Document Control · Violent & Aggression Warning Marker SOP Health and Safety Manager and LSMS Corporate Governance, Workforce Development Directorate Page 6 of 21 Non Physical assault

Violence and Aggression Warning Marker SOP

Corporate Governance Department Violence and Aggression Warning Marker v1.0 Mar17 Page 1 of 21

Document Control

Title

Violence and Aggression Warning Marker Standard Operating Procedure

Author

Author’s job title Health and Safety Manager and Local Security Management Specialist (LSMS)

Directorate Workforce Development

Department Governance

Version Date

Issued Status Comment / Changes / Approval

0.1 Draft Initial Version for Consultation

0.2 Draft Revisions made in response to Consultation

0.3 Sept 2016

Draft Submitted to Health & Safety Committee for approval. (Not approved, further amends required)

1.0 March 2017

Final Various amends following consultation, approved at Health and Safety Committee 16 March 2017

Main Contact Health & Safety Manager & LSMS Suite 8, Munro House, North Devon District Hospital, Barnstaple, North Devon EX31 4JB

Phone: 01271 311725

Lead Director Director Workforce and Development (Security Management Director)

Document Class Standard Operating Procedure

Target Audience All Staff

Distribution List Trust wide

Distribution Method Trust’s internal website

Superseded Documents

Issue Date March 2017

Review Date May 2018

Review Cycle 14 months (due to General Data Protection Regulation implementation May 2018)

Consulted with the following stakeholders

Applications Support Team Lead, IT Services

Contact responsible for implementation and monitoring compliance: Local Security Management Specialist



Clinical Team Lead, Liaison Psychiatry, Devon Partnership Trust

Configuration Manager TrakCare (Hospital Service Electronic Healthcare Record)

Consultants (x2) Emergency Department

Community Safety Partnership Police Constable, Devon & Cornwall Police

Corporate Governance Support Officer

Customer Relations Manager

Deputy Director of Nursing & Head of Professional Practice

Divisional Nurse, Planned Care

Fire and Security Advisor

Governance and Assurance Lead, Facilities

Head of Corporate Governance.

Head of Information Governance.

Head of IM&T Services Management.

Head of Quality and Safety

Health and Safety Committee members.

Healthcare Records Manager

Healthcare Records Deputy Manager

IT Services Community and Projects Manager

Medical Director

Non-Executive Director

Northern Rapid Intervention, Urgent Care Nursing & Care Homes Team Manager

Operations Lead for Inpatients

Outpatients Manager

Project Support Officer RiO (Community Services Electronic Record Project)

Practice Lead Liaison Psychiatry, Devon Partnership Trust.

Security Management Director (Director of Workforce Development)

Senior Nurse Community Nursing (Northern)

Education/ training will be provided by: Information concerning the Standard Operating Procedure can be provided by the Health and Safety Manager and Local Security Management Specialist.

Approval and Review Process

Health & Safety Committee Local Archive Reference G:\Corporate Governance\Compliance Team\LSMS\LSMS Main

Folder Oct2016\Violent Patient Marker\Violent Patient Marker SOP & Guidance Dec2016 Folder Filename Violence and Aggression Warning Marker SOP revision 10Feb2017



Policy categories for Trust’s internal website (Bob) Health and Safety

Tags for Trust’s internal website (Bob) Violence, Aggression, Marker, Warning, Flag, Patient marker, violent patient, violent patient marker, red flag

Violent & Aggression Warning Marker SOP

Health and Safety Manager and LSMS Corporate Governance, Workforce Development Directorate Page 4 of 21

CONTENTS

Document Control.................................................................................................................... 1

1. Purpose.............................................................................................................................. 5

2. Scope ................................................................................................................................. 5

3. Definitions ......................................................................................................................... 5

4. Duties ................................................................................................................................. 6

5. Considerations for Placing Warning Markers ............................................................... 8

6. Information Sharing ....................................................................................................... 10

7. Procedure for Placing a Marker .................................................................................... 12

8. Essential Marker Information ........................................................................................ 12

9. Review Process for a Warning Marker ......................................................................... 13

10. Notifying the patient ....................................................................................................... 13

11. Informing and supporting the victim ........................................................................... 14

12. Appeals Process ............................................................................................................. 14

13. Record Keeping .............................................................................................................. 15

14. Monitoring ....................................................................................................................... 15

15. References ...................................................................................................................... 15

16. Associated Documentation ........................................................................................... 16

Appendix A: Placement of Warning Marker Examples ................................................................. 17

Appendix B: Marker Procedure Flow Chart ................................................................................. 18

Appendix C: Notification of Warning Marker Template Letter .................................................... 19

Appendix D: 12 Monthly Review of Warning Marker Template Letter ......................................... 20

Appendix E: Appeals to Review Panel Template Letter ............................................................... 21



1. Purpose

1.1. The purpose of this Standing Operating Procedure is to set out Northern Devon Healthcare NHS Trust’s procedure for placing a risk of violence and aggression marker on the healthcare record of individuals who have acted in a violent, aggressive or anti-social manner.

1.2. It provides a robust framework to ensure a consistent approach across the Trust and is compliant with legislation and statutory regulations such as but not limited to the following:

Data Protection Act 1998

Secretary of State’s Directions on work to tackle violence against staff and professionals who work or provide services for the NHS (2003) and security management measures (2004)

Health & Safety at Work etc Act 1974

Management of Health and Safety at Work Regulations 1999

Corporate Manslaughter and Corporate Homicide Act 2007

1.3. The implementation of a warning marker system will:

Provide an early warning to staff of a particular individual or situation that represents a risk to them, their colleagues, contractors, patients or the public;

Provide security warnings and handling advice to avoid or minimise risk;

Aim to reduce the number of violent, aggressive or anti-social acts against staff;

Assist in creating a safe and secure environment for staff, patients and visitors; and

Ensure information is shared with internal and external stakeholders for the purposes of community safety and security.

2. Scope

2.1. This Standard Operating Procedure (SOP) is written for the purposes of safety and security. Where applicable if will apply to those frontline staff, other agencies (e.g. G.P. Practices, Social Services, South West Ambulance Trust, Mental Health Trust) who may

be involved with the patients on-going care.

3. Definitions

3.1. Work Related Violence

The Health and Safety definition of work-related violence is: Any incident, in which a person is abused, threatened or assaulted in circumstances relating to their work. This can include verbal abuse or threats as well as physical attacks.

3.2. Physical Assault

NHS Protect definition of Physical assault is defined as: The intentional application of force to the person of another, without lawful justification, resulting in physical injury or personal discomfort.

3.3. Non Physical Assault



Non Physical assault is defined as: The use of inappropriate words or behaviour causing distress and/or constituting harassment.

3.4. Anti-Social Behaviour

The Oxford dictionary defines the term “anti-social” as being contrary to the laws and customs of society.

The Police describe Anti-social behaviour as a wide range of unacceptable activity that causes harm to an individual, or to their environment. This could be an action by someone else that leaves others feeling alarmed, harassed or distressed. It also includes fear of crime or concern for public safety, public disorder or public nuisance.

In Healthcare associated environments this could include disruption to services due to:

Nuisance, rowdy, inconsiderate and un-cooperative behaviour;

Acts of vandalism or graffiti;

Consumption of alcohol, drugs or psychoactive substances; and

Failure to control aggressive or dangerous dogs.

4. Duties

4.1. Security Management Director

The Director of Workforce and Development is the nominated Security Management Director (SMD) and is responsible for ensuring the Trust has in place appropriate standing operating procedures for the management of violence and aggression markers and for making adequate resources available to implement these procedures.

The Security Management Director will be responsible for the endorsement of the decision taken by the Review Panel for the placement of a patient marker.

4.2. Local Security Management Specialist

The Trust Local Security Management Specialist (LSMS) is responsible for:

Reviewing investigations of incidents, risk assessing alerts received, assessing the risks to staff, making a recommendation for a marker and placing the marker on the patient records.

Notifying the members of the Warning Marker Review Panel, responsible for approving the LSMS’s recommendation for placement and / or removal of a marker.

Ensuring that all information is recorded on the Trust’s incident reporting system.

Ensuring where appropriate a letter is sent to the patient, relative or associate advising them of the placement and / or removal of a marker.

Sharing information concerning the placement or removal or markers with external stakeholders including but not limited to the Police (Community Safety Partnership), NDHT Community Teams, G.P and Devon Partnership Trust.

The nominated Deputy for the LSMS is the Compliance Officer, Corporate Governance.



4.3. Warning Marker Review Panel

The Warning Marker Review Panel will consist of members of a “Virtual Panel” which will be incorporated into the Terms of Reference for the Central Alerts System (CAS) Group.

The Review Panel’s role is to:

Approve recommendations made by the Local Security Management Specialist (as endorsed by the Security Management Director) with regards to marking records;

Provide the Trust Board assurances that the decision making process is objective, transparent and fair; and

Review warning markers on a 12 monthly basis (as directed by the LSMS) to ensure they are relevant, proportionate, ensuring the interests of individuals are appropriately safeguarded.

4.4. Central Alerts System (CAS) Group

The Review Panel is incorporated within the Central Alerts System (CAS) Group. The Review Panel has the following membership:

Divisional Nurse Planned Care;

Emergency Department Consultant;

Non-Executive Director;

Quality Improvement Facilitator, Quality and Safety; and

Senior Governance Manager (Compliance)

Review Panel members will be responsible for approval of the placement of Violent Patient Markers (as recommended by the LSMS or other external stakeholder and as endorsed by the Security Management Director)

Information concerning patient markers and notification letters will be managed as a confidential section of the CAS Group.

The sharing of information will be cascaded applying the principles of existing CAS Group cascade procedures.

4.5. Healthcare Records Manager

Upon request and instruction from the LSMS or Deputy, the Healthcare Records Manager and / or Deputy will be responsible for:

Facilitating requests for warning markers on electronic recording systems such as the Patient Administration System (PAS).

Placing information relating to the marker onto paper based systems e.g. ensuring a hard copy of the warning letter (sent to the individual by recorded delivery) is filed in the patient’s healthcare record.

Removal of information relating to markers (subject to Review Panel decision to remove after upholding appeal decision or after 12 monthly review).

4.6. IM&T Services

The IM&T Services are responsible for:



Facilitating requests for warning markers on electronic recording systems (where subject to the software platform or system, the marker placement cannot be facilitated by the Records Manager).

Supporting the procedures and processes for placing markers onto software packages and platforms.

4.7. Managers

Managers must ensure:

They understand how the standard operating procedure is applied, when it should be enacted and their role within the procedure.

Staff are provided suitable and sufficient information regarding plans to manage individuals identified with a patient marker.

Handovers and team meetings are conducted which share suitable and sufficient information with staff and others as is necessary such as but not limited to Sodexo or Devon Partnership Trust staff, who have direct involvement in the patients care or are likely to have contact with the patient.

Where appropriate, information regarding plans to manage identified risks are shared with frontline contracted staff (e.g. Sodexo) and other external stakeholders working in conjunction with Trust within the Ward, Department or Service under the control of the manager.

Where necessary, staff who have been the victims of violent or aggressive acts receive support such as access to counselling services as outlined in the Supporting Staff Involved in an Incident, Compliant or Claim Policy.

Staff are supported in the completion of incident reports in accordance with Trusts Incident Management Policy.

4.8. Staff

Staff must ensure:

They take responsibility for keeping themselves informed and up to date regarding warning markers on patient healthcare and associated records where they are likely to have contact with patients, their relatives or associates.

Handover meetings and team meetings are attended.

Relevant advice regarding control measures or actions on how to manage identified risks are applied at all times.

Incident reports are completed in accordance with the Trusts Incident Management Policy.

They take reasonable care of their own safety and comply with supporting Policies and procedures such as but not limited the Trusts Health and Safety Policy, Violence and Aggression Policy, Lone Working Policy and Code of Conduct leaflet.

5. Considerations for Placing Warning Markers

5.1. A warning marker may be applied regardless of whether the act was intentional or not. The use of a marker will help reduce possible risks to Trust staff and others by enabling the implementation of measures for everyone’s protection and safety. Examples of types of incident that may warrant a violence and aggression warning marker are shown in Appendix A.

http://ndht.ndevon.swest.nhs.uk/supporting-staff-involved-in-an-incident-complaint-or-claim/

http://ndht.ndevon.swest.nhs.uk/incident-management-and-investigation-policy/





5.2. A marker does not just apply to circumstances where the individual is a patient, but may equally apply where the person is the patient’s associate such as a friend, relative or guardian. It could also apply to a patient or associate in the community who is responsible for a dangerous animal.

5.3. It is important to state that the marker is not a mechanism for attributing blame; it is a process for alerting staff to the possibility of violence or aggression, whether such actions are deliberate or take place as a result of a medical condition or as a response to treatment or medication.

5.4. The marker and associated additional information such as warnings or handling advice, should be available to all Trust staff or others (such as but not limited to Sodexo staff) who may have face-to-face contact with a particular individual and may be subject to an increased risk of violence or aggression.

5.5. All incidents involving physical assault must be reviewed to consider placing a marker on records.

Non-physical assault (including threatening behaviour) can be equally serious and incidents should be reviewed to consider placing a marker on records.

Review of reported incidents are undertaken by the LSMS or nominated deputy.

5.6. Where NHS staff, partnered or contracted staff (such as but not limited to Sodexo staff) witness assaults committed by patients or members of the public against other patients or members of the public it may warrant the placement of a marker due to the distress or disruption caused.

5.7. There are various electronic and paper based healthcare record platforms. The way markers can be flagged will vary between systems and the level of information may vary subject to the systems software and capacity to store data. Regardless of platform, in essence the key is to ensure information is relayed to flag the risk to protect staff from risk of harm. It is important to ensure that those who access the system can understand the warning being flagged and that the flag is easily accessed.

As an indication of markers, on TrakCare, under the “Staff Safety Category” the following marker categories can be placed:

Physically Aggressive;

Verbally Aggressive or Intimidating Behaviour;

Previous Racial Abuse;

Previous Inappropriate Sexual Behaviour;

Challenging or Aggressive Behaviour; and

Known Inappropriate Use of Alcohol, Drugs or Psychoactive Substances.

5.8. Supporting information for warning markers can include any associated risks to other patients or their relatives/associates.

5.9. The evidence to support the warning marker process must be in line with the eight principles of the Data Protection Act 1998:

Processed fairly and lawfully.

Obtained for specified and lawful purposes.

Adequate, relevant and not excessive.

Accurate and up to date.



Not kept any longer than necessary.

Processed in accordance with the “data subject’s” (the individual’s) rights.

Securely kept.

Not transferred to any other country without adequate protection in situ.

5.10. The following risk factors should be considered when determining whether a warning marker should be placed against an individual:

Nature of the incident (i.e. physical or non-physical)

Degree of violence used or threatened by the individual.

Injuries sustained by the victim.

The level of risk of violence that the individual poses.

Whether an urgent response is required to alert staff.

Impact on staff and others who were victims of or witnessed the incident.

Impact on the provision of services.

Likelihood that the incident will be repeated.

Staff are due to visit a location where the individual may be present in the near future.

The individual is a frequent user of the service (e.g. to a clinic or out-patients).

The individual is an in-patient.

The incident, while not serious itself, is part of an escalating pattern of

behaviour.

The medical condition and medication of the individual at the time of the incident.

5.11. Warning markers will not be placed against any individual where:

There is insufficient evidence of actual violent, aggressive or anti-social acts towards staff or others (such as, but not limited to Sodexo staff).

Based on actual outcomes, severity ratings of reported incidents are low or minor and /or the potential for similar incidents is considered unlikely.

Mitigating circumstances do not warrant the placement of a marker.

The incident or circumstances do not satisfy the eight principles of the Data Protect Act 1998.

6. Information Sharing

6.1. Article 8 of the Human Rights Act gives protection to an individual’s right to respect for their private and family life. Respect for private life includes the respect for private and confidential information, particularly the storing and sharing of such information.

Article 8 is a qualified right and as such the right may be lawfully limited. A balance must be struck between the competing interests of the individual and of the community as a whole. Reasons for sharing information legitimately include:

The protection of rights and freedoms of others;

For the purposes of public safety;

The prevention of crime or disorder; or

The protection of health.

6.2. The Crime and Disorder Act 1998 allows any person to disclose information to a relevant authority under section 115 where disclosure is necessary or expedient for the purposes of the Act (i.e. for the reduction and prevention of crime and disorder).



In addition under section 17a there are duties to share information which is relevant to the reduction of crime and disorder including anti-social behaviour. For the Trust this duty applies to the sharing of information in circumstances such as records relating to hospital admissions relating to assaults, alcohol related harm, domestic abuse and behavioural disorders due to drug use.

6.3. The sharing of information will be guided by the Caldicott principles. Information is shared where it:

Is justified;

Is absolutely necessary;

Uses the minimum personal confidential data necessary for purpose;

Restricts access to the data on a strict need to know basis;

Is clear those who handle such information are aware of their responsibilities; and

Complies with the law.

Following a review of the Caldicott principles during 2012, an important addition to the principles was added:

The duty to share information can be as important as the duty to protect the patient.

“Health and social care professionals should have the confidence to share information in the best interests of their patients within the framework set out by these principles”.

6.4. Information concerning warning markers will be shared with other agencies as is appropriate and as is necessary (e.g. GP Practices, Social Services, South West Ambulance Service, Devon Partnership Mental Health Trust), the Caldicott and Data Protection principles concerning the transfer of patient identifiable information will be applied at all times.

6.5. Information concerning violent patient markers and / or those associated with anti-social behaviour will be shared with Community Safety Police Officer and the Local Councils Anti-Social Behaviour Officer via the North Devon and Torridge Community Safety

Partnership. Information will be shared in accordance with the Home Office National Framework document for community safety partnerships.

6.6. Where information is shared with any stakeholder, it is for the purposes of safety, security or the prevention or detection of crime. Information will only be shared once the Review Panel have approved the endorsed recommendation for placement of a marker.

6.7. Warning markers will be discussed confidentially and information shared for approval with members of the “Virtual Panel” that comprises of the following members:

Divisional Nurse Planned Care;

Emergency Department Consultant;

Non-Executive Director;

Quality Improvement Facilitator, Quality and Safety; and

Senior Governance Manager (Compliance)

Deputies may be nominated by Review Panel members subject to circumstances to avoid unnecessary delays in the approval process for the placing of markers on a patient’s healthcare record.

https://www.gov.uk/government/publications/information-sharing-for-community-safety




The “Virtual Panel” will be consulted with by email and by phone following the occurrence of an incident and the circumstances that may warrant recommendation by the LSMS for the placement of a marker. It is anticipated that Panel members will be contacted on a monthly basis on average, however this may vary subject to the frequency of incidents that may occur.

7. Procedure for Placing a Marker

7.1. Following any violence and aggression incident (physical or non-physical), the member of staff affected (or a colleague subject to circumstances) must report the incident in

accordance with the Incident Management Policy.

7.2. The LSMS or nominated deputy will investigate reported incidents and decide from the outcome and the evidence available whether a recommendation for the placement of a warning marker against an individual will be made to the Review Panel.

The nominated deputy for the LSMS for the purposes of warning marker placement is the Compliance Officer, Corporate Governance. Other deputies may be nominated as authorised by the Senior Governance Manager (Compliance) subject to circumstances.

7.3. Psychiatric assessment of individual patients independent of any LSMS led investigation may also identify a requirement for a warning marker. Where this is the case, the healthcare professional making the recommendation must liaise with the LSMS in the first instance to enable the LSMS to process the request in accordance with the SOP.

Situations are likely to arise when an assessment has been undertaken by another organisation for example the Psychiatric Liaison Team employed by Devon Partnership Trust. Information will be shared between organisations applying the Calidcott and Data Protection principles concerning the transfer of patient identifiable information.

7.4. Upon LSMS recommendation, the Review Panel and SMD will be contacted for approval and endorsement of placing the warning marker against the individuals Healthcare Record.

To avoid any unnecessary delays in the placement of makers, should individual panel members be unavailable, i.e. on annual leave, sickness absence or secondment, a majority decision from available Review Panel members will be taken.

Markers can only be placed against Patient Healthcare Records regardless of data base / software platform on the instruction of the LSMS (or nominated deputy) once the placement of a marker has been approved by the Review Panel (as endorsed by the Security Management Director).

7.5. Once a warning marker has been approved by the Review Panel and endorsed by the SMD, it will be placed against the healthcare record of the individual in question. The LSMS will write to the person concerned where appropriate. See section 10.4 for exceptions as to when the individual is not notified in writing.

8. Essential Marker Information

8.1. For all marker systems, the marker should include the following information:

Who, or what the marker applies to;




A brief classification of the type of incident (see Appendix A);

Date the marker is effective from and review date;

Whether the individual has been notified; and

Essential and relevant handling information or advice to staff about who to contact for further advice or guidance. This should include a relevant contact for staff who

work off-site or out of hours.

8.2. Where possible, the marker will aim to provide staff with additional information to manage the risks that an individual poses. NHS Protect guidance suggests that the additional information may include:

Advice that staff should exercise caution when dealing with the individual;

A brief description of the incident, e.g. physical or non-physical assault;

Information relating to an individual’s medical condition, treatment and care if relevant;

Advice that the individual should not be denied treatment and care;

Security warnings, specific areas of risk or trigger factors;

Essential guidance on how to deal with the individual; and

Advice for staff about who they should contact if another incident occurs, whether

that is the LSMS or police.

8.3. The same principles apply when placing a marker regarding a patient’s associate, irrespective of whether a marker relates to a carer, relative, friend or animal. All decisions on marking records will be based on the risk to staff or others rather than on any relationship between the individuals concerned.

8.4. Where an associate, carer or relative of the patient is the perpetrator (rather than the patient), the marker will be placed upon the patient’s record, however it will clearly identify that the patient is not the offender and that the marker is for the associated individual or circumstances.

9. Review Process for a Warning Marker

9.1. All warning markers placed against a patient’s healthcare record will be reviewed on a 12 monthly basis by the Review Panel. The Panel consists of nominated members including clinical representatives.

9.2. Information concerning patient markers will be reported via the Central Alerts System (CAS) Group.

10. Notifying the patient

10.1. In the majority of instances, the patient will be informed in writing as soon as possible following a decision to mark their records. Where the patient does not have capacity, a letter may be sent to their next of kin as appropriate. Letters will be sent by recorded delivery.

10.2. The LSMS is responsible for sending the notification letter to the patient outlining the reason for the marker. The letter will explain:

The time, date and nature of the incident;

That their records will show a marker and the reason for the marker;

The review process for the marker;



Action to be taken if additional incidents are reported and investigated; and

How to raise a concern if they wish to query placement of the marker or do not agree with decisions taken.

10.3. If the incident is committed by an associate of the patient, a letter will where feasible be sent to both the patient and the associate, if the associate’s identity and whereabouts is known. The patient’s letter should inform them of the decision that has been made; the associate’s letter should include all the relevant information as above.

10.4. There may be exceptional cases when it is decided that notifying the individual may increase the risk that they pose to staff and that notification is not appropriate. These may include:

Where informing the individual may provoke a violent reaction and put staff at further risk.

Notifications of a marker may adversely affect an individual’s health.

In such instances a record completed by the LSMS or nominated deputy will be logged on the Trust incident reporting software against the incident report (that triggered placement of a marker) concerning any decisions regarding markers and notification letters.

11. Informing and supporting the victim

11.1. The LSMS will inform the member of staff (victim) and / or others affected by the incident of the decision reached. When a marker is placed on records, the reporter and / or victim will be informed. Providing feedback reflects best practice.

11.2. Where a decision has been reached that a marker is not required, the LSMS will explain the reasons to the victim and offer them any further assistance that is necessary.

11.3. Managers must ensure that victims have access to appropriate support if required and as is necessary in accordance with the Supporting Staff Involved in an Incident, Complaint or Claim Policy.

12. Appeals Process

12.1. Where an individual wishes to appeal against Review Panel decision for a marker being placed on their healthcare record, their concern will be referred for consideration to the Review Panel in the first instance.

12.2. Where the appeal is upheld by the Review Panel, the warning marker will be removed with immediate effect. The individual will be informed in writing (Appendix E).

12.3. Where it is deemed that the marker is appropriate and should remain against the individual’s record, the individual will be notified of the decision in writing (Appendix E).

12.4. Should the individual be dissatisfied with the Review Panels appeal decision to retain the marker against their healthcare record, they will be referred to the Customer Relations Department and the concern will be dealt with in accordance with the Raising Concerns and Complaints Policy.



http://www.northdevonhealth.nhs.uk/2012/04/raising-concerns-and-complaints-policy/




13. Record Keeping

13.1. The Trust LSMS is responsible for keeping appropriate records to include the following:

Clear rationale for instigating a warning marker.

Date the marker was applied to the patient record.

Date the individual and/or their associate was informed by letter.

Date the marker was approved by the Panel.

Whether the individual raised a concern or query including the date and outcome

Date(s) the marker was reviewed by the Review Panel to determine whether it should remain.

Date and rationale when the marker is removed from the individual’s patient record.

13.2. The Trust LSMS will ensure that records concerning individuals that have a marker on their records is kept securely with access restricted and meet requirements of the Data Protection Act.

14. Monitoring

14.1. The Trust’s Health and Safety Committee will receive regular updates from the Central Alerts System (CAS) Group via minutes of the CAS Group meetings confidential section.

14.2. The Quarterly Health and Safety Incident Report presented at the Health and Safety Committee includes the number of warning markers placed during that quarter (data is presented under the Violence and Aggression section of each quarterly incident report).

14.3. Any exceptions to compliance with the standing operating procedure will be included in the annual Central Alerts System Committee compliance report and reported to the Health and Safety Committee.

15. References

Caldicott review: information governance in the health and social care system. April 2013.

Crime and Disorder Act 1988.

Data Protection Act 1998.

Department of Health. Information: To Share or not to Share. Government Response to the Caldicott Review. 2013.

Health and Safety at Work Act 1974.

Home Office National Support Framework. Delivering Safer and Confident Communities. Information sharing for community safety guidance. Aug 2010.

Human Rights Act 1998

Management of Health and Safety at Work Regulations 1999.

NHS Protect guidance on procedures for placing a risk of violence marker on electronic records.

Secretary of State NHS Directions 2004 – security management measures.

Social Care Institute for Excellence website. What does the law say about sharing information? – Adult Safeguarding: sharing information.

Police description of Anti-social behaviour. Police UK website accessed 13.02.17.

https://www.gov.uk/government/publications/the-information-governance-review

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/251750/9731-2901141-TSO-Caldicott-Government_Response_ACCESSIBLE.PDF


http://www.legislation.gov.uk/ukpga/1998/42/pdfs/ukpga_19980042_en.pdf

http://www.nhsbsa.nhs.uk/3137.aspx

http://www.nhsbsa.nhs.uk/3647.aspx

http://www.scie.org.uk/care-act-2014/safeguarding-adults/sharing-information/what-does-the-law-say.asp

https://www.police.uk/crime-prevention-advice/anti-social-behaviour/



16. Associated Documentation

Caldicott Guardian (Trust intranet page)

Confidentiality Policy

Code of Conduct Leaflet

Health and Safety Policy

Incident Management Policy

Information Security Policy

Lone Working Policy

Raising Concerns and Complaints Policy

Risk Management Policy

Supporting Staff Involved in an Incident, Complaint or Claim Policy

Transfer of Confidential Information – Information Security Policy Guidance

Violence and Aggression Policy

http://ndht.ndevon.swest.nhs.uk/information-governance/caldicott-guardian/

http://www.northdevonhealth.nhs.uk/2016/02/confidentiality-policy/

http://www.northdevonhealth.nhs.uk/2015/03/code-of-conduct/

http://ndht.ndevon.swest.nhs.uk/health-and-safety-policy/


http://ndht.ndevon.swest.nhs.uk/information-security-policy-2/

http://ndht.ndevon.swest.nhs.uk/lone-working-policy/



http://ndht.ndevon.swest.nhs.uk/transfer-of-information-to-other-organisations-it-security-guidance-it_ispg-5-16/

http://ndht.ndevon.swest.nhs.uk/managing-violence-and-aggression-policy/

Violent & Aggression Warning Markers SOP Health and Safety Committee 27.09.16


Appendix A: Placement of Warning Marker Examples

It is impossible to list every category of incident which may warrant marking a patient’s healthcare record. Not only will the nature of the incident have to be considered but also the effect the incident has on all involved (NHS staff, Hotel Services Staff, Contractors, Staff from other Healthcare Associated Organisations and patients) and the likelihood of a further incident taking place.

NHS Protect uses two definitions to establish a nationally consistent reporting standard for the NHS. Staff should be familiar with these definitions so that they know what types of incident should be reported to their LSMS. The following definitions and categories are applicable when considering placing a marker on records and each category should include appropriate handling information. Note: These lists are not exhaustive.

Physical Assault is defined as: The intentional application of force against the person of another, without lawful justification, resulting in physical injury or personal discomfort.

Types of categorised physical assault include:

Physical assault (no physical injury suffered) – spitting is included in the definition of physical assault, in circumstances where the spittle hits the member of staff;

Physical Assault (physical injury sustained).

Non-Physical Assault is defined as: The use of inappropriate words or behaviour causing distress and/or constituting harassment.

Types of categorised non-physical assault include:

Offensive or obscene language, verbal abuse and swearing*

Brandishing weapons or objects which could be used as weapons

Attempted assaults

Offensive gestures

Threats

Intimidation

Harassment or stalking

Damage to buildings, equipment or vehicles which causes fear for personal safety

Offensive language or behaviour related to a person’s race, gender, nationality, religion, disability, age or sexual orientation.

Inappropriate sexual language or behaviour.

* Note the use of swear words may warrant a marker depending on the circumstances in which they are used. For some individuals, swear words may be used in everyday speech, however a marker should be considered where swear words are used aggressively.

Some of the above examples of non-physical assault can be carried out by phone, letter or electronic means.

Violent & Aggression Warning Markers SOP


LSMS

Responsibilities Key

External Stakeholder

Local Security Management Specialist

Review Panel

Security Management Director

Customer Relations Department

Marker required?

LSMS submits evidence to Review Panel to support recommendation

NO

No further marker action required

YES letter sent to patient to confirm marker placed

Responsible manager / LSMS investigates reported incident and assesses risk of violence, aggression or

anti -social behaviour towards staff

YES

NO

LSMS, in consultation with those associated with the person’s care decide it is not appropriate to notify the individual because it may:

a) Provoke a violent reaction

b) Jeopardise individuals health

INCIDENT OCCURS

Review Panel approves marker (as recommended

by LSMS)

Patient to be notified in writing of the decision?

Patient writes to query the decision for a marker being placed against their healthcare record

Panel decision concerning notification

Complaint upheld by Review Panel?

NO Individual notified

that decision for marker stands

Individual not satisfied with Review Panel decision and referred to the Customer Relations Department

NO Decision not to notify individual of marker is

documented

YES Decision reached to remove marker

LSMS requests removal

of marker from

records

Where applicable the individual is notified as soon as possible.

Victim kept informed of the panel decision.

Feedback to reporter or victim where appropriate

External stakeholder review undertaken by (but not limited to) Devon Partnership Trust Mental Health Professionals or Devon and Cornwall Police.

Patient advised of appeals process (via Review Panel)

SMD endorses decision for warning marker

Appendix B: Marker Procedure Flow Chart

LSMS contacts Records Manager for marker to be placed against Patient Healthcare Record

Marker reviewed by Panel on a 12 monthly basis



Appendix C: Notification of Warning Marker Template Letter

Individuals Name Address, Postcode, Date: Date of letter Trust Reference: (Incident reference number)

FAO:

Warning letter – Violent, Aggressive and Unacceptable Behaviour

I am the Local Security Management Specialist for the Northern Devon Healthcare NHS Trust. One of my roles is to protect NHS staff from abusive and violent behaviour and NHS resources from misuse and it is in connection with this that I am writing to you.

I have received reports (incident reference number noted) that (brief description of incident events dates and outcomes added here.

The Northern Devon Healthcare NHS Trust is firmly of the view that all those who work in or provide services to the NHS have the right to do so without fear of violence or abuse.

Such disruptive behaviour deprives staff of valuable time and resources and may result in other patients having their treatment delayed or postponed. Just as the NHS has a responsibility to you, so you have a responsibility to use its resources and treat NHS staff in an appropriate way.

Should there be any repetition of this type of behaviour; consideration will be given to taking further action against you such as:

Excluding you from certain NHS premises (for non-emergency, non-life threatening care).

Seeking an Acceptable Behaviour Agreement.

Providing NHS services at a different location.

Reporting to the police where your behaviour constitutes a criminal offence and fully supporting any prosecution they may pursue.

Consideration of civil proceedings taken against you supported by NHS Protect.

If any legal action is necessary any costs incurred will be sought from you and these may be considerable.

A copy of this letter will be shared with your GP, the Safer North Devon Hub (Community Safety Partnership Scheme) and the Police for the purposes of community safety and security. A copy will also be placed on your Hospital Healthcare Records which will be accessed by those employed by the Trust who may come into contact with you as part of any on-going or future care. The violent patient marker will be reviewed in 12 months time. You will be advised in writing of the outcome of this review and whether the marker will be removed from your records or whether it is considered that it should remain in place. If you have any queries following receipt of this letter, they should be submitted in writing and marked for my attention. Should you wish to appeal against the marker decision, your appeal will be referred to an independent panel for review and you will be notified of any decision taken following panel review.

Regards, Local Security Management Specialist, Northern Devon Healthcare NSH Trust


Corporate Governance

Suite 8 Munro House

North Devon District Hospital

Raleigh Park

Barnstaple

EX31 4JB

Direct Line: 01271 311725

Email: lsms [email protected]



Appendix D: 12 Monthly Review of Warning Marker Template Letter


FAO:

Ref: Notification of risk of violence marker being removed from NHS Healthcare Record I am the Local Security Management Specialist for the Northern Devon Healthcare NHS Trust. I wrote to you previously on date / reference concerning the placement of a risk of violence marker on your records after consideration of an incident on (brief description of incident events added here, this may include additional incidents that may have occurred following the placement of the original marker).

The risk of violence against staff marker placed against your Healthcare Record was recently reviewed after a period of 12 months by an independent Panel. Template Option A (Marker remains following 12 monthly Panel review) a) The Review Panel have carefully considered the events that triggered the placement of a marker against your Healthcare Records. Based on the facts and circumstances, the decision to place a marker on your Healthcare Record stands. The risk to staff is considered sufficient to warrant the marker remaining in situ until further review in another 12 months time. If you have any queries following receipt of this letter, they should be submitted in writing and marked for my attention. Should you wish to appeal against the marker decision, your appeal will be referred to an independent panel for review and you will be notified of any decision taken following panel review.

Template Option B (Marker removed following 12 monthly Panel review) b) After careful consideration, a decision has been reached that there is no further cause for concern. There have been no further incidents recorded by the Trust linked to you concerning any unacceptable behaviour. Therefore, the risk of violence against staff marker has been removed from your Hospital Healthcare Records. Any organisations with whom marker information was shared with will be notified of our decision to remove the marker. You are advised that any future incidents in which you are involved, and which indicate anti-social behaviour or a risk to staff from violent or aggressive behaviour is likely to result in a marker being reinstated. Regards, Local Security Management Specialist, Northern Devon Healthcare NSH Trust



Suite 8 Munro House


Raleigh Park

Barnstaple

EX31 4JB





Appendix E: Appeals to Review Panel Template Letter


FAO:

Ref: Appeal Concerning Marker Reviewed by Independent Panel I am the Local Security Management Specialist for the Northern Devon Healthcare NHS Trust. I wrote to you previously on date / reference concerning the placement of a risk of violence marker on your Hospital Healthcare record following an incident that occurred on (date and brief description of incident events added here).

The letter you subsequently sent to me on (date / individuals reference) has been submitted to an independent Panel for review. Template Option A (Marker remains following Panel review of appeal) a) The Review Panel have carefully considered the events and note the concerns you have raised. Based on the facts and circumstances, the decision to place a marker on your Healthcare Record stands. Your appeal has not been upheld. The risk to staff is considered sufficient to warrant the marker remaining in situ until further review in 12 months time. Should you be dissatisfied with the Review Panel decision to keep the marker against your records, any further queries or concerns must be referred to the Customer Relations Department who can be contacted in writing at the following address: Customer Relations Manager North Devon District Hospital Raleigh Park Barnstaple EX31 4JB Template Option B (Marker removed following Panel review of appeal) b) The Review Panel have carefully considered the events and note the concerns you have raised to appeal against the decision to place a marker against your Hospital Healthcare Record.

Your appeal has been upheld and the marker has been removed from your Hospital Healthcare

Record. Organisations with whom marker information was shared with will also be notified of the decision to remove the marker.

Regards Local Security Management Specialist Northern Devon Healthcare NSH Trust



Suite 8 Munro House


Raleigh Park

Barnstaple

EX31 4JB

