TREATMENT RISK ASSESSMENT AND MANAGEMENT OF TREATMENT RISK TRAINING

Transcription

1 SECTION: 15 RISK MANAGEMENT POLICY AND PROCEDURE: NATURE AND SCOPE: SUBJECT: POLICY TRUSTWIDE TREATMENT RISK ASSESSMENT AND MANAGEMENT OF TREATMENT RISK TRAINING Training in the management of risk is a key requirement for modern services. This Policy sets out the staff that require training and at what level, in a training needs analysis. DATE OF LATEST RATIFICATION: OCTOBER 2012 (Re-issued August 2013) RATIFIED BY: EXECUTIVE LEADERSHIP TEAM IMPLEMENTATION DATE: AUGUST 2013 REVIEW DATE: AUGUST 2014 ASSOCIATED TRUST POLICIES AND PROCEDURES: Care Programme Approach (CPA) Policy in Partnership with Social Services in Nottinghamshire 1.05 Employee Induction Safeguarding Vulnerable Adults Safeguarding Children ISSUE 2 AUGUST 2013

2 NOTTINGHAMSHIRE HEALTHCARE NHS TRUST TREATMENT RISK ASSESSMENT AND MANAGEMENT OF TREATMENT RISK TRAINING POLICY 1.0 Introduction 2.0 Policy Principles 3.0 Duties 4.0 Implementation 5.0 Training 6.0 Target Audience 7.0 Review Date 8.0 Consultation 9.0 Relevant Trust Policies 10.0 Monitoring Compliance 11.0 Equality Impact Assessment 12.0 Legislation Compliance Champion and Expert Writer 14.0 Source Documents CONTENTS Appendix 1 Clinical Risk Assessment Tools in Use within the Trust Appendix 2 Record of Changes Appendix 3 Employee Record of Having Read the Policy ISSUE 2 AUGUST

3 NOTTINGHAMSHIRE HEALTHCARE NHS TRUST TREATMENT RISK ASSESSMENT AND MANAGEMENT OF TREATMENT RISK TRAINING POLICY 1.0 INTRODUCTION 1.1 Nottinghamshire Healthcare NHS Trust (the Trust) recognises, as part of its duty of care, its responsibilities to ensure that staff receive an appropriate level of training and support in relation to risk assessment and the management of risk, which is consistent with the roles and responsibilities they will be required to undertake. The area of practice referred to is Treatment Risk. This refers to the risks associated with an individual s likelihood of harming themselves or others, or being subject to unacceptable risk, by nature of their mental health issues, and the interventions required to reduce the likelihood of the risk behaviour occurring. 1.2 The purpose of this policy is to outline the essential treatment risk assessment and risk management training requirements for direct care staff employed by the Trust. 2.0 POLICY PRINCIPLES 2.1 To meet the requirements of national guidance. The philosophy underpinning this framework is one that balances care needs against risk needs, and that emphasises: Positive risk management; Collaboration with the service user and others involved in care; The importance of recognising and building on the service user s strengths; and The Trust s role in risk management alongside the individual practitioner s 2.2 To ensure timely and up-to-date training is delivered. 2.3 To ensure staff and managers are aware of their responsibilities in regard to this training. 2.4 To ensure learning points identified are incorporated into the training packages developed. 2.5 To ensure the training and other training tools are regularly reviewed and monitored. 2.6 To ensure the training compliments the application of the various practices and systems related to treatment risk assessment across the Trust. 2.7 To ensure that the principles of recovery are adhered to and included in the practice of and evidence base underpinning training. 3.0 DUTIES 3.1 Managers have the responsibility to: Ensure all staff attend all relevant training, including the up-dates, at the required frequency Enable staff to attend training on which they are booked and to attend for the full duration Build attendance at essential training into the individual Performance Appraisal and Development (PAD) Enable staff to transfer learning into everyday practice and monitor the practice via examination of Risk Assessments and Safety plans. Ensure that Individual Risk Assessments will be reviewed on a monthly basis to ensure compliance with guidance. ISSUE 2 AUGUST

4 Keep the Learning & Development Department informed of training arranged locally and provide records of attendance for input onto the central database Ensure only approved Level 1 and and safety planning are in use within their respective clinical areas 3.2 Individuals have the responsibility to: Attend all relevant essential training Attend the session on which they are booked Inform their line manager and the Learning & Development Department when unable to attend a booked session Apply learning to the job Read relevant policies Plan and review training attended through the PAD process 3.3 The Learning & Development Department has the responsibility to: Provide sufficient learning opportunities to meet the training need Record completion of learning events on a centralised database Provide two-monthly attendance reports to managers Send out non-attendance records as required Provide reports as required Provide monthly essential training statistics to the Trust Board Provide department/individual attendance reports as required Undertake an annual review of current training content with the Nurse Consultant in Treatment Risk assessment to reflect current literature and Trust Incident review. 4.0 IMPLEMENTATION 4.1 The reviewed policy will be implemented immediately after ratification 5.0 TRAINING 5.1 A training needs analysis has been undertaken within each Directorate and Service Area outlining which staff are required to do which training. Reference can be made to the specific grids through General Managers, Heads of Service, Directorate and Service links. 5.2 Training will incorporate: Suicide Awareness Training which focuses on an awareness of current data regarding suicide and self harm; the recognition of demographic, psychological, behavioural and organisational risk factors associated with suicidal behaviours; the assessment and management of suicide risk from Treatment and Local Policy perspective this training links directly to the National Suicide Prevention Strategy. Risk Assessment Training which focuses on the definitions of risk, the concept of risk; risk assessment to risk management as a systematic process; clinical and actuarial approaches to risk assessment; categories of risk which must include violence, harm to others, harm to self, severe self neglect and suicide/self harm; vulnerable adults; the indicators of risk and the principles of risk management; risk assessment to risk management and drug/alcohol related issues. Safeguarding Adults Training which focuses on an awareness of current data regarding working with vulnerable adults ISSUE 2 AUGUST

5 recognition of abuse and responsibilities with respect to both Trust and Multi-Agency Policies and Procedures specialist training for referrers specialist training for investigators specialist training for managers co-ordinating investigations Safeguarding Children Training which focuses on the concept of risk, risk assessment and management recognition of abuse and responsibilities with respect to both Trust and Multi-Agency Policies and Procedures record keeping; promoting the keeping of clear, accessible, comprehensive and contemporaneous records To include statutory guidance, Roles and Responsibilities, Local Safeguarding, Children s Boards, development and supervision for interagency working, lessons from research, implementing the principles on working with children and their families, safeguarding and promoting welfare, and managing individuals who pose a risk. 5.3 Specific training in relation to individual treatment risk assessment tools is available or is organised at Directorate/Service level through local induction processes, supervision and critical learning. See Appendix 1 which lists the Level 1 and Level 2 tools approved for use by the Trust. 5.4 The refresher training which has to be undertaken within a three year period can either take the form of a face to face training session, by accessing the relevant e-learning package on the Trust intranet system or completion of a relevant workbook. Unless an individual can evidence to their manager that they have undertaken equivalent training. 5.5 Specific packages will be produced in conjunction with relevant stakeholders in order to meet the needs of different areas of work. There will be service user, carer and Involvement Team input to the development and delivery of training packages. 6.0 TARGET AUDIENCE 6.1 All new staff in a direct care role will be provided with relevant training during the induction period. 6.2 All existing direct care staff will attend up-date training, access e-learning or complete a relevant workbook on a maximum three yearly basis. 7.0 REVIEW DATE 7.1 Review of this policy will take place in August CONSULTATION 8.1 Serious Clinical Incident Review Groups and the Executive Leadership Council. 9.0 RELEVANT TRUST POLICIES Care Programme Approach (CPA) Policy in Partnership with Social Services in Nottinghamshire 1.05 Employee Induction Safeguarding Vulnerable Adults Safeguarding Children ISSUE 2 AUGUST

6 10.0 MONITORING COMPLIANCE Treatment Risk Assessment and Management of Treatment Risk Training A formal record of attendance or records of completion of e-learning or a relevant workbook will be held on a centralised training database Attendance reports are available for managers which also identifies who failed to attend a session Did not attend letters will be sent to individuals and managers as courses are registered on the central training database Monthly statistics will be provided to the Trust Board, the Services Management Group, the Local Services Management Group, Directorate and Service areas The training package(s) will be evaluated on an ongoing basis and will be reviewed and adapted in line with any national or local requirements, which will include at least an annual review of content with the Nurse Consultant in Treatment Risk Assessment Treatment risk tools are reviewed and evaluated at directorate governance groups on an annual basis EQUALITY IMPACT ASSESSMENT 11.1 Following the EIA screening exercise it has been concluded that a full EIA is not required for this policy. The policy aims to provide a framework and process which ensures Trust staff are enabled to access relevant and appropriate education, training or development opportunities. It ensures appropriate support and guidance is available to both staff and managers LEGISLATION COMPLIANCE 12.1 None refers CHAMPION AND EXPERT WRITER 13.1 The Champion of this policy is Dr Peter Miller, Executive Director: Clinical Governance and Medical Affairs. The Expert Writer is Tony McGranaghan, Nurse Consultant SOURCE DOCUMENTS 14.1 All recommendations are made in accordance with the requirements of the NHS Litigation Authority, NICE guidelines for Self Harm (2004), Safety First: Five Year Report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (2001), The National Suicide Prevention Strategy for England (2002) and Best Practice in Managing Risk (DoH June 2007). ISSUE 2 AUGUST

7 APPENDIX 1 CLINICAL RISK ASSESSMENT TOOLS IN USE WITHIN THE TRUST Please note: The CPA documentation and associated risk assessments (three levels plus extended for Services) contain all the information relating to safeguarding. Care Group/Directorate Clinical Risk Assessment Tool Adult Mental Health Adult Mental Health Adult Mental Health Adult Mental Health Adult Mental Health Emergency Department / Medical Unit / Emergency Assessment Perinatal Psychiatry AMH Perinatal Psychiatry AMH Perinatal Psychiatry AMH Perinatal Psychiatry AMH Perinatal Psychiatry AMH Perinatal Psychiatry AMH Alcohol and Drug Alcohol and Drug Alcohol and Drug Alcohol and Drug Alcohol and Drug Eating Disorders Eating Disorders Eating Disorders Eating Disorders Dual Diagnosis Team Dual Diagnosis Team Dual Diagnosis Team Dual Diagnosis Team Dual Diagnosis Team Personality Disorder Service Personality Disorder Service Personality Disorder Service Macmillan Close Implementing a Resident Zoning System Risk Assessment Tool used by Department of Psychiatric Medicine and Mansfield Accident & Emergency Liaison Louis Macro 1 (under 12 months) Mother and Child Risk Assessment CPA initial Assessment Specialist Risk Assessment for Perinatal Psychiatric Services Specialist Risk Assessment for Perinatal Psychiatric Services Nottingham and Alcohol Drug Team Risk Assessment Porchester Ward Risk Assessment Eating Disorders Assessment Tool Additional Dual Diagnosis Risk Assessment Tool (summary for clients who misuse substances and who have mental health problems) Management of Risk with clients who have a co-morbidity of severe mental health problems and substance misuse Safeguarding Children Risk Assessment Screening Tool ISSUE 2 AUGUST

8 Care Group/Directorate Psychotherapy Psychotherapy CAMHS CAMHS CAMHS Alcohol and Drug Alcohol and Drug Alcohol and Drug Alcohol and Drug Mental Health Services for Older People Mental Health Services for Older People Mental Health Services for Older People Mental Health Services for Older People Mental Health Services for Older People Mental Health Services for Older People Clinical Risk Assessment Tool Clinical Outcomes in Routine Evaluation Nottingham Psychotherapy Unit Risk Screening HONOSCA Risk Assessment Risk Assessment Proforma Substance Misuse and Mental health Brief Assessment Tool (SuMMBAT) Risk Assessment (specify significant risk to self or others) Initial Health and Social needs Assessment Screening Assessment for Dysphagic patients Risk Assessment for the Use of Bedrails HoNOS 65 Plus Scores (to be used in conjunction with Risk Analysis and Management Plan) Risk Taking for Behaviours Risk Taking for Activities Epilepsy Profile in the Community EPIC Interview and mini PAS-ADD Dyskinesia Identification System; Condensed User Scale DISCUS Monitoring of Side Effect Scale MOSES Liverpool University Neuroleptic Side Effect Rating Scale. The OK Health Checklist LUNSERS Camberwell Assessment of Need CAN Scale of Assessing Coping Skills SACS Risk Assessment Tool for Use with People With Dysphagia Guide To level of Risk Of Negative Health Consequences From Dysphagia Risk Analysis and Management Plan ISSUE 2 AUGUST

9 HONOS-LD Community Community Risk Assessment Tool Community Patient Risk Profile Community Structured Clinical Judgment Risk (Please note this will supersede the Patient Risk Profile) Community Treatment Risk Information Management System (nurses only) HCR-20 History clinical risk 20 (version 2 ) TRIMS Treatment risk information management system PANNASS positive and negative syndrome scale PCL-SV Psychopathy checklist; screening version PCL-R Psychopathy checklist; revised Honos health of the nation outcome scales Honos secure Honos LD VRAG violent risk appraisal guide SARA Spousal assault risk assessment SCR 20 SVR 20 sexual violence risk 20 Static 99 / static 2002 VRS violence risk assessment scale IPDE international personality disorder examination LUNSERS Liverpool university neuroleptic side effect rating scale MCMI III millon clinical mutiaxial inventory III SNAP security needs assessment profile BSI behavioural status index (BEST) MOHOST model of human occupation screening tool BSS becks scale for suicide ideation BHS becks hopelessness scale KGV (krawiecka, Goldberg and Vaughan BAI behaviour assessment intervention BDI-II becks depression inventory MMPI Minnesota multiphasic personality inventory 2 PAI personality assessment inventory WAIS Wechsler adult intelligence scale WTAR Wechsler test for adult reading BADS behavioural assessment of the dysexecutive syndrome SPAI social phobia and anxiety inventory SPSI-R social problem solving inventory GAQ global assessment question PSYRATS psychotic symptom rating scale AIAQ anger irritability and assault questionnaire DAST drug abuse screening test ISSUE 2 AUGUST

10 APPENDIX 3 Policy/Procedure for: TREATMENT RISK ASSESSMENT AND MANAGEMENT OF TREATMENT RISK TRAINING Issue: 02 Status: Author Name and Title: APPROVED Tony McGranaghan, Nurse Consultant Issue Date: AUGUST 2013 Review Date: AUGUST 2014 Approved by: EXECUTIVE LEADERSHIP TEAM (October 2012) Distribution/Access: NORMAL DATE AUTHOR POLICY/ PROCEDURE 09/07 D Harrison CL/CP/15 04/08 D Harrison CL/CP/15 09/08 D Harrison CL/CP/15 08/10 D Harrison RECORD OF CHANGES DETAILS OF CHANGE 4.0 New heading Implementation 5.3 Para Safeguarding Adults Training Para Safeguarding Children Training 9.0 New heading Relevant Trust Policies 10.0 New heading Monitoring Compliance and Effectiveness 14.0 New heading Source Documents 14.1 Addition of Best Practice in Managing Risk (DoH June 2007) Appendix 2 - Addition of CDLS HONOS-LD tool 3.1;3.2;3.3;5.1 Replacement of OD&L with the Learning & Development Department 3.1 Addition to ensure clinical risk management tools are in use within their respective clinical area 10.0 Delete and effectiveness 10.2 Replace bi-monthly with monthly 10.3 Inclusion of DNA reports 10.6 Inclusion of statement regarding review and evaluation of clinical risk tools Front Page: Change title of Policy to Clinical Risk Assessment and Management of Clinical Risk Training 3.1;3.2;3.3;5.1 Replacement of Training & Development Department with Education & Training Department 3.1 Addition of approval of clinical risk management tools by directorate Governance Groups 3.1;3.2;3.3;5.1 Replacement of Learning & Development with the OD&L 8.1 Deletion of Clinical Policy Group Up-dating of Clinical Tools Appendix 2 03/11 D Harrison (Issue 5a) Minor amendment to Section 5.6 April 11 D Harrison (Issue 5b) Amendments to Appendix 1 to reflect the changing structure of the Trust ISSUE 2 AUGUST

11 DATE Sept 2012 Aug 13 AUTHOR T Mcranaghan T McGranaghan POLICY/ PROCEDURE Section change (Issue 1) (Issue 1) DETAILS OF CHANGE Name change of policy to Treatment Risk Assessment and Management of Treatment Risk Training. Changes made throughout the document to reflect Treatment Risk. SUMMBAT risk tool added to list. Removed from Appendix 2 the following tools: Becks Depression Inventory Version II BDI-II, Beck Scale for Suicide Ideation BSS, Relationships and Sexuality assessment RAS as not used in Services. Changes to issue number, issue date and review date only ISSUE 2 AUGUST

12 EMPLOYEE RECORD OF HAVING READ THE POLICY APPENDIX 4 Title of Policy/Procedure: TREATMENT RISK ASSESSMENT AND MANAGEMENT OF TREATMENT RISK TRAINING I have read and understand the principles contained in the named policy/procedure. PRINT FULL NAME SIGNATURE DATE ISSUE 2 AUGUST