ID Badges & Secure Wards/ Departments
•
ID badges must be worn at all times whilst on Trust property.
•
It is important to challenge individuals in secure areas who you do not
recognise. It is important to be vigilant and security aware at all times; “when in
doubt” IMMEDIATLEY make the 2222 call and ask for assistance.
•
When entering a secure ward it is vital to ensure that individuals do not
“tailgate” you onto/ off the ward. Always make sure that you check behind you,
and should there be someone trying to follow you into/out of the secure area,
ask whether you are able to assist the person: your response must be “Sorry, I
am unable to let you in/out, however if you press the contact button a member of
staff will assist you”.
•
Any adverse reaction to this request must be reported immediately to the
security department via the 2222 number.
Trust & Personal Property
•
The Trust does not have a security guard presence, it is therefore vital that we
all keep alert and vigilant. The Trust requires all staff to report any security
breach or suspicious activities; should your suspicions be raised, do not
hesitate, challenge and immediately call for assistance via 2222.
•
Do not bring personal items of value or large amounts of cash into the work
place unless you have somewhere safe and secure to keep them. Should you
choose to do so, this will be entirely at your own risk.
•
At the end of the day remember to lock items of value away and ensure that
your office windows are shut and that the door is locked
•
All incidents of theft must be recorded on a “Trust Incident reporting system”
and reported to the Police via 101, the Police will issue an Event Number and
Crime Number relevant to the incident, both to be included on the incident
report.
The Management of Violence and Aggression
•
In line with the Secretary of State for Health's 2003 Directions, the Trust
is required to provide “Conflict Resolution Training” to all staff who deal
directly with patients, visitors and the public. This training, which is
mandatory, will help you to identify possible situations that may
escalate into serious incidents and will assist you in preventing this
happening.
•
It is surprising how easily conflict can be avoided; for example a simple
question such as “How can I help you” accompanied by a smile, can
work wonders. Try to maintain eye contact and invite the individual to
sit down these are proven de-escalation techniques.
•
Always try to solve the problem and never make promises that you
cannot keep.
•
Please remember that the WSH Trust operates a Zero Tolerance policy
(see The Management of Violence and Aggression Policy PP(12)183),
and if “Talk Down” fails call for assistance via 2222.
Restrictive Physical Intervention Team
• Physical intervention should be seen as one in a range of
strategies and actions to help staff address the needs of
individuals who behaviour posses a serious challenge too
provided services.
• Safer Physical intervention techniques are a skilled hands-on
method of physical restraint. Its purpose is to safely immobilise
or restrict the individual involved.
• The Trusts RPI team will comprise of pager holders to form a
rapid response unit which will operate 24/7.
• The Team will consist of a minimum of three persons; all trained
in conflict resolution, breakaway skills and restrictive physical
intervention techniques. An RPI team attendance can be
requested via the trusts emergency 2222 number.
Blood Borne Viruses
Jenny Saunders
Occupational Health Manager
Ext. 3423
Blood Borne Viruses
Blood Borne Viruses (BBV’s) can be carried by some
people in their blood and can cause severe disease
in certain people and few or no symptoms in others.
The Virus can spread to another person, whether or
not the carrier of the virus is ill or not
These viruses can be found in body fluids as well as
blood e.g. semen, vaginal secretions and breast milk.
Other body fluids such as urine, sputum, sweat, tears
or vomit carry a minimal risk of BBV’s unless
contaminated with blood
How can BBV’s be spread in the
workplace?
• Needlestick Injury
• Carrying out surgery (EPP)
• During delivery of baby
• Splashes of bloodstained fluids in mucous
membrane of eyes or mouth
• Human bites
E.P.P.
• Exposure Prone Procedures are those in
which there is a risk that injury to the Health
Care Worker could result in exposure of the
patient’s open tissue to the blood of the
Health Care Worker placing the patient at
risk.
• Such procedures occur mainly in surgery,
obstetrics and gynaecology, midwifery and
dentistry
Action following exposure
(needlestick/sharps injury/splash)
•
•
•
•
•
Bleed injury by squeezing
Wash wound
Cover wound
Report immediately to senior member of staff
Attend Occupational Health Department (or A
& E between 16.30 and 08.30 hrs and
weekends) immediately
• Complete Incident Form
Antimicrobial Prescribing
Gemma Kerridge
Antimicrobial Pharmacist
Ext. 3232 (bleep 514)
Appropriate antimicrobial prescribing
•
Antibiotics are a finite & vulnerable resource that need protecting
–
–
•
Poor prescribing causes immediate and long-term problems
– Clostridium difficile
–
–
–
–
–
–
–
•
Threatened by increasingly diverse antibiotic resistance among pathogens
Limited by a shrinking development pipeline (i.e. too few new antibiotics)
MRSA
VRE (Vancomycin-resistant Enterococci)
ESBL (extended-spectrum β-lactamase) - producing coliforms
Penicillin resistant Strep. pneumoniae
Multi-resistant Pseudomonas & Acinetobacter
Drug-resistant TB
Financial cost (Drug costs, Bed-days, Fines etc.)
Check compliance with Antibiotic Guidelines (see intranet Pink Book) and
ensure that justification of any variation has been documented
•
Consultants are ultimately responsible for the prescribing for their patients and
should provide leadership for their team.
Additional advice is available via the duty Consultant Microbiologist on
Ext 2579
Prepared by Gemma Kerridge, Antimicrobial Pharmacist Bleep 514 and Dr Robert Sue-Ho, Consultant Microbiologist
Are antibiotics appropriate for your patient?
A check list:
•
•
•
•
•
•
Indication(s) - confirm by clinical assessment and document in medical notes
Previous microbiology – check for resistant organisms
Allergy Details – check on the front of the drug chart
Interactions with other medication?
Compliance with Antibiotic Guidelines according to indication?
Is the Dose appropriate? (weight, renal function, liver function)
Follow-on therapy check list:
•
•
•
•
Clinical Indication - still current?
Review antibiotics daily with Micro Results and clinical response
Switch to narrow spectrum as soon as possible
Switch IV to oral as soon as practical
• Maximum of 48-72 hours IV needed in most cases after clinical review
•
Set a duration
• 5-7 days duration is usually sufficient (See exceptions in guidelines)
When NOT to use antibiotics
• Colonisation (N.B Infection is assessed clinically NOT by micro report)
e.g. leg ulcers (No surrounding cellulitis)
catheter urine (No systemic signs of infection)
asymptomatic bacteriuria (No urinary symptoms in elderly)
• Contamination
e.g. skin flora in blood culture
• Viral infections
e.g. colds, sore throats and acute bronchitis
• Mild or Improving self-limiting infections
e.g. gastroenteritis
Also Consider: Specific dressings for wounds instead of antibiotics, debride wounds/drain abscesses where
possible, remove/change catheters, serial observation and appropriate investigations rather than antibiotics
that are just in case.
DO be aware of possible drug interactions
•
Methotrexate: NEVER prescribe trimethoprim, not even a short course or a low dose, to patients
receiving methotrexate. Note: Co-trimoxazole (Septrin®) contains trimethoprim. This is a
POTENTIALLY FATAL interaction.
•
Warfarin: While almost all antibiotics can ‘potentiate warfarin’ but this effect can be amplified
in those antibiotics that inhibit warfarin's metabolism such as: ciprofloxacin, clarithromycin,
erythromycin, metronidazole and co-trimoxazole (Septrin®) especially in elderly patients. (Arch.
Intern. Med. 2010, 170 p.617).
•
Statins: should NOT be used with fusidic acid (Fucidin) because of the risk of (potentially fatal)
rhabdomyolysis. The statin should not be restarted until 7 days after the last dose of fusidic
acid. (MHRA Drug Safety Update Sept 2011, Vol 5, issue 2)
The plasma concentration of statins can be increased by macrolides. Avoid concomitant use of
clarithromycin or erythromycin with simvastatin. See the current BNF for other statin-macrolide
interactions.
•
Macrolides: (e.g. erythromycin, clarithromycin, azithromycin) and many other drugs that inhibit
or are metabolized through Cytochrome P450 Pathways
Macrolides can increase the level of digoxin and lead to toxicity – monitor digoxin levels if this
combination is required.
Avoid macrolides in certain disorders: e.g. Porphyria, certain Heart rhythm disorders
Rifampicin: Rifampicin is a potent inducer of certain cytochrome P-450 enzymes and interacts
with many drugs that are metabolised by this route.
•
•
Gentamicin: Carefully monitor patients renal function and review any concomitant nephrotoxic
medication. E.g. NSAIDs may not be necessary during treatment with gentamicin. Monitor
patients auditory function – ototoxicity can be a delayed event.
• THIS IS A SMALL SUMMARISED SELECTION. PLEASE CHECK CAREFULLY
BEFORE INITIATING ANTIBIOTICS IN PATIENTS WHO ARE ALREADY TAKING
MEDICATIONS.
Preventing falls in hospital
Shubhada Sinha
Consultant Geriatrician
Ext. 3890 (bleep 479)
What puts patients at
risk of falling?
•
•
•
•
•
•
•
Medical conditions affecting mobility
Multiple medications
Poor vision
Dehydration and malnutrition
Incontinence
Dementia and “acute confusion/agitation”
Postural hypotension
What can you do to prevent falls
• Ask all patients about falls in previous year
• All patients who have fallen should have a
multidisciplinary assessment including
physio, OT, nurse and doctor
• Patients who are confused or agitated should
have enhanced supervision
Medical Assessment
• Is it syncope?
• Is there undiagnosed neurological or
cardiovascular disease
• Check for postural hypotension
• Consider whether medication can be reduced
or stopped, especially antidepressants,
sedatives, opiate analgesics or antipsychotics
• Prescribe calcium & vitamin D if frail or
housebound
Onward Referral
• Patients with recurrent falls or a single
fall with abnormal gait or balance should
be referred to community teams for
follow-up
• This is done by faxing a “single point of
access” form to the team covering the
patient’s locality
Medications Management
Jenny Hannah
Pharmacy
Ext. 2813 (bleep 969)
Prescribing errors at West Suffolk Hospital
These significant errors have all been reported in the last 12 months:
Ramipril prescribed, patient allergic
to this, nothing written in allergy
box at the time of prescribing, one
dose given
Actrapid insulin
written as 4U
instead of 4units
Patient prescribed wrong dose of
perindopril,80mg instead of 8mg.
Patient takes weekly methotrexate
(25mg on Mondays s/c) and has
been prescribed trimethoprim. He
has received one dose of 200mg
trimethoprim.
Trimethoprim prescribed for patient
on Methotrexate (also Methotrexate
prescribed by Dr not authorised to
prescribe Methotrexate)
Insulin dose changed on existing
prescription and dose prescribed
with abbreviated U instead of units.
Insulin prescribed with abbreviation
"u" instead of word "units" and not
signed by the doctor
Outpatient prescription for
'methotrexate 10mg PO daily'
prescribed. The prescriber was
not aware that methotrexate is
given once weekly
Patient allergic to
penicillin –
prescribed penicillin
Do you check the patient’s drug chart
during your ward rounds? Do you
encourage good prescribing by your
team? Do you lead by example?
• Prescribers of unlicensed medicines have a personal responsibility for their
use, which cannot be transferred to the drug company producing or
importing the product.
• Trust policy is only to use unlicensed medicines when no licensed alternative
exists. It is also Trust policy to require evidence that the use of unlicensed
medicines, or the unlicensed use of a licensed medicine, is evidence based
and peer supported.
• Patients must be provided with a suitable information leaflet to aid them in
making an informed decision regarding the risks and benefits of the
unlicensed treatment – this is the responsibility of the prescriber
• It is vital that the patient's GP is also informed of the decision to treat using
an unlicensed preparation, particularly if the patient is to be discharged to the
care of the GP.
Update on anticoagulants
•
Is your patient currently receiving an anticoagulant? This may be extended VTE prophylaxis
post-surgery. The patient may be on rivaroxaban, tinzaparin or unfractionated heparin and
will fulfil one of the following criteria:
–
–
–
–
–
Patients who have undergone elective total hip replacement (THR) in last 28 days
Patients who have undergone elective total knee replacement (TKR) in last 14 days
Patients with fracture neck of femur in last 28 days
Patients with lower limb casts
Patients who have had major cancer surgery in the abdomen or pelvis within last 28 days
•
These anticoagulants should be continued for the specified time unless there are new contraindications. See CG10211-1 Extended Venous Thromboembolism (VTE) Prophylaxis In
Adult Non-Pregnant Patients for more details
•
As well as the vitamin K antagonist oral anticoagulants i.e. warfarin, phenindione, and
acenocoumarol (also known as nicoumalone), watch out for the new oral anticoagulants :
apixaban, dabigatran, rivaroxaban. All of the new oral anticoagulants:
–
–
–
–
–
Can be given without therapeutic monitoring.
Are either contra-indicated or require a decrease in dose in renal impairment
Have haemorrhage as a common side-effect hence patients should be monitored for signs of bleeding
or anaemia; treatment should be stopped if severe bleeding occurs.
Should be avoided in severe hepatic impairment associated with coagulopathy.
Have no specific antidote.
Our Medicines Information Department produce regular medicines alerts.
Did you catch all the 2012 updates?
IV paracetamol – reduce dose in:
Low body weight (<50kg)
Patients with/at risk of hepatocellular insufficiency
Renal impairment (CrCl<30ml/min)
Long term PPIs:
Risk of hypomagnasaemia
Increased risk of Clostridium difficile infection
Increased risk of bone fractures
QT prolongation with citalopram/escitalopram – review dose,
checkFor
formore
drug information please see our pages on the Pink
Book:
interactions & contra-indications
https://www.wsh.nhs.uk/Extranet/SupportServices/Pharm
Mandatory Blood Transfusion Update
for Medical
TitleStaff
slide2012/2013
(focussing on new guidance)
All transfusion guidelines are
under the pathology handbook on
the intranet. See also information
on pink prescription chart.
For specific transfusion advice
contact duty haematologist via
switch or BMS in blood bank
(3316) or Transfusion Nurse
Specialists (TNS) Gilda Bass or
Joanne Hoyle via
TNS@wsh.nhs.uk Ext 3089 Bleep
455/262
Consent
•
•
•
•
•
•
•
(* specified in new guidance from SaBTO)
Written consent is not currently required
A discussion between the doctor and patient needs to take
place and be documented in the patient notes. The
discussion should cover : the risks, benefits and
alternatives to transfusion and the patient’s right to
refuse transfusion*.
The NHS patient information leaflet should be offered to
patients. The leaflet gives a summary of the risks and
includes the unknown risk of vCJD which we are required to
tell patients about.
For patients having multiple transfusions this discussion can
cover the series of transfusions as long as that is made clear
in the notes*.
For patients who refuse blood and blood products for
whatever reason refer to Trust policy for treatment of
Jehovah’s Witnesses CG10013
Patients who may not have been aware they were
transfused (e.g if transfused in theatre or on ITU) need to be
informed prior to discharge so they have a chance to ask any
questions they may have*.
Patients who have received blood may not be blood donors.
Specific Blood requirements
• Some patients require specific products e.g. CMV negative or
irradiated products:
• Irradiated products:
– In general significantly immunocompromised patients e.g those having
drugs such as purine analogues or antagonists for CLL, lymphoma etc
(e.g. fludarabine, cladrabine, deoxycoformycin, bendamustine, clofarabine) or atemtuzumab
(Campath) for any indication (new British Committee for Standards in Haematology (BCSH)
guideline) or any patient who has had Hodgkins lymphoma should have
irradiated products to avoid risk of fatal transfusion associated graft
versus host disease.
– See prescription form for summary and ‘Indications for Irradiated blood
products’ Guideline CG 10094 for more details.
• CMV negative products (new guidance from SaBTO):
– Some patients need CMV negative blood. These are mainly neonates
or pregnant women to avoid transmission to the fetus. See ‘Use of
CMV negative blood components’ guideline CG 10208 for more details
Transfusion Reactions
New reactions algorithm
•
Stop the transfusion
•
If called to a potential transfusion reaction
patient should be assessed immediately.
•
Refer to Transfusion Reactions guideline
CG10126 and use algorithm (new algorithm from
updated BCSH guideline)
•
Inform blood bank
•
If a major reaction obtain all samples and
discuss further management with duty
haematologist
•
Complete transfusion reactions form and
send to blood bank with samples required
•
Complete Trust incident form on Datix for all
major reactions
•
Consider potential impact on patients
receiving blood products from the same
donor in other hospitals
•
Follow up on results from transfusion
reaction
Blood in an Emergency
•
O negative emergency blood is kept in the blood fridge in Blood bank.
Send a runner or porter to collect. If no-one is BARs trained ask a member
of the lab staff to release the blood.
•
If the patient has a valid group and save sample ‘group specific blood’
should be requested and can be ready in 5 mins – phone blood bank.
If a new sample is sent group specific blood will take approx 10 - 20 mins.
•
• NB group specific or O neg blood does carry of small risk of causing
reactions if a patient has developed red cell antibodies. Fully crossmatched
compatible blood which is safe will be available in approx 30-40 minutes.
•
If the patient is likely to require a significant amount of blood – approx one
blood volume then the ‘Massive Haemorrhage policy’ should be triggered
by calling the blood bank – see algorithm on next slide.
Massive Blood Loss Algorithm
Acute oncology service (AOS)
Dr Dan Patterson
Consultant Medical Oncologist
‘Acute oncology’
• The management of patients who develop severe
complications following chemotherapy or as a
consequence of their previously diagnosed cancer, as well
as the management of patients who present as emergencies
with previously undiagnosed cancer.
WSH Acute Oncology Service
• Chemo pts: dedicated phone no. for advice (24/7)
• AOS available to see patients Mon-Fri 9-5
• Out of hours: Addenbrookes Onc SpR/Cons on
call
• Daily cancer patient email alerts
• Assessment beds on Macmillan Day Unit
• Commenced Sept 2011 – ran by CNS &
Consultant
Please use the pink book for emergency
treatment guidelines and contact numbers
Basic Fire Precautions
Please Note: Staff MUST undertake a face to face classroom
session with the Trust Fire Safety Advisor every alternate year
In your place of work
You should ensure you are
familiar with:
How to raise the alarm
The location of break-glass call points
Means of escape routes
Evacuation procedure & fire assembly point
Location of first aid fire fighting equipment
Fire prevention
 Do not leave machinery switched on overnight unless it is designed for
that purpose
 Close all doors and windows at the end of the working day
 Ensure all electrical appliances are switched off at the wall socket, with
the exception of computers which are in use 24/7.
 Switch off any portable heaters
 Ensure that nothing flammable is kept too near any heat source
 All containers of flammable liquids or medical gases are returned to
their proper storage area when not in use
 Any faulty equipment should immediately be taken out of use and
reported on the Helpdesk service ext 5555
What not to do
Do not wedge fire doors open
Do not remove first aid fire fighting equipment
from its designated position or use as a door
stop
Do not restrict width of fire exit routes or store
any flammables on fire exit routes
The Fire Triangle
Fire relies on all 3 aspects to remain combustion
 Ignition Source – Naked flame, spark, welding. Method
of extinction: remove or isolate
 Oxygen – all around us – method of extinction
smothering
 Fuel – anything which will burn. Method of extinction:
remove fuel
Remove any 1 of the 3 to extinguish the fire
Action in the event of a fire
If you see, suspect or smell smoke/flame, carry out the following
actions:
Raise the alarm – use the nearest break glass call point, or
shout FIRE FIRE FIRE.

Evacuate the immediate vicinity, closing all doors and
windows (if safe to do so)

Call the switchboard on 2222 and report fire and its location

Make your way to a Fire Assembly Point

Try to account for everyone in your department

The Trust Fire response team will investigate and take
control.

Only attempt to fight the fire if safe to do so, you’re confident,
you’re trained and always take someone with you for safety
In a real fire situation, the Senior fire officer (Suffolk Fire
Service) is in charge and only that officer can tell you
when it is safe to re-enter the building or area
Fire Fighting Equipment
 Carbon Dioxide Fire extinguisher Used on Flammable liquids &
Electrical fires.
Hazard – Do not hold the horn or the
bottom of the cylinder
 Foam (AFFF) Fire extinguisher –
Used on paper, cardboard, wood &
contained flammable liquid fires.
Hazard – Do not use on electrical fires
 Fire Blanket – Ensure you protect your
hands before attempting to smother
the fire or object
Evacuation policy
 On hearing an alarm
 All non clinical areas to evacuate totally to a
designated fire assembly point
 All clinical areas are to horizontal evacuate to either
an intermittent zone or a clear zone
 Evacuation methods:
Walk
Wheelchairs
Beds
Safeguarding Adults
Jayne Holmes
Deputy Chief Nurse
Ext. 2746
Safeguarding vulnerable adults
A vulnerable adult is any person aged 18 or over who:
• Is or may be in need of community services by reason of
mental, physical, or learning disability, age or illness and
who:
• Is or may be unable to take care of himself or herself or
unable to protect him or herself against significant harm
or serious exploitation which may be occasioned by the
actions or in-actions of other people.
Responsibilities
• If you suspect that, a vulnerable adult is at risk of, or is
actually suffering harm, you should:
• In working hours, contact the hospital social care
department for Suffolk patients or relevant county’s oncall social worker.
• Outside of normal working hours, contact “Customer
First” via switchboard.
• The “Cause for Concern Communication Form”
should be used to record the concern and action taken.
A copy should be sent to Jayne Holmes, Safeguarding
Lead and the form put into the patients notes
What information do I need?
Social services will require information about:
•
•
•
•
•
The nature of the problem
General background about the people concerned
The name of the G.P. and other agencies in contact with the person
The level and nature of the immediate risk (and why)
Whether the person concerned is aware of/consenting to the
referral
• Previous occurrences
• Who has been informed
• Any actions taken or requested
Mental Capacity Act 2005
• The Mental Capacity Act protects people who
can't make decisions for themselves or lack the
mental capacity to do so. This could be due to:




a mental health condition
a severe learning difficulty
a brain injury, such as a stroke
or unconsciousness due to an anaesthetic or sudden
accident.
Assessing Capacity
This is a 2 stage assessment:
Does the person have:
•
•
an impairment or disturbance in the functioning of the mind or brain, and
an inability to make decisions.
A person is unable to make a decision if they cannot:
•
•
•
•
understand the information relevant to the decision,
retain that information,
use or weigh that information as part of the process of making the decision,
or
communicate the decision.
The final decision about a person’s capacity must be made
by the person intending to make the decision or carry out
the action on behalf of the person who lacks capacity
Best Interests
• If it is concluded that a decision should be made
for them, that decision must be made in that
person’s best interests.
• The Mental Capacity Act gives a “best interests”
checklist.
• Document your rationale. A form to aid with this
can be accessed on the “Forms” section of the
Intranet
Independent Mental
Capacity Advocates
Independent Mental Capacity Advocates (IMCA) should be used to
contribute information on a patient’s best interests when they do not
have any relatives/informal carers.
• They must be involved when an NHS body is proposing to:
– provide, withhold, or stop any serious medical treatment or
– Arrange accommodation in a hospital or care home and:
• The person will stay in the hospital for longer than 28days or
• They will stay in the care home for more than 8 weeks
Guidance in how make a referral to an IMCA can be found on the Trust
Policy: Guidance on the instruction of Independent Mental
Capacity Advocates (IMCAs)
Deprivation of liberty
safeguards (DOLS)
• The aim of the DOLS is to provide legal protection for those
vulnerable people who are deprived of their liberty otherwise than
under the Mental Health Act 1983, to prevent arbitrary decisions to
deprive a person of liberty and to give rights to challenge
deprivation of liberty authorisations.
• The safeguards exist to provide a proper legal process and suitable
protection in circumstances where deprivation of liberty appears to
be unavoidable. The safeguards require that the deprivation of
liberty be made lawful through ‘standard’ or ‘urgent’ authorisation
processes. (refer to Deprivation of Liberty Safeguards policy)
Use of restraint
• Consider if there are other less restrictive options and
document the rationale for the decision to restrain.
When restraining a patient lacking capacity, doctors are
protected from liability if the following two conditions are
met:
 the doctor must reasonably believe the restraint is necessary to
prevent harm to the person who lacks capacity; and
 the amount or type of restraint used and the amount of time it
lasts must be a proportionate response to the likelihood and
seriousness of harm.
Further Information
• Further information relating to the Mental Capacity Act, Deprivation
of Liberty Safeguards and Independent Mental Capacity Advocates
can be found by clicking on the following link to the Department of
Health website
• There is an e-learning package that can be accessed on:
http://www.kwango.com/sfkmcalogin
Login to the course with the username and password below:
USERNAME - WSHOSP
PASSWORD - WSHOSPMCA
• Further training materials are also available from the Deputy Chief
Nurse, Jayne Holmes
MAJAX
Gerald Kelly
MAJAX Officer
Ext. 3171 (bleep 978)
MAJAX. What is a major incident?
“Any occurrence which presents serious threat to the health of the community,
disruption to service, or causes (or is likely to cause) such numbers or types of
casualties as to require special arrangements to be implemented…by hospitals,
ambulance trusts or primary care organisations”
In any circumstance a Major Incident only exists when the Major Incident
Controller says so! Our Major Incident Controller is always the on-call
Gynaecologist, because
• They are clinicians who work in and know most areas of the hospital
• They have been trained
• There will not be a call for them to get clinically involved
But it could be anything…. road crash, chemical fire, surgical or medical,
external or internal – anything that means we can’t cope on our own. It may also
be that we are not directly affected, but joining in to support others.
Controlled Areas
Bear in mind that although we use a system of ‘Controlled Areas’,
which have special arrangements in place and regular training, any
incident is going to be ‘as well as’ not ‘instead of’. So whether or not
you work in one of the Controlled Areas, you will almost certainly be
affected.
The Major Incident Controller (MIC) sits in the Hospital Control
Centre with a team of managers, and performing three main tasks:
• Link the hospital to the other agencies involved
• Ensure that clinical staff have the resources they need
• Help us survive the incident and get us back to the day job as
quickly as possible
Controlled areas continued….
If you work in a Controlled Area, you should have a look in the box labelled
“MAJOR INCIDENT” on one of the walls. It contains a number of things you
should aware of:
A yellow jacket for the Area Controller
When an incident occurs, the Area Controller is the most senior person in the
department. If that happens to be you, put the jacket on as people will be
headed in your direction who may not know the area and they mustn’t waste
time or distract others trying to find out who is in charge. The Area Controllers
job is to control the area, NOT to be hands-on with patients
Action Cards
For the department, the Area Controller, and for those who will be sent to you
Message pads
We have to assume that the phones will be overloaded, and that even if they
weren’t, the person who answers the phone may not understand! ‘Runners’
from non-clinical departments will be sent to you, so write it down and send a
runner
Apart from the Hospital Control Centre, we set
up controlled areas in:
Triage
A&E foyer area
Major Treatment Area
A&E Resuscitation area
Admitting Ward
F6
Portering
Everywhere
Relative Reception
You need to
remember
this!!
Intermediate Treatment Area
Chapel
Fracture Clinic
Staff Holding
Minor Treatment Area
Pain Clinic reception (near G8)
Physiotherapy ODP area
Preoperative Area
Press Centre
Committee room
Endoscopy unit ward
Discharge Area
Operating Theatres
Dead
Operating theatres
Main OT department
Mortuary
Intensive Therapy Unit
External Decontamination
ITU
Front area of hospital
The thing to note is that for the most part, these are things
done 24/7 by those who normally do them…..
A salutary tale…
During the Kings Cross fire, 3 middle grade Orthopaedic Surgeons were stopped
(in separate cars) doing speeds in excess of 100mph on the M3. The conversation
with the Police went something like this:
PC:
“Hello, hello, hello. Where’s the fire then, sir?”
Doc:
“Well actually Officer, it’s at Kings Cross, and I’m an
Orthopaedic Surgeon, and I’m needed…”
By now you should know:
• They hadn’t been invited
• They almost certainly weren’t needed
• At those speeds they were putting themselves and others at risk
• And what about the patients they were supposed to be seeing back in
Southampton?
They were prosecuted!
Hospital Arrangements
The Trust response is based on a ‘Command and Control’ model,
since we cannot predict what the situation will be. So we have a
framework and reporting lines which allow us to shape our response
to almost anything. (These are all laid out in our Major Incident plan
which you can find on the intranet). This means that you might well
be asked to work in an area you are not used to; it does not, and
must NEVER mean that you work beyond your competence.
So what should you do?
There are really only two possibilities we need to consider – are you
on duty when you hear about a Major Incident or not?
On Duty or Not….
If you remember what they are doing in the Hospital Control Centre, it all
becomes a lot more straightforward….
Their task is to get us through the incident and back to our normal job. That
includes plotting and planning staffing levels and skill mix throughout the Trust,
and the only way that can be done is if they know who is available and when.
So if you are already on duty, just carry on unless and until you are asked to go
elsewhere.
If you’re not on duty do NOTHING – the only assumption you should make is
that Control Centre is going to be slotting you in when and where you can do
the most good. If you’re needed before your next normal shift, you will be
phoned……. (But please don’t phone us – Switchboard will be creaking at the
seams!)
If you ARE asked to come in, you will be asked to report either to your normal
ward or department, or to Staff Holding. Either way, please only use the
entrance by the Rainbow Outpatients at the back of the building, and please
remember to bring your ID badge.
The key things to remember………
It could be External, Internal: Surgical or Medical
We move to ‘Command and control’
If you’re called in, come to the back entrance and bring
your ID with you as you WILL be challenged
If you’re not asked to help, stay clear
A Major Incident is a RARE occurrence, we have practice
alerts to keep within the law and to ensure key people
know what to do in the event of a real MAJAX
Health and Safety/Risk
Management
Mike Dixon
Health and Safety Advisor
Ext. 3944
Risk Assessment
A hazard is something with the potential to cause harm.
A risk is the likelihood of harm occurring, and the level of
severity of the resultant harm.
A risk assessment is carried out with a systematic approach
in order to identify and manage workplace hazards safely. It
involves identifying the hazard, then looking at who could be
affected by the hazard. Once these have been indentified the
risk of harm occurring to those persons has to be taken into
account. Once all this information is collated, appropriate
control measures can be explored to eliminate the hazard, or
remove / reduce the risk of harm.
Risk assessments should be undertaken by a competent
person and completed on the Datix risk register. Some
specific risks, e.g. stress, moving and handling may require
more detailed and structured risk assessments.
The 5 steps to Risk
Assessments are:
1, Identify the hazards
2, Decide who might be harmed and how
3, Evaluate the risks and decide on
precautions
4, Record your findings and implement them
5, Review your assessment and update if
necessary
Risk Assessment Cont:
All Risk assessments must be recorded on Datix risk register.
Active risk assessments rated as a RED will be reviewed at least every 3 months.
Active risk assessments rated as AMBER will be reviewed at least every 6 months.
Active risk assessments rated as GREEN will be reviewed at least every 12 months
Accepted risk assessments are to be reviewed at least every 12 months
Risk assessments should also be reviewed following an incident to ensure the
identified hazard and associated risk are controlled appropriately. It is good practice
when carrying out or reviewing assessments to involve the employees who either
undertake or come into contact with the assessed task/activity.
For details of risk assessment and Datix risk register training please contact the
Risk Office on ext: 3944
Health and Safety:
The Health & Safety at Work Act 1974 and the
Management of Health & Safety Regulations 1999 are
considered to be the main pieces of health and safety
legislation.
One new act has recently been introduced to ensure health
and safety failings are appropriately dealt with.
The act is:
The Corporate Manslaughter and Corporate Homicide Act
2007
The Corporate Manslaughter and
Corporate Homicide Act 2007:
• This Act sets out the legal liability of individual Board
Members for health and safety failures. The Act came
into effect 6th April 2008.
• In short, any person or any organisation can be liable to
prosecution under H&S laws and regulations for a
range of offences.
• This includes any Managers, Supervisors, Site Level
Managers and Directors in fact anyone deemed to have
responsibility for employees and their safety
• The company can also be ordered to publicise their
failings, at their own expense, in any nominated media
arena. This publicity could have lasting impressions for
any business
Health and Safety Cont:
To ensure the Trust and its Directors, Management and employees
comply with legislation:
The Trust has an overarching health and safety policy and this is the
Health, Safety & Welfare policy (PP018).
This policy is available on the intranet and has been updated.
All WSH Trust employees must read and understand this policy and its
contents. Any non understanding can be addressed with training.
This policy is split into two sections:
1: The organisational structure for managing health and safety. This
details all health and safety responsibilities.
2: The arrangements in place to manage health and safety matters.
Health and Safety Cont:
The following extract is from the Trust’s Health, Safety &
Welfare Policy. It details some of the employee / managers
responsibilities, these are not exhaustive and other
responsibilities may be applicable within specific
areas/departments. You should ensure you are familiar
with them.
• It shall be the duty of every employee, whilst they are undertaking work activities, to take
reasonable care for the health and safety of themselves and of other persons who may be
affected by their acts or omissions. Also employees are required to co-operate with the
employer on health and safety matters. Where an employee feels a health and safety
measure needs to be improved they should raise this with their Line Manager initially.
•It will be the responsibility of all employees to bring to the employer’s attention any
defective equipment or potential hazard they have identified, which might present a
serious and imminent danger to health and safety of themselves and others within the
organisation.
•Ensuring that all staff, including those who come into the area as part of their daily work,
are aware of the general outline of the Health and Safety at Work etc Act 1974. This will
include ensuring that staff, have an understanding of their individual responsibilities.
Health & Safety Arrangements
The Trust has many health and safety arrangements in place,
Arrangements detailed in the Health, Safety and Welfare Policy point
the reader to where further information on those arrangements can be
found.
Here are some example arrangements:
• For localised inductions for all new employees both full time, fixed term,
bank or temp.
• For appropriate Health & Safety training is provided for all employees.
• For consultation on Health & Safety issues with employees.
• For procedures to cover reporting incidents and accidents along with follow
up investigations.
• For reporting RIDDORS to the HSE.
• For the control and management of asbestos.
• For control of contractors.
• For safety in the event of fire.
• For the provision of PPE.
• For the management of slip, trips and falls.
• For security awareness.
• For the undertaking of risk assessments.
Health and Safety Cont:
•
The Trust has a legal responsibility to ensure it provides training and
information on health and safety to all its managers & employees. The
Trust has numerous ways to give managers & employees information
such as:
•
Health and safety updates to policies and procedures notified by emails
and the green sheet news letter.
•
Notice boards displaying information on health & safety topics- the
Trust’s dedicated health and safety notice board is located just outside
of the Nursing and Governance Directorate offices.
Health and safety updates from your departmental health & safety link
person or a health & safety representative (Union)
•
•
It is a legal responsibility for managers & employees to ensure
they read and understand all health & safety information provided
to them by the Trust.
Incident reporting
The Trust incident system is in place to record any incident or
accident that has or poses a risk to the Trust, or has or could
lead to personal harm to an employee or other person affected
by the Trust’s undertakings. It is also important to ensure all
incidents are investigated appropriately. This will allow for proactive measures to be implemented to ensure similar incidents /
accidents do not happen again.
The Trust uses Datix to record all incidents clinical and nonclinical. Everyone has access to report on this system and no
log-in access is required.
On occasion Consultants will be required to carry out
investigations, e.g. if a junior doctor under their supervision has
been involved in an incident. The investigation process requires
a Datix log-on which every Consultant has been allocated.
Training in the use of the Datix system is available on request by
emailing the Datix administrator at Datix@wsh.nhs.uk or by
phone on 3770.