raising standards in healthcare security · defining violence, abuse or challenging behaviour...
TRANSCRIPT
Jayne King
Head of Security & Site Services
Guy’s & St Thomas’ NHS Foundation Trust
Chair
National Association for Healthcare Security (NAHS)
Security in Healthcare
• Context
• Role of NAHS
• In house V’s Contracted out
• Are SIA licences applicable?
Who are our people
• 2nd career for managers and Security Officers?
or
• Make it a 1st career choice, addressing career pathways and/or apprenticeships
• Is the pool drying up?
Training
• Sector specific?
• Acute
• Community units
• Mental Health
• Ambulance
Conflict
Resolution
Training
Course
Training
Need
Skills
Gap
Conflict
Resolution
for
Managers
Course
3 Year Refresher Year 1 Year 2 Year 3
Conflict
Resolution
Junior
Refresher
Course
Skills Fade
Senior
Staff
Nurse
Ward
Manager
Senior
Staff
Nurse
Control &
Restraint
Training
Course
Conflict
Resolution
Training
Course
Day
1
Day
2
Security Officer Training
Yearly Refresher
Training
Ethos &
Syllabus
Do no
harm
Early
Intervention
Physical Intervention
a last resort
Inclusive Problem
Solving
Risk Assessment
& Management
Human Behaviour /
Attitude
Positive
Interactions
De-escalation
Skills
Practical Safety
Techniques
The Contract
• Procurement of Security services in the NHS
• Understanding the market/adjust?
• Working with stakeholders (internal & external)
What do we do - Specialist role
• Violence - 1100 incidents per year - approx 170 incidents of physical violence however approx 135 of those are patients whose clinical condition may be a factor.
• Teach conflict resolution to frontline staff - definition front line (NHS Protect) any staff that may contact with patient or visitor
• Theft - every hospital has this issue.
• Safeguarding issues - vulnerable persons, elderly, dementia, mental health, children
• VIPs ( anyone who may be subject to press intrusion, high risk prominent prisoners)
• Location attracts a wealth of high profile visitors, PM’s/Ministers, Royal family
• Major Incident.
• Site Issues (facilities role)
• Crime prevention adviser (CPDA) New builds (Evelina, CTC) ongoing project works
• Domestic violence issues work closely with DV team
Defining violence, abuse or challenging behaviour
• Violence is defined as the intentional application of force to a person of another, without lawful justification, resulting in physical injury or personnel discomfort
• Abuse is defined as the inappropriate use of words or behaviour causing distress, alarm and or constituting harassment
• Challenging behaviour is defined as any non-verbal, verbal or physical behaviour which makes it difficult to deliver good care safely
The majority of the incidents we see are related to Challenging behaviour
Very unwell aggressive patient broke IV pole in half
7 days of Violence and Aggression in ED
Aggressive alcoholic patient sleeping in ED entrance
refused to leave
Patient very verbally aggressive to nurse calling her ‘fucking bitch’ and
threatening to slap her
Patient in waiting area been discharged but refusing to
leave
Patient left department and then jumped 13 feet off a wall
Patient with self-harm punched security guard in the face, pushed over the
nurse and consultant
Patient started shouting aggressively because waiting
time was too long
High risk mental health patient trying to leave -restrained
Patient was throwing punches, punched the doctor once then punched the nurse in the
chest.
Confused elderly man lashing out hitting security with his
walking stick
Aggressive patient who had self-harm cut his wrists
attempting to leave dept
Patient punched Dr then put his hands round Drs neck
Patient shouted ‘fuck you’ then hit nurse and security guard
Patient threatening to kill nurses family and follow her
home after work
Patient became very aggressive and shouting to nurse that she was 'a cunt'
and a 'motherfucker'
Patient deliberately pulled out cannula spraying blood
everywhere
Patient stated ‘wait till Monday comes and you find out what
happens to you'
Examples of medical causes for patients becoming violent or aggressive
• Head injury
• Hypoxia (low oxygen levels)
• Hypoglycaemia (low blood sugar)
• Shock (sepsis, hypovolaemia, anaphylactic, cardiac)
• Stroke
• Neurological disorders
• Seizures
• Intracranial infections (infection in the brain)
• Encephalitis (swelling of the brain)
• Hyponatraemia (low sodium levels)
• Drugs and alcohol
• Mental health problems
• Many other medical problems
It’s not just about our staff...
The scene from an incident on
one of our wards recently at 3am
Why do we have a problem
• Increase in drug & alcohol abuse
• Increase in the number of mental health patients in crisis
• Staff hesitant to take action, giving the patient or family a second chance
• Delay in identifying a problem, leading to crisis
• Staff accepting its part of the job
• Difficulty in trying to identify cause - ? Clinical
• Not always agreement or support amongst the MDT
• Staff don’t always stick to the plan
• Lack of confidence & courage, staff hesitant to report and press charges
• Our behaviours
How do we support our staff?
Instil a culture that accepts it is not part of the job
Give staff the skills & confidence to
identify a potential or actual
deteriorating situation
Staff respond with confidence and are supported by their managers and the Trust
Our aim is to ensure staff feel they can do their job without the fear of violence and aggression towards themselves and their patients.
Networks
• Private and public sector partnerships (SBBW, LB Security Forum, Security Commonwealth, etc)
• The Security Industry - common goals and links.
• Best Practice – what can we learn from each other
• Is there/should there be a strategy?
Ambulances
Injury in the night-time economy requires:
Scene Management to:
– Ensure there is room for crews to work
– Direct people away from scene, inside or outside
– Protect the safety of ambulance crews
Looking ahead
• Going forward
• fit for the future
• long term strategy
CQC Inspection 2016
Emergency Department
Areas of outstanding practice-
‘The role of the security team in the Emergency Department was embedded into the day to day working of the department. The team was multi-lingual and trained in effective de-escalation techniques and demonstrated outstanding empathy to patients.’
Q&A