Practice No.
443
Reference:
10/06
Version 3
HCC AS 10/06 102
HCC AS 10/06 103
HCC AS 10/06 104
HCC AS 10/06 105
HCC AS 10/06 106
HCC AS 10/06 134
HCC AS 10/06 136
HCC AS 10/06 141
HCC AS 10/06 142
HCC AS 10/06 143
HCC AS 10/06 145
HCC AS 10/06 147
HCC AS 10/06 210
HCC AS 10/06 204
HCC AS 10/06 306
HCC AS 10/06 400
HCC AS 10/06 401
HCC AS 10/06 402
HCC AS 10/06 422
Page 1 of 5
Last up-dated
March 2011
NMC Code of Professional
Conduct
GSCC Code of Practice
STAFF – NIGHT DUTY GUIDANCE
This summarizes the arrangements in place to ensure a safe environment within a
residential or nursing home during the night hours:
1.
INTRODUCTION
This guideline summarizes the tasks, roles, and specific responsibilities of
staff working within the ‘night shift’ hours. All aspects of care are covered in
other guidelines of the Care Practice Manual and should be used as a
continuing reference.
Night duty refers to the designated ‘night duty’ period within a specific home.
This will vary to accommodate the needs of the specific location and service
provided.
The prime responsibility of staff on night duty is to ensure the health and
safety, physical, medical, social, and psychological wellbeing of residents.
Respect, dignity, privacy, enabling and encouraging independence, valuing
diversity and promoting equality are core values that underpin all interactions
and interventions. See guideline 210. Residents are to be involved as far as
they are able in all decisions relating to their care, as reflected in care plans
and risk assessment.
2.
STRUCTURE
The night team will be comprised of one Night Care Co-ordinator or
Registered Nurse and two or more Night Care Assistants. The number of
Night Care Assistants will vary depending on the size and layout of the home,
number of residents, and dependency level.
In the event of unexpected staffing shortfalls a risk assessment must be in
place to work with less than 2 care staff. This should include a contingency for
contacting other staff who may be able to provide cover. In all cases, the
Registered Manager or designated other member of the management team
must be informed immediately of such a shortfall.
The Night Care Co-ordinator or Registered Nurse will take the role of Duty
Manager throughout the night and will be accountable to the Registered
Manager. The Duty Manager will be responsible for the efficient running of the
home in accordance with departmental policies and procedures and ensuring
the safety and wellbeing of residents and staff at all times. The Duty Manager
will also lead, supervise, and work alongside the Night Care Assistants to
ensure residents needs are met.
Night Care Assistants will work as directed by the Duty Manager. The specific
role profiles provide full details of the duties, roles, and responsibilities.
On those occasions when a regular night Duty Manager is not available a
Relief Night Care Co-ordinator or Registered Nurse will cover and receive the
appropriate pay enhancement. Alternatively Assistant Unit Managers who
work less than 37 hours a week may be asked to cover a Waking Night duty.
In general, Sleeping-in duties will no longer be undertaken, but they will
continue in specific homes.
3.
SAFETY AND SECURITY
Regular tours of the building are to be conducted at no less than hourly
intervals and a tour log must be signed off to confirm that this has been done.
All parts of the building must be checked including, lounges, kitchens, toilets,
and laundry, to ensure that a resident has not fallen or wandered, and to
check on the security and safety of the building.
The first round will include:
 an initial check to ensure residents are safe and settled and
to assist those needing support
 a security check to ensure all external doors and windows
are locked to keep out intruders – small windows in
bedrooms may be left open if at the resident’s request
 a security check that all bathrooms are locked to ensure the
safety of residents
 fire checks in line with the Fire Safety Plan are conducted
and recorded to ensure communal spaces are made safe
(See guidelines 400 and 401)
 the rounds must be given high priority but must not disrupt
the care of individual residents.
On occasions when a resident may need more frequent checks. It is advisable
for a staff member remains in the proximity of the resident’s room, to be
available to respond to their needs.
If the needs of residents become such that rounds cannot be conducted
hourly, the Night Duty Manager is to inform the Day Duty Manager at morning
hand-over the next morning. The dependency levels of residents at night
must then be reviewed.
Tours at greater than two hourly intervals are not acceptable.
4.
INFORMATION SHARING
Night staff are to have access to a list of residents who are residing in the
home on any one night, and must be made aware of any absences,
discharges and admissions.
The Night Duty Manager will be given this information in the hand-over from
the Duty Manager at the end of the day shift. Any changes in care needs,
possible concerns or medical interventions will be included in this hand-over.
This procedure will also be followed in the hand-over from Night to Day Duty
Manager the following morning.
The written and verbal communication systems within the home will be used
as appropriate (See guideline No: 422).
5.
Primary Responsibility – Person-Centred Care
The main priority for all night staff, irrespective of position is to provide
person-centred care. This will entail undertaking tasks for residents identified
in advance and responding to new requests for assistance. Care plans and
risk assessments will be written and regularly updated by the Night Duty
Manager and Key worker, in consultation with each resident. (See guideline
No: 204).
If residents need assistance with dressing, undressing, going to bed or rising
in the morning, the nature and timing of that assistance will be determined as
far as is possible, by the resident. At times decisions may be made,
based on risk assessment, to ensure the safety and wellbeing of a resident
who may not be able to make an informed choice. This decision will be
recorded on a risk assessment form and authorised by the Registered
Manager. If a resident does not wish to go to their bedroom, or is anxious or
disorientated, a drink and snack may be provided in a lounge area with time
spent engaging with that resident. (See guidelines 141, 142, 143 and 145)
Residents may request assistance by using the call bell system, or ask to be
checked at regular intervals or specific times of the night. Where residents
cannot make their wishes known, a staff member is to check on those
residents by quietly opening their bedroom door to ensure all is well.
Preferences and decisions are to be recorded on the care plan.
The Night Duty Manager and key worker are to involve the resident (with
advice from the continence advisor) in agreeing a night continence plan,
which encourages independence and maintains hygiene and dignity. This is to
be recorded on the resident’s care plan.
Guidelines for end of life care must to be followed (see guideline No: 134).
The resident’s and their relative’s wishes are to be taken into account in terms
of the care given, with pain and discomfort minimised and a pleasant
environment maintained.
In caring for older people with dementia or mental health needs, at times
behaviours may become disruptive and challenging. These behaviours need
to be recorded to aid the identification of triggers. Night staff are required to
attend dementia care training to gain the necessary skills and knowledge.
If a resident chooses to lock their bedroom door, a risk assessment will be
necessary and must be recorded, including the understanding that Night Staff
may gain entry if there is a concern for the resident’s wellbeing. Residents’
doors must not be locked from the outside with the resident in their bedroom
as this will be interpreted as restraint (see guidelines Nos: 104 & 105). Bed
rails may only be used, following a risk assessment, for the safety of a
resident who is not mobile and is at risk of falling out of bed. The risk
assessment must be made in consultation with the resident, their relatives
and the relevant members of the multidisciplinary team, including the
occupational therapist (see guideline No 106).
All incidents, accidents and near misses during the night hours must be
recorded by the Night Duty Manager and reported using the Incident
Reporting System (see guideline No. 306). A resident who slips, trips or falls
will be assessed by the Night Duty Manager for potential injury, and a
decision will be made to assist the resident to become mobile or to call the
emergency medical services. (See guideline No.415)
The Night Duty Manager is responsible for administering medication that is
required in the night hours in accordance with medication guidelines (See
guidelines Nos. 127 & 128, 128a/b/c/d/e). The Night Duty Manager is
responsible for responding to all emergencies to include requesting
appropriate and timely medical intervention. The Night Duty Manager will be a
Qualified Appointed First Aider (see guideline No. 402).
All assistance provided and changes to physical or emotional wellbeing during
the night is to be recorded on individual residents’ daily contact sheets, in
accordance with recording and reporting guidelines. Confidentiality of
information is to be maintained at all times (see guideline No. 102).
If a bed is found to be empty after the resident’s usual bedtime, the list of
residents in the fire log is to be double checked, followed by a systematic
search of the building. The Night Duty Manager will follow the Missing
Persons Procedure (see guideline No. 136).
In the event of the fire alarm sounding the Fire Procedure (see guideline No.
400) will be followed. Two-way radios are provided to enable effective
communication between night staff in the event of an emergency.
The Night Duty Manager will ensure that all night staff remain alert and fulfil
their responsibilities. If a Night Care Assistant is observed to become drowsy
or is not fulfilling their duties it is the responsibility of the Night Duty Manager
to take appropriate steps to engage them in their designated tasks.
Sleeping on duty is a disciplinary offence. Staff should be aware that sitting in
a chair with closed eyes may be interpreted as sleeping. All breaks should be
taken in designated staff areas. The use of blankets whilst sitting may
encourage sleep and should only be used at times of unusually low
temperatures, e.g. in severe external weather conditions.
If any member of the night staff suspects abuse of a resident by a staff
member or by another resident, it is their duty to report this to the Night Duty
Manager or another person, who will take the relevant action (see guideline
No. 103). Similarly any incidents where a resident physically or verbally
abuses a staff member are to be recorded and reported with the relevant
support given. (See guideline 306)
6.
Secondary Responsibilities - Ancillary Tasks
Ancillary tasks may be carried out in the night hours to assist in providing a
clean and safe environment for the residents. Any tasks undertaken must not
disturb residents, compromise health and safety standards, or be undertaken
at the expense of attending to residents or hourly rounds.
Tasks undertaken within each home may vary depending on the layout of the
building, location of the laundry (to comply with the Fire Safety
Recommendations), and the priorities at any one time. A list of expected
duties will vary according to the home.
7.
Staff - Performance Management, Supervision and Support
Night Duty managers will receive formal supervision from the Registered
Manager given their level of responsibility and accountability.
Night Duty managers will provide direction, supervisory and clinical support on
a nightly basis for Night Care Assistants.
Assistant Managers and Senior Nurses will provide formal supervision for
Night Care Assistants. The arrangements for formal supervision may differ but
will be in accordance with the corporate policy, as set out in the Managers’
Guide (see http://intranet.hants.gov.uk/azindex/azindex-m.htm. When
planning supervision, support and development the needs of night staff must
be considered. However there is an expectation that night staff will attend
training that takes place in the daytime following adequate notice.
All new night staff will receive a full induction with the relevant health and
safety training. It is good practice for new staff (on a paid basis) to meet
residents before starting work. All human resource policies and procedures
apply.
8.
Quality Assurance Visits
A Senior Manager, Registered Manager or designated person will visit each
home a minimum of four times a year during the night hours. This is to ensure
quality and consistency of care across the Homes, and identify areas for
improvement.