pm


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APPENDIX 4

Person completing the form: Organisation Name: Service / Ward Name: Phone contact details: Date of Notification to Adult Social Care Direct:

Details of incident/suspected or actual abuse To be completed by the manager or lead officer within the organisation responsible for safeguarding adults

Date of alleged incident/harm: Time of alleged incident/harm:

Area where incident/harm took place: Who reported the alert: Date:

Who was involved:

Details of Alleged Victim Name: Address: Date of Birth: Phone :

Name and address of GP: Ethnic Origin: Nature of alleged victims’ vulnerability: Any other details (e.g. communication needs):

Safeguarding adults Multi-agency Alert Form Reference: SAMA1 This form is to be used to notify Adult and Culture Services Directorate / Adult Social Care Direct Team of any suspected or actual instances of abuse. Phone 0191 278 8377 (8.00am- 6pm) or 0191 2328520 after 6.00pm


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Details of Perpetrator Name : Address: Date of Birth: Phone Contact: If the perpetrator is a staff member please provide staff details (E.g. job role, employer, address of place of work)

Ethnic Origin: Relationship to victim: Are they a vulnerable adult? Yes/No Alleged perpetrators vulnerability (if applicable): Any other details:

Have you made the victim aware that details of the incident are being recorded and will be investigated:

Yes/No

If not, why not?



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Details of Perpetrator Name : Address: Date of Birth: Phone Contact: If the perpetrator is a staff member please provide staff details (E.g. job role, employer, address of place of work)

Ethnic Origin: Relationship to victim: Are they a vulnerable adult? Yes/No Alleged perpetrators vulnerability (if applicable): Any other details:

Have you made the victim aware that details of the incident are being recorded and will be investigated:

Yes/No

If not, why not?


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Type of Abuse (Please tick one or more)

!

Sexual

Physical

Emotional

Neglect or omission

Psychological

Financial/Material

Discriminatory Abuse

Institutional

Other i.e. suspicious death of a service user

Description of alleged incident / alleged harm, detailing all people involved including witnesses On this page please give a detailed description of the incident (please include times) and any other comments you feel are relevant. If necessary attach further pages.

What action did you take immediately after the incident/allegation of harm (E.g. administered first aid, asked perpetrator to leave, took victim to secure area)



14

Type of Abuse (Please tick one or more)

!

Sexual

Physical

Emotional

Neglect or omission

Psychological

Financial/Material

Discriminatory Abuse

Institutional

Other i.e. suspicious death of a service user

Description of alleged incident / alleged harm, detailing all people involved including witnesses On this page please give a detailed description of the incident (please include times) and any other comments you feel are relevant. If necessary attach further pages.

What action did you take immediately after the incident/allegation of harm (E.g. administered first aid, asked perpetrator to leave, took victim to secure area)


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Were the Police called: Yes / No

Were any other emergency services called: If yes, which service(s)? Yes / No

Names and badge numbers of Police:

Outcome: (Response time, taken to hospital etc)

Are there any other Agencies involved? Yes/No

Please provide details of agencies:

Are there any capacity issues? Yes/ No

Please provide details:

Has the victim made any previous referrals/alerts? Yes/No

Please provide details (e.g. dates, type of abuse):

Is the victim in immediate danger of further abuse? Yes/No

Have any immediate actions been identified to reduce the potential for further abuse? Yes/No

Has an initial assessment been made to determine further potential risk to the victim? Yes/No

What actions have been taken to reduce the potential for further abuse?

Are there any risks to others? Yes/No (Vulnerable adults, children)

Please provide details (include who this information has been shared with – e.g. Children’s Social Care, Police):

Signed:

Date: Time:



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Were the Police called: Yes / No

Were any other emergency services called: If yes, which service(s)? Yes / No

Names and badge numbers of Police:

Outcome: (Response time, taken to hospital etc)

Are there any other Agencies involved? Yes/No

Please provide details of agencies:

Are there any capacity issues? Yes/ No

Please provide details:

Has the victim made any previous referrals/alerts? Yes/No

Please provide details (e.g. dates, type of abuse):

Is the victim in immediate danger of further abuse? Yes/No

Have any immediate actions been identified to reduce the potential for further abuse? Yes/No

Has an initial assessment been made to determine further potential risk to the victim? Yes/No

What actions have been taken to reduce the potential for further abuse?

Are there any risks to others? Yes/No (Vulnerable adults, children)

Please provide details (include who this information has been shared with – e.g. Children’s Social Care, Police):

Signed:

Date: Time:


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This form must be sent to the Adult Social Care Direct team within 24 hours of the suspected or actual abuse, or as soon as possible after being made aware. Phone Adult Social Care Direct 0191 278 8377 .This form can be faxed: 0191 278 8312 Or emailed: [email protected]

This must be accompanied a phone call to the Adult Social Care Direct Team advising alert is being sent.

Decision by safeguarding manager (Adult and Culture Services Directorate Only) Safeguarding Alert Yes / No If NO – please give reasons

This is a confidential document and should be stored securely according to your own organisation’s procedures. It is your responsibility to ensure that this is done.


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This form must be sent to the Adult Social Care Direct team within 24 hours of the suspected or actual abuse, or as soon as possible after being made aware. Phone Adult Social Care Direct 0191 278 8377 .This form can be faxed: 0191 278 8312 Or emailed: [email protected]

This must be accompanied a phone call to the Adult Social Care Direct Team advising alert is being sent.

Decision by safeguarding manager (Adult and Culture Services Directorate Only) Safeguarding Alert Yes / No If NO – please give reasons

This is a confidential document and should be stored securely according to your own organisation’s procedures. It is your responsibility to ensure that this is done.


Appendix 5 Suggested structure for Investigatory Reports

Patient history Include any factors associated with the patient ’s behaviour that should be • taken into consideration

Medical historyDoes the patient have chronic disease which may impact on skin integrity? e.g. • Rheumatoid Arthritis

Is the patient receiving palliative care?•

Does the patient have any mental health problems which might impact on skin • integrity? e.g. dementia / depression

Monitoring of skin integrityShould the illness, behaviour or disability of the patient have reasonably • required the monitoring of skin condition (where no monitoring has taken place prior to skin damage occurring)?6

Did the patient refuse monitoring? If so, did the patient have the mental • capacity to refuse such monitoring?7

If monitoring was agreed, was the frequency of monitoring appropriate for the • condition as presented at the time?

Expert advice on skin integrityWas appropriate assistance sought? •

Was advice provided? If so was it followed? •

Care planning & Implementation – skin integrityIf expert advice was provided did it result in a care plan? •

Were all of the actions on the care plan implemented? If not, what were the • reasons for not adhering to the care plan?

•

6 Family have no right to refuse monitoring 7 The patient’s consent to monitoring should always be sought, but if the patient lacks

the metal capacity to make a decision as to whether monitoring should take place, then the decision as to whether or not monitoring should take place should be made in the patient ’s best interests.


Did the care plan include provision of specialist equipment? •

Was the specialist equipment provided in a timely manner?•

Was the specialist equipment used appropriately? •

Was the care plan revised • within appropriate time scales?

Care provided in general (hygiene, continence, hydration, nutrition, medications)

Does patient have continence problems? If so are they being managed? •

Are skin hygiene needs being met? (including hair, nails and shaving)•

Has there been deterioration in physical appearance?•

Are oral health care needs being met?•

Does patient look emaciated or dehydrated?•

Is there evidence of intake monitoring (food and fluids)? •

Has patient lost weight recently? If so, is patient s weight being monitored? •

Is patient receiving sedation? If so is the frequency and level of sedation • appropriate?

Does patient have pain? If so has it been assessed? Is it being managed • appropriately?

Other possible contributory factorsHas there been a recent change (or changes) in care setting? •

Does the patient have a history of falls? If so has this caused skin damage? Has • the patient been on the floor for extended periods?


Notes

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