searching mental health patients and their belongings · guideline: searching mental health...

Guideline No: 2013-9057 v4 Guideline: Searching Mental Health Patients and Their Belongings

This document reflects what is currently regarded as safe practice. However, as in any clinical situation, there may be factors which cannot be covered by a single set of guidelines. This document does not replace the need for the application of clinical judgement to each individual presentation.

Approved by: Policy, Procedure and Guideline Committee Date Effective: 1st January, 2018 Review Period: 3 years Team Leader: CNC Area/Dept: Psychological Medicine

Date of Publishing: 11 January 2018 9:12 AM Date of Printing: of 24 K:\CHW P&P\ePolicy\2017 ePolicy\Dec 17\searching mental health patients and their belongings.docx This Guideline may be varied, withdrawn or replaced at any time.

SEARCHING MENTAL HEALTH PATIENTS AND THEIR BELONGINGS

PRACTICE GUIDELINE ©

DOCUMENT SUMMARY/KEY POINTS

THIS DOCUMENT HAS BEEN UPDATED TO INCLUDE ‘SEARCHING PATIENTS’ FOR DETECTION OF PROHIBITED ITEMS THAT MAY BE USED TO HARM SELF OR OTHERS AND ENVIRONMENTAL SAFETY CHECKS

• As a Mental Health Service we have a responsibility to try to maintain a safe environment for all patients, staff and visitors. Consequently, circumstances may arise where searching patients, their belongings and/or their environment for the detection of dangerous or prohibited items is considered necessary to ensure a safe environment.

• Building a therapeutic alliance with young people underpins the foundation of building a safe relationship and environment. It is imperative to work together for individual needs to be recognised and to promote safety for all.

• Searching a patient may trigger past experiences of trauma and may invoke fear, distress, helplessness and/or humiliation for the patient. This could contribute to the patient’s journey being traumatic or re-traumatising. With this in mind, actions by staff should be respectful and consideration should be given to the dignity and privacy of the young person at all times.

• In almost all circumstances, consent to search the patient and/or their belongings is required from the patient and their parent/guardian. This document acts to guide staff in issues surrounding consent, and when consent is not obtained.

• Dependent on individual patient risk assessments, searches of patients may be required on initial presentation, admission or return to ward following leave.

• All patient belongings are to be searched upon entry to the acute mental health unit. In situations where the patient is granted leave, it is a condition that both the patient and their parent/guardian agree to refrain from bringing back any prohibited items to the hospital and agree to have belongings searched by staff on their return.


This document reflects what is currently regarded as safe practice. However, as in any clinical situation, there may be factors which cannot be covered by a single set of guidelines. This document does not replace the need for the application of clinical judgement to each individual presentation.

Approved by: Policy, Procedure and Guideline Committee Date Effective: 1st January, 2018 Review Period: 3 years Team Leader: CNC Area/Dept: Psychological Medicine


• Patients and/or their belongings may also need to be searched if their behaviour or mental state deteriorates or if staff have reasonable grounds to believe a patient may be in possession of or concealing potentially harmful items.

• If a search is conducted by health staff, it must be carried out by two staff members and (where possible) with the parent/guardian present.

• Emergency department and general wards:

• Whilst this document is applicable to all mental health patients within the Sydney Children’s Hospital Network, there are some unit specific considerations outlined in relation to the emergency department and general ward settings.

CHANGE SUMMARY

This is a review of the previous guideline.

READ ACKNOWLEDGEMENT

• All clinical staff working in the acute mental health inpatient settings, emergency department, and general ward settings that caters for mental health patients, should read and acknowledge they understand the contents of this document.



TABLE OF CONTENTS 1 Introduction ............................................................................................................... 5 2 Purpose ..................................................................................................................... 5 3 Searching Patients and their Belongings ............................................................... 5 4 Types of Searches .................................................................................................... 6 4.1 An ordinary environmental search .............................................................................. 6 4.2 An ordinary search of a patient’s belongings and room ............................................... 6 4.3 An ordinary search of a patient’s person ..................................................................... 6 4.4 A frisk search .............................................................................................................. 7 4.5 A search under Duty of Care....................................................................................... 7 5 Consent ..................................................................................................................... 7 5.1 Age of consent ............................................................................................................ 7 5.2 If consent is refused .................................................................................................... 8

5.2.1 Voluntary patient Consent Refusal ....................................................................... 8 5.2.2 Involuntary Patient Consent Refusal .................................................................... 8

5.3 Parents uncontactable ................................................................................................ 8 6 Searching – Emergency Department ....................................................................... 9 6.1 When to search........................................................................................................... 9 6.2 Role of the police/paramedics ..................................................................................... 9 6.3 Storage of items in ED ...............................................................................................10 6.4 Visitors .......................................................................................................................10 6.5 List of prohibited items ...............................................................................................10 7 Searching – General Wards ....................................................................................10 7.1 When to search..........................................................................................................10 7.2 Role of the Emergency department............................................................................10 7.3 Storage of items in the general wards ........................................................................10 7.4 Visitors .......................................................................................................................11 7.5 List of prohibited items ...............................................................................................11 7.6 Authorisation ..............................................................................................................11 8 Searching – Acute Mental Health Inpatient Unit ....................................................11 8.1 Admission, transfer to the unit and return from leave .................................................11 8.2 Role of the Emergency department............................................................................11 8.3 During Admission .......................................................................................................11 9 When not to search .................................................................................................11 9.1 Exclusion Criteria .......................................................................................................12 9.2 Unlawful searches .....................................................................................................12 10 Searching Procedures .............................................................................................12 10.1 Conducting a search: .................................................................................................12 10.2 An environmental search (mental health inpatient only) .............................................13 10.3 Searching Belongings and Room ...............................................................................13

Belongings: ......................................................................................................................13 Room: ..............................................................................................................................14

10.4 Non-contact search of a patient’s person ...................................................................14



10.5 A frisk search .............................................................................................................14 11 Storage of prohibited items ....................................................................................15 12 Weapons ...................................................................................................................15 13 Illicit Substances .....................................................................................................15 14 Management of Items Brought in by Visitors (mental health inpatient only) ......16 15 Post Searching Procedures ....................................................................................16 16 Documentation .........................................................................................................16 17 Audit and Education ................................................................................................17 18 References ...............................................................................................................17 APPENDIX 1: TYPES OF SEARCH ....................................................................................18 APPENDIX 2: PATHWAY POST SEARCH OF PATIENT AND/OR THEIR BELONGINGS 19 APPENDIX 3: LIST OF PROHIBITED ITEMS ......................................................................20 APPENDIX 4: USING A HAND HELD METAL DETECTOR DEVICE ..................................21 APPENDIX 5: CONSENT FLOWCHART .............................................................................22 APPENDIX 6: DOCUMENT FLOWCHART ..........................................................................24



1 Introduction

Our aim is to provide and maintain a safe and therapeutic environment that promotes the safety, wellbeing and recovery of the children and young people in our care, visitors and staff. Every effort should be made to minimise the risk of deliberate self-harm, harm to others and suicidal behaviour, whilst being respectful of the patient and remaining trauma informed.

2 Purpose

The purpose of this document is to:

a) Promote respect and dignity of the patient whilst working in collaboration to ensure a safe and therapeutic environment

b) Provide guidance around the legal requirements for searching

c) Describe the types of searches that may be conducted and

d) Outline the procedures for staff when conducting searches in order to enable

a consistent approach that is in collaboration with the child/young person and their parent/guardian.

3 Searching Patients and their Belongings

Searching a patient or their belongings is an intrusive intervention that is to be used when it is the only reasonable and practicable course of action to avoid or prevent a serious risk of harm to patients, staff or others. When determining whether to search a patient and/or their belongings, issues that may be considered by the treating team include the patient’s safety, past history of abuse/trauma, human rights issues, therapeutic relationship, environmental safety and workplace health and safety. If there are less intrusive options to ensure safety, then these must be considered and the reasons why these options were or were not adopted documented in the clinical record. Wherever possible, medical staff treating the patient should be involved in the decision making when consideration is being given to searching a patient. Respect, privacy, dignity, confidentiality and sensitivity to gender issues and cultural and religious diversity are to be maintained to the greatest extent possible under the circumstances when conducting a search. The power to search an individual is allowed under Criminal Law and the Mental Health Act 2007 or when the patient consents. Any actions taken must be reasonable and proportional to the identified risk factors for the individual patient. Staff must have consent to initiate a search of a patient and/or their belongings. Unlawful search of a person constitutes an assault.



4 Types of Searches

Searching patients and/or their belongings is complex in nature and should be guided by individual risk assessment and in accordance with policy and legislation. Types of searches can be classified into the following categories:

a) Ordinary Searches b) Frisk Searches and c) Searching under Common Law

‘Ordinary Searches’ are defined as: “A search of a person or of articles in the possession of the person that may include:

(a) requiring the person to remove only his or her overcoat, coat or jacket or similar article of clothing and any gloves, shoes, socks and hat, and

(b) an examination of those items.” MH Act (2007) Within this context, an ‘ordinary search’ is considered standard practice within the acute mental health settings where risk is identified. ‘Frisk Searches’ are defined as: (a) a search of a person conducted by quickly running the hands over the person’s outer clothing or by passing an electronic metal detection device over or in close proximity to the person’s outer clothing, or

(b) an examination of anything worn or carried by the person that is conveniently and voluntarily removed by the person, including an examination conducted by passing an electronic metal detection device over or in close proximity to that thing. MH Act (2007) Searching under Duty of Care: Under common law health professionals may exercise the use of duty of care to search a patient. In exceptional cases, searching without consent may be permitted where this is called for to preserve life. The search must, however, be reasonable and proportional to the risk which may be posed to the patient, staff, and others if it is not carried out. With this in mind, there are five types of search (Appendix 1) that can be considered to maintain safety:

4.1 An ordinary environmental search A search of the general environment including bedrooms, bathrooms, seclusion room and other areas of the ward. It does not include searching of patient belongings. Environmental searches can be nurse initiated.

4.2 An ordinary search of a patient’s belongings and room A search of patient’s rooms, including their belongings and under bed covers and mattresses may be required if there is an identified risk and/or suspicion of dangerous or prohibited items being hidden. Searches of rooms/belongings can be nurse initiated.

4.3 An ordinary search of a patient’s person A search of a patient that does not involve actual bodily contact. The person may be asked to empty his/her pockets or remove their outer jacket or shoes and socks for examination. They can be asked to open their mouth. This does not include the use of a metal detector and can be nurse initiated.

https://www.legislation.nsw.gov.au/#/view/act/2007/8




4.4 A frisk search A frisk search is reserved for higher risk circumstances where risk has been identified. When conducting a frisk search with children and young people, SCHN do not support the use of pat down searches. Therefore the following practice is to be used:

(a) a search of a person conducted passing an electronic metal detection device over or in close proximity to the person’s outer clothing, or

(b) an examination of anything worn or carried by the person that is conveniently and voluntarily removed by the person, including an examination conducted by passing an electronic metal detection device over or in close proximity to that thing. MH Act (2007), This level of search is not considered routine practice and requires authorisation by the Admitting Medical Officer (AMO) (or delegate) and should be documented clearly in the patient’s clinical file. SCHN will not use the pat down method as defined with a frisk search due to respecting trauma informed care. Physical touch may be distressing for some young people.

4.5 A search under Duty of Care Searching under Duty of Care is a practice which surpasses the use of the MH Act (2007), and is covered by Common Law. This level of search is for extreme cases only where there is immediate need to preserve life. Consent is not required in these life threatening situations. Any actions taken at this level of search must be reasonable and proportional to the risk posed to the patient, staff, and others if it is not carried out. This level of search is not considered routine practice and requires authorisation by the Admitting Medical Officer (AMO) (or delegate) and should be documented clearly in the patient’s clinical file and with an IIMS.

5 Consent

Informed consent must be sought prior to any search of a patient and/or their belongings. In ED and on general wards, verbal consent should be obtained from the patient and a parent/guardian in the presence of two clinicians and documented in the patient’s clinical file. Written consent is to be obtained for all patients on the acute mental health inpatient unit prior to admission. If the parent/guardian on admission to such unit is not with the patient, telephonic consent can be obtained. If a young person lacks capacity (eg due to current mental health status/intellectual disability), their parent/guardian must consent to a search on their behalf. Consideration is to be given to patients under the care of the Minister. It is important that patients and their families fully understand what they are consenting to. The use of an accredited interpreter may be needed to obtain consent from patients and families of diverse cultural and linguistic backgrounds.

5.1 Age of consent Consent should be obtained from the young person, irrespective of their age, AND/OR their parent/guardian, depending on their age. The following is a guide as to what the law says about age of consent:

• A young person may provide consent to a search if they are 16yrs or over.





• A young person 14yrs – 16yrs can consent and where this occurs it is best practice that their parent/guardian is informed. Both the patient’s consent and the fact that the parent has been informed must be recorded in the medical record. If the patient refuses or fails to consent then the consent of a parent/guardian can be obtained. This must be recorded in the medical record.

• Children under 14yrs require consent from their parent/guardian.

5.2 If consent is refused • Before a search can be commenced there must be clear evidence that there is a

serious risk to the patient’s or others, identifying that this situation cannot reasonably be managed by any other means. The parent/guardian is to be informed of this decision and rationale prior to search taking place.

• If temporarily unable to obtain consent due to patient being sedated, for example, search may need to be delayed. Consider need to increase Care Level (based on risk assessment) until consent can be obtained

• Where consent is refused, the parent/guardian should be consulted to provide consent on behalf of the patient (age dependant).

5.2.1 Voluntary patient Consent Refusal • If the patient is voluntary and they, or their parent/guardian, do not consent to a search,

the search must not occur and the matter should be referred to the senior nurse on duty and the AMO (or delegate) for assistance and negotiation with the patient. Consideration should be given as to whether care should continue, or status change under the Mental Health Act (e.g. involuntary) is required.

5.2.2 Involuntary Patient Consent Refusal • If an involuntary patient and their parent/guardian refuses the search, all attempts to

negotiate will be made. The matter should be referred to the senior nurse on duty and the AMO (or delegate). Where negotiation fails, and if discharge from the hospital or refusal of services is unreasonable, the patient will be informed that the search is necessary for safety reasons and the search can take place. The search may be authorised without consent provided the need for a search is indicated by the risk assessment and with lawful reason and provided the AMO (or delegate) authorises the search. This should only occur in exceptional circumstances.

5.3 Parents uncontactable • If parent/guardian consent is required and they are uncontactable, consideration should

be given to safely managing the patient until consent is obtained. This may include placing all patient belongings in a safe/locked storage and initiating a higher Care Level until consent can be obtained.

• If a patient and their parent/guardian refuses a search due to clinical reasons (eg phobia), this should be dealt with on a case by case basis in consultation with the AMO.



See Appendix 5: Consent Flowchart

6 Searching – Emergency Department

The following serves as a guide for searching mental health patients in the Emergency Department (ED). If a search of a patient and/or their belongings is required prior to mental health involvement with a patient, the decision to search, and the type of search is to be decided by the ED Staff Specialist (or delegate) in conjunction with Nursing Unit Manager (or delegate). Searching patients and/or their belongings should only occur for patients where risk has been identified.

6.1 When to search Following consent, as outlined in Section 5, and where risk has been identified,

• A search of patient belongings is to be conducted on items brought in to the ED that have not been taken home or removed by the family.

• Searching is to be conducted in accordance with Appendix 1 and based on the patient’s level of risk.

• Individual management plans should be consulted (where applicable) for guidance around any variance to level of search that is conducted based on the individual patient needs.

• In cases where there is uncertainty regarding risk, nursing Care Level may need to be increased until a mental health review can occur.

• If it becomes apparent during an interaction with a patient that a search needs to be conducted, the decision to search should not be delayed (if safe to do so) until another agency arrives, for example mental health team, security. Safety of all in attendance should be the primary focus of such decision making.

• Level of search to be conducted in accordance with Appendix 1. Section 4.4 authorisation is required by the ED Staff Specialist (or delegate).

• Handover to occur between ED and the acute inpatient mental health unit prior to transfer regarding level of risk and associated search that has been conducted. This should be clearly documented in the patient’s clinical file; including: the type of search, who authorised the search, confirmation that the consent was obtained, if parental consent was obtained, and the two people who conducted the search.

6.2 Role of the police/paramedics • Patients being transported to ED via police or paramedics may have already had a

search undertaken. Despite this search having already occurred, health staff are to conduct their own search on presentation to Emergency based on the level of risk as outlined in this guideline.



6.3 Storage of items in ED • Any items removed from the patient or their visitors are to be stored in a secured

cupboard/locker

• Items stored in the cupboard/locker are to be documented in the patient’s clinical file.

6.4 Visitors • Staff are to be mindful of items that may be inappropriate for patient use based on their

level of risk, and restrict access to these items where appropriate.

6.5 List of prohibited items • Appendix 3 should serve as a guide for prohibited items to be considered in general

ward settings.

7 Searching – General Wards

7.1 When to search Following consent, as outlined in Section 5, and where risk has been identified,

• A search of patient belongings is to be conducted on items brought in to the general wards that have not been taken home or removed by the family.


• Searching to occur on admission/transfer, return from leave, or when there is a deterioration in the patient’s mental state and a suspicion that they are concealing a prohibited or dangerous item.

• In cases where there is uncertainty regarding risk, nursing Care Level may need to be increased until a mental health review can occur.

7.2 Role of the Emergency department • Patients being transported to the general ward via the ED may have already had a

search undertaken. In the case a search has already been conducted, another search is not required. During handover from ED, communication about the search occurrence and outcome is to be discussed.

7.3 Storage of items in the general wards • The general wards are to follow their local processes regarding the storage of items.



7.4 Visitors • Staff are to be mindful of items that may be inappropriate for patient use based on their

level of risk, and restrict access to these items where appropriate.

7.5 List of prohibited items • Appendix 3 should serve as a guide for prohibited items to be considered in general

ward settings.

7.6 Authorisation In reference to search processes, as outlined in Appendix 1, the following exceptions apply in general wards:

• Nurse initiated searches require authorisation and consultation with the admitting team.

8 Searching – Acute Mental Health Inpatient Unit

8.1 Admission, transfer to the unit and return from leave • A routine search of patient belongings will be conducted on all items brought in to the

ward on admission, on return from leave or if brought in by visitors (irrespective of risk).


8.2 Role of the Emergency department • Patients being transported to the inpatient unit via the ED may have already had a

search undertaken. In the case a search has already been conducted, another search is not required. During handover from ED, communication about the search occurrence and outcome is to be discussed.

8.3 During Admission • Searches of a patient and/or their belongings is appropriate at various points in an

episode of care, as risk is dynamic and changeable, or if there are reasonable grounds to suspect that a patient may be concealing dangerous or prohibited items

• Consideration should be given to risk prior to episodes of seclusion/restraint

9 When not to search

With reference to the considerations regarding consent, as outlined in Appendix 5, and consideration to individual risk assessment, the following should be taken into account.



9.1 Exclusion Criteria Searches are not to be undertaken for the purpose of finding ‘stolen’ items of another patient. These matters need to be referred to Hospital Security or the Police.

9.2 Unlawful searches • A search may be considered illegal and an assault upon the person if:

• Consent was not provided.

• There were no reasonable grounds to search the person.

• Staff did not introduce themselves and inform the person of the reason for the search.

• The search is excessive or conducted in any way that may be considered inappropriate.

10 Searching Procedures

• Explain the procedure to the patient and their parent/guardian prior to the search

• Consent as per Section 5

• Authorisation as per Appendix 1

• Patient and their parent/guardian to be provided with the opportunity to dispose of any prohibited items prior to searching.

• The patient may select a support person (e.g. parent/guardian) to be present during the search and the search should occur in their room or a private space.

• Gloves to be worn by the person/s attending the search. Care should be given to any sharp items that may be concealed.

• If a parent or guardian is not available to take items home, any items removed are to be clearly labelled and stored in relevant area.

• Offer debriefing as soon as practical and as safe to do so.

• Document in the patient’s clinical file the type of search undertaken and outcome of search as per Section 15

10.1 Conducting a search: • A minimum of two staff are required to conduct a search of a patient or their belongings.

One staff member acts as ‘searcher’ and the other staff as an ‘observer’. For a routine search of a patient’s belongings, a parent or guardian may be used as a substitute for the second nurse when checking items brought in by visitors if deemed appropriate by the nurse in charge.

• For a search of property or patient’s room to continue, the person whose items are being searched must be informed and be given the opportunity to be present – provided it is safe to do so.



• Where possible, unless it is an emergency, both staff members conducting the search should be of the same identified gender as the patient, and consideration should be given to any gender sensitivities (eg trauma history) the patient may have. If this is not possible, the person of the same identified gender is to act as ‘searcher’. Where relevant, any member of the multidisciplinary team may be required to assist.

• All searches are to be conducted in a respectful manner. Privacy, dignity, confidentiality and sensitivity to cultural, religious and gender issues and linguistic diversity is to be maintained to the greatest extent possible under the circumstances.

• Protective equipment such as gloves are to be worn by staff whenever conducting a search.

• Care to be taken at all times when handling items in case sharps are concealed within clothing or other items.

10.2 An environmental search (mental health inpatient only) • An environmental search is a nurse-led initiative and is to be attended daily as a routine

safety check, when a patient has been discharged or when a patient is being relocated to another room

• Is a nurse led initiative.

• Documentation to occur in the Environmental Search register

• IIMS to be completed if dangerous items have been found during the search

10.3 Searching Belongings and Room

Belongings:

• Patients should be asked prior to search if they have any prohibited or unsafe items they would like to surrender.

• If appropriate, the parent/guardian may assist in the search of their belongings.

• Every item and article of clothing should be searched. Religious headwear should not be removed.

• Staff should never place unprotected hands into pockets or bags. Patients are to be asked to empty their bags voluntarily where possible.

• Relevant items to be gently shaken to identify any potential prohibited items Appendix 3

• Ask the patient to identify and remove any metal items (e.g. watches or metal jewellery)

• Staff are to perform a risk assessment of all patient’s jewellery to assess if they are suitable and safe.

• Remove any dangerous or inappropriate items and either dispose of item or return items to the parent/guardian to be taken home.



• Sensitivity must be applied on removing items which have religious and cultural significance.

Room: Room searches may be required in a high risk situations where staff have reason to believe that a patient may be in possession of a dangerous or restricted item to inflict harm to themselves or others eg when items such as scissors or cutlery are missing.

• Identify two suitably experienced clinical staff to conduct the search. Identified gender consideration should be taken into account.

• Give the patient a detailed explanation regarding the reason for the search and how it will be conducted

• When considered safe to do so, allow the patient (and parent/guardian if relevant) the opportunity to remain present during the search.

• The two staff systematically search the room and its contents thoroughly.

• Staff should take care to include a check of areas where items may be secreted such as underside of shelving, clothing, in bedding, under furniture, drawers, and under blu-tack to ensure no prohibited items are being concealed

• Clothing/belongings to be checked as per 10.3.

• Relevant items to be gently shaken to identify any items prohibited on the ward.


10.4 Non-contact search of a patient’s person • Ask the patient to empty their pockets

• If deemed appropriate, ask the patient to remove shoes and socks and any outer garments such as jackets or cardigans and examine these items,

• When examining these items, always be aware that items may contain sharps. Rather than putting hands into pockets, the pockets should be turned inside out or shaken to detect the presence of any objects.


• If items unable to be taken home immediately, they are to be placed in a secured locker/cupboard until this can occur.

10.5 A frisk search This type of search may be required in a high risk situation where staff have reason to believe that a patient may be in possession of a dangerous or restricted item such as a knife or blade.



• Ask the patient if they have any prohibited or dangerous items concealed on their body or within their clothing and indicate where these are.

• Ask the patient to empty their pockets and remove outer garments such as jackets, cardigan and shoes and socks.

• Pass an electronic metal detector device over or in close proximity to the person’s outer clothes

• To assist with the procedure, ask the patient to stand with their arms extended horizontally to the shoulders.

• See Appendix 4: Use of a metal detector

• Privacy and dignity should be considered at all times when conducting this type search. Reference should be given to considerations in 10.2

11 Storage of prohibited items

• If prohibited or dangerous items are located during any search, these items must be sent home with their parent/guardian.

• If the parent/guardian is not available at the time, items to be stored in relevant storage area.

• Storage of items are to be kept in the patients designated locker

• Prohibited items of negligible value such as blades or broken implements are to be discarded in an appropriate sharps container.

• Valuable items such as jewellery or money are to be sent home, or if this is not possible they are to be entered into the patient’s clinical file and securely stored as follows:

• Hall Ward: Label item and store in locked cupboard in clinical room

• Saunders Unit: Label item and store in allocated storage

• Emergency Department: as per “Protecting People and Property - NSW Health Policy and Standards for Security Risk Management in NSW Health Agencies” (Chapter 14)

• See Appendix 3: List of prohibited items

12 Weapons

• Any items that could be used as weapons – staff should be guided by the “Protecting People and Property - NSW Health Policy and Standards for Security Risk Management in NSW Health Agencies” (Chapter 14)

13 Illicit Substances

As per Unidentified or Suspected Illicit Substances

http://webapps.schn.health.nsw.gov.au/epolicy/policy/3892



14 Management of Items Brought in by Visitors (mental health inpatient only)

• All visitors should be made aware of which items are not permitted

• Staff are to ask visitors each time they visit if they have any prohibited or restricted items in their possession.

• Personal bags of visitors and any restricted items are to be placed in ‘visitor’s lockers’ prior to entry.

• Items brought in for patients are to be searched by staff as per Appendix 1

• If there are reasons to believe that a visitor may be concealing prohibited / controlled items in their bag, then staff should request the visitor to remove them for inspection but not touch the contents.

• Visitors who do not follow these instructions should be referred to the Nursing Unit Manager/After Hours Nurse Manager and consideration given to refusing entry. Staff should act to maintain the dignity of visitors at all times throughout this process.

15 Post Searching Procedures

• Debriefing should be offered to the patient as soon as practicable following a search and as required. Education should be provided regarding the rationale for the search.

• See Appendix 2

16 Documentation

• Documentation in clinical notes is required for all searches conducted, excluding environmental searches which are to be documented in the appropriate Environmental Search Register.

• Any movement of a patient’s belongings coordinated by staff must be documented in the patient’s clinical file e.g. whenever an item is placed in or out of a patient’s or secured locker or placed in or taken out of the ward safe.

• All changes to the above must be clearly documented in the patient’s clinical file

• A comprehensive documentation of every search, its justification and outcomes must be recorded in the patient’s clinical file.

• An IIMS must be generated when a prohibited item is found, or in the rare case a search was conducted without consent. A consequential risk assessment and risk management plan must be documented in the patient’s clinical file.



17 Audit and Education

All clinical staff should be made aware of the requirements of this procedure as part of their orientation to mental health. Audits of the searching process may be done as required by the NUM or delegate on the implementation of the following key areas:

• Clearly displayed communication about the policy to visitors, staff and patient.

• Obtaining a patient’s consent prior to a search

• Authorisation of a search

• Document the type of search and rationale in the patient’s clinical file.

• Adherence to Occupational Health and Safety during searches

18 References

1. Criminal Law ACT 2. Law Enforcement (Powers and Responsibilities) ACT 2002 3. NSW Mental Health ACT 2007 4. NSW Ministry of Health Policy (MOHIB2013_024) Protecting People and Property: NSW Health Policy

and Standards for Security Risk Management in NSW Health Agencies, 2013 5. NSW Police Force MOU for Mental Health 2017 – DRAFT 6. “Protecting People and Property - NSW Health Policy and Standards for Security Risk Management in

NSW Health Agencies” 7. Victoria’s Chief Psychiatrist’s Guidelines – Criteria for searches to maintain safety in an inpatient unit for

consumers, visitors and staff (2013) 8. Work Health and Safety Act

Copyright notice and disclaimer:

The use of this document outside Sydney Children's Hospitals Network (SCHN), or its reproduction in whole or in part, is subject to acknowledgement that it is the property of SCHN. SCHN has done everything practicable to make this document accurate, up-to-date and in accordance with accepted legislation and standards at the date of publication. SCHN is not responsible for consequences arising from the use of this document outside SCHN. A current version of this document is only available electronically from the Hospitals. If this document is printed, it is only valid to the date of printing.



APPENDIX 1: TYPES OF SEARCH

Type of search Description Authorisation Consent Documentation An A search of communal Nurse Unit Nil required Document environmental hospital property Manager or in the relevant search either inside or outside Nurse-In- registers (inpatient only) the clinical area Charge A search of a A search of a Nurse Unit Room: nil Document in the

patient's clinical file and review with MDT

patient's patient's possessions Manager or consent required belongings and and/or room Nurse-In- Belongings: room

Charge

Consent required. Can be verbal (ED

& general wards) or written (inpatient) A non-contact A search of patient's Nurse Unit Consent required Document in the


search of a person that does not Manager or Can be verbal patient's involve actual bodily Nurse-In- (ED & general person

contact. May include the removal of outer

Charge

wards) or written (inpatient)

Clothing e.g. hat, coat, socks, shoes and asking the patient to empty his/her pockets or open their mouths A frisk A search of patient's Admitting Consent required Document in the


search of a person that does not Medical Can be verbal patient involve actual bodily Officer (ED & general

contact. May include the removal of outer

wards) or written (inpatient)

clothing e.g. hat, coat, socks, shoes and asking

the patient to empty

his/her pockets or open their mouths and may include the use of a metal detector A search under A search of the patient Admitting Consent is Document in the

patient's clinical file, IIMS and review with MDT

Duty of Care reserved for life Medical not required threatening situations Officer

and is covered under Common Law.

* Please see Section 7.6 for alterations to authorisation in the general ward settings



APPENDIX 2: PATHWAY POST SEARCH OF PATIENT AND/OR

THEIR BELONGINGS

Documentation in clinical notes Situations when an IIMS is required Complaints management

Debriefing: Following any search, debriefing is to be offered to the patient as soon as practical and when safe to do so.

Documentation: All searches attended, including routine searches of patients and/or their belongings must be documented in the patient’s clinical file by the person who led the search. In certain circumstances, as outlined below, an IIMS is to be submitted

Reason for search Consent Who authorised the search (when relevant) Staff who conducted the search Type of search conducted Outcome of the search Whether debriefing was offered Arrangements for storage or disposal of any prohibited items found

When prohibited or dangerous items were detected Where the search was conducted in response to concerns that a patient was in possession of or concealing dangerous or prohibited items If the search was attended post refusal to consent

If any parent or patient wishes to lodge a complaint re the search process, staff are to assist that person with the Network’s complaint policy process



APPENDIX 3: LIST OF PROHIBITED ITEMS

The following list of prohibited items is to be implemented in the acute mental health inpatient settings. It should also serve as a guide for prohibited items to be considered in general ward settings. Clothing:

• No clothing with cords or ties - (if cords are unable to be removed, clothing item is to be sent home). Note that NO cords are permitted, whether loose or sewn in.

• No hooded jackets, scarves, belts, tights, leggings or long socks • No shoes with laces or steel tipped shoes or boots • No clothing with logos that could be considered offensive to others

Toiletries, grooming and make-up items:

• No aerosol deodorants or other toiletries or make up in aluminium cans or bottles • No facial cleansers or other items that could be potentially harmful if ingested • No nail files, nail polish or nail polish remover • No mirrors, make-up sharpeners or tweezers or other make-up items that could potentially be

used as a means to self-harm • No razors or electric razors • No electric hair grooming appliances such as hair dryer or straighteners • No hair ribbons, hair pins/bands that could potentially used as a means to self harm

Jewellery

• Jewellery items including watches to be assessed on an individual basis. • No jewellery items of significant value • Note that consideration is to be given to jewellery items of religious or cultural significance

Books, stationery and art supplies

• No spiral bound books, books or magazines with staples, paper clips • No books that contain inappropriate reading material for age group • No pencil sharpeners, geometric instruments or metal pencil containers or other sharp items • No permanent markers • No art supplies that could be considered potentially harmful

Cigarettes etc.

• No cigarettes, lighters, matches, alcohol, prescription/non-prescription or illicit substances. Mobile devices

• No mobile phones, iPads, laptops or electronic gaming devices • Note: If laptop is required for school purposes this will be at the discretion of the treating team

and is only to be used at specified times. • Note: Bluetooth iPods (without camera function, internet /wifi access or cords) or Bluetooth

headphones (without cords) may be permitted. This is at the discretion of the treating team

Bags • No plastic bags or bags with straps. • All suitcases and other storage bags etc to be sent home with the parent/guardian

Food

• No food items other than fruit or bottled water in clear containers to be brought into the ward. Food is allowed in the Emergency Department (no hot drinks).



APPENDIX 4: USING A HAND HELD METAL DETECTOR

DEVICE

When will a Metal Detector be used? o The metal detector will be used as part of an authorised ‘high-risk non contact’ search

Prior to using the metal detector

o Prior to commencing a search using a metal detector, ensure the metal detector has been tested to ensure it is functioning and that battery is not depleted.

Caution: When conducting searches utilizing a metal detector, it is important for all staff to be aware that blades and other items constructed with titanium might not be detected by the metal detector and as such, there may be circumstances that blades may have been secreted into the ward undetected.

Search Procedure:

Prior to using metal detector:

o Test that metal detector is functioning prior to commencing search o Follow relevant search procedure as outlined

Using the metal detector:

o The detector is to be used as close to the body as possible (without physical contact to the

body), no further than 10 centimetres. o To assist with the process, ask the patient to stand in centre of room with arms extended

horizontally to the shoulders.

Front facing: o Using a systematic approach start on one arm, go over the patient’s head and across the

other arm o Then wave metal detector slowly from top of head, down right side of body to toes, o Ask patient to lift their right foot to knee height so detector is not activated by floor. o Repeat procedure from left collarbone down left side of body to toes, asking patient to lift left

foot to knee height o Wave metal detector down midline of body from sternum to groin area, taking care not to

touch body parts with detector.

Back facing o Repeat above process over back of body

Sides o Run detector down left and right sides of patient, asking patient to lift arms when required.



APPENDIX 5: CONSENT FLOWCHART



APPENDIX 6: DOCUMENT FLOWCHART

searching mental health patients and their belongings · guideline: searching mental health...

Documents