lone working policy and guidance - nhs waless... · title: lone working policy and guidance owner:...

Aneurin Bevan Health Board

Lone Working Policy and Guidance

N.B. Staff should be discouraged from printing this document. This is

to avoid the risk of out of date printed versions of the document. The Intranet should be referred to for the current version of the document.

Status: Issue 2 Issue date: 11 April 2013 Approved by: Health & Safety Committee Review by date: 11 April 2016 Owner: Health & Safety ABHB/H&S/0434

Aneurin Bevan Health Board ABHB/Health & Safety/0434Title: Lone Working Policy and Guidance Owner: Health & Safety

Contents: 1. INTRODUCTION..................................................2 2. POLICY STATEMENT ...........................................3 3. AIM ....................................................................3 4. OBJECTIVES .......................................................4 5. DEFINITION .......................................................4 6. SCOPE OF POLICY ..............................................5 7. LEGISLATIVE AND NHS REQUIREMENTS ............5 8. HAZARDS, ADVERSE INCIDENTS AND NEAR

MISS REPORTING...............................................5 9. RESPONSIBILITIES ............................................6 10. TRAINING AND INSTRUCTION ...........................7 11. RESOURCES........................................................8 12. STANDARDS FOR HEALTH SERVICES WALES ......8 13. EQUALITY...........................................................9 14. ENVIRONMENTAL IMPACT..................................9 15. AUDIT ................................................................9 16. POLICY REVIEW .................................................9 17. SUPPORTING POLICIES AND INFORMATION....10 GUIDANCE DOCUMENTS APPENDIX 1 – GUIDANCE ON SAMPLE CONTROL

MEASURES........................................................11 APPENDIX 2 - STAFF CONTACT INFORMATION.........17 APPENDIX 3 - LONE WORKER PERSONAL SAFETY

GUIDANCE........................................................18 APPENDIX 4 - CHECKLIST FOR HOME OR ON-CALL

VISITS..............................................................25 APPENDIX 5 - HOME VISITING CHECKLIST FOR

MANAGERS.......................................................28 APPENDIX 6 - ACTION TO BE TAKEN IF A LONE

WORKING STAFF MEMBER IS BELIEVED TO BE MISSING. .........................................................29

Status: Issue 2 Issue date: 11 April 2013Approved by: Health & Safety Committee Review by date: 11 April 2016

Page 1 of 30


1. INTRODUCTION Due to the nature of the work within the NHS a significant number of employees are required to work alone. Lone working may be undertaken as part of a person's normal work duties or because circumstances so dictate. People who work alone face the same hazards in their daily work as other workers, however, for lone workers the risk of harm is often greater - there is no-one there to help if something goes wrong or if the person suffers a sudden illness. A lone worker needs to be more aware and alert to recognise and avoid danger and know how to get help quickly. Some of the hazards which lone workers may face include:

• violence from members of the public • accidents or emergencies arising out of the work and

the lack of first aid assistance • fire • inadequate provision of rest, hygiene and welfare

facilities • manual handling • sudden illness • vehicle breakdowns.

Aneurin Bevan Health Board (ABHB or the Health Board) recognises the various risks to which employees may be exposed and supports local action to eliminate or reduce these risks. Whilst recognising that this document is aimed at lone workers, the majority of practice can apply to other situations where staff are working remotely. Health and safety legislation currently in force does not prohibit lone working, except in a few specific circumstances e.g., working in confined spaces. The employer has a general duty under Section 2(1) of the Health and Safety at Work etc. Act, 1974, to ensure so far as is reasonably practicable the health, safety and welfare


Page 2 of 30


at work of employees. Further, the Management of Health and Safety at Work Regulations, 1999, requires that work activities are risk assessed. The risk assessment needs to consider options to eliminate or control a hazard in order to decrease the degree of risk to as low as is reasonably practicable. The assessment should consider the suitability of the member of staff to undertake lone worker duties. Whereas the final procedures must be based on local conditions, this Policy will deal with generic aspects of management of risk. It provides advice on various control measures that may be utilised to reduce the level of risk. The content of this policy is linked to Standards for Health Service 2, 7, 8, 10, 12, 22, and 26. 2. POLICY STATEMENT Aneurin Bevan Health Board will ensure, so far as is reasonably practicable, that staff who are required to work alone or unsupervised for significant periods of time are protected from risks to their health and safety. Measures will also be adopted to protect anyone else affected by lone working. Lone working exposes staff to particular hazards. The Boards intention is where practicable, to entirely remove the risk from these hazards or, where complete elimination is not practicable, to reduce the risk to an acceptable level. 3. AIM This document is intended to demonstrate the commitment of the Health Board in addressing the issues associated with lone working, and to provide guidance to managers in developing effective systems to ensure the health and safety of those staff who are involved in lone working activities.


Page 3 of 30


4. OBJECTIVES

• To ensure that staff are aware of the potential for increased risks associated with lone working.

• To support the development of a safety culture through risk assessment and preventative measures.

• To provide guidance to staff on a range of control measures to support safer working.

5. DEFINITION This policy intentionally sets out not to identify specific groups of staff thought to be lone workers, or to delineate a specific time when lone working is deemed to occur. The overarching principle must be that lone working can occur anywhere, at anytime and within any group of staff. Staff that can be affected can be involved in quite diverse activities and some examples could typically be:

• staff working in a community visiting role • where only one person works on a premises or within

a department, this may be caused by being the first to arrive, last to leave, working at weekends or being on-call

• where people work separately from others, such as in treatment/interview rooms, reception work, stores, maintenance or site delivery

• those that work outside normal hours such as cleaners, maintenance, security and on-call staff

• those that travel alone between Health Board sites or undertake escort duties

• those who work from home for much of the time • staff out of visual or aural contact with other

members of staff who would be able to respond effectively in an emergency.

This list is by no means exhaustive and in recognising this, the Health Board has therefore adopted the HSE lone working definition of “those who work by themselves without close or direct supervision”.


Page 4 of 30


6. SCOPE OF POLICY This policy applies to all lone workers, whether they are working or acting directly or indirectly for or on behalf of the organisation, and the staff that manage them. 7. LEGISLATIVE AND NHS REQUIREMENTS For most circumstances, there are no specific legal duties on employers in relation to lone working. However, employers have a general duty under the Health and Safety at Work etc. Act, 1974 to maintain safe working arrangements. Regulation 3 of the Management of Health and Safety at Work Regulations 1999 also requires employers to risk assess the work that their employees undertake, recording and reviewing the significant findings regularly. Under Section 7 of the Health and Safety at Work, etc. Act 1974, it is the responsibility of employees to take reasonable care of their own health and safety at work and that of other persons who may be affected by their acts or omissions. All staff must comply with all safety procedures/safe systems of work and approved codes of practice pertaining to their particular work activities and report all incidents that have led or may lead to injury or damage. 8. HAZARDS, ADVERSE INCIDENTS AND NEAR MISS

REPORTING The Health Board has in place arrangements for the recording of hazards, adverse incidents and near misses via the DatixWeb system. It is important to ensure that if an adverse incident or hazard involves a lone worker, specific reference should be made to that fact in the recording mechanisms.


Page 5 of 30


Following any adverse incident or near miss an investigation must be undertaken to identify if any lessons can be learnt. Risk assessments must then be amended accordingly. 9. RESPONSIBILITIES 9.1 Chief Executive

The Chief Executive has ultimate responsibility for ensuring compliance with the Health and Safety at Work, etc. Act 1974 and the Management of Health and Safety at Work Regulations 1999 and the effectiveness of this policy.

9.2 Director of Therapies and Health Science

This Executive Director has responsibility for health and safety and will ensure that the performance of the Health Board in implementing this policy and guidance is monitored and communicated to the Chief Executive, Health and Safety Committee and the Executive Board as necessary.

9.3 Senior Managers

Managers at Directorate and Divisional level are responsible for ensuring that:

• risk assessments are undertaken, • local policies and procedures are introduced, • safe systems of work are adopted, • training is available, • effective monitoring is undertaken to determine

whether systems in place are effective. 9.4 Line Managers

Local Managers are responsible for:

• establishing and supervising safe systems of work, • ensuring that staff have received appropriate

training,


Page 6 of 30


• ensuring that health and safety training records are maintained,

• ensuring that staff have easy access to the DatixWeb incident reporting system and are encouraged to use it,

• ensuring that policies and procedures are observed. 9.5 All Staff

All employees are required to comply with the organisational and any local policy/procedure developed to safeguard lone workers. Staff are also expected to take all reasonable steps to protect themselves and others from harm, including:

• attending training, • using safety/ communication equipment

appropriately, • reporting unsafe activities or faulty equipment to

their Line Manager and • reporting all adverse incidents or near misses using

the Board’s DatixWeb incident reporting system.

All Health Board staff are expected to follow the ‘4 R’s’ if faced with risks to their personal safety: • Retreat, • Raise the Alarm, • Reassess, • Report.

9.6 Health and Safety Team Members of the Health and Safety department will provide advice and guidance to managers and staff in the development, implementation and monitoring of any local policy/procedure and may assist in the review of serious incidents. 10. TRAINING AND INSTRUCTION Training and instruction is crucial for all groups of staff that work alone and those who manage them.


Page 7 of 30


A training needs analysis must be carried out by local managers and must be identified through the risk assessment process. Training should be developed locally, must be relevant to the nature of the work undertaken and should be considered as part of the measures to control risk. Staff must be made aware of the Board’s Management and Prevention of Violence to Staff Policy and the requirement for all staff to complete mandatory personal safety/violence and aggression training every 2 years. Line managers are required to make adequate arrangements to ensure that staff attend courses and that training is regularly updated. Training records will provide the basis for such arrangements in accordance with the organisation’s training recording provision. It is the employee’s responsibility to attend any training provided for them. 11. RESOURCES There are no additional resources required to enable the implementation of this policy. 12. STANDARDS FOR HEALTH SERVICES WALES This policy supports compliance with the Standards for Health Services Wales by affirming the organisational commitment to treating staff, patients and visitors with respect and promoting a safe environment for our patients, visitors and staff. It promotes a health and safety risk management approach to service & care planning and delivery. The policy identifies the importance of staff training and support to do their job properly and react safely to difficult and dangerous situations. It emphasises the importance of planning care for patients with complex


Page 8 of 30


needs. The content of this policy is linked to Standards 2, 7, 8, 10, 12, 22, and 26. 13. EQUALITY An equality impact assessment has been undertaken and can be obtained from the Health & Safety department. 14. ENVIRONMENTAL IMPACT There is no requirement to undertake an environmental impact assessment as a result of this policy. 15. AUDIT Regular local monitoring must be undertaken within Aneurin Bevan Health Board to ensure:

• Lone worker incidents are being reported and investigation results/lessons learnt communicated to staff;

• Safe systems are in place; and • Staff have received adequate training.

At a Divisional level, this will be monitored and issues of concern addressed through the Divisional Quality and Patient Safety group and Health and Safety audit programme. On an organisational basis, issues of concern will addressed through the Health and Safety Committee. 16. POLICY REVIEW

This Policy will be reviewed within three years of issue or sooner if:


Page 9 of 30


• There are significant changes in work practices; • There are changes in legislation; and/or • An incident occurs that requires improvement in

practice. 17. SUPPORTING POLICIES AND INFORMATION

• Health & Safety Guidance on Developing Local

Policies and Procedures to Address Risk • Prevention of Violence to Staff policy • Occupational Health & Safety policy • All Wales Violence and Aggression Training

Passport and Information Scheme • Handling Violence and/or Aggression (Internal

Sanctions) Policy and Procedure • Incident Reporting Policy and Procedure • Health & Safety Risk Assessment 1A and 1B Forms • Health and Safety at Work etc. Act, 1974 • Management of Health and Safety at Work

Regulations, 1999 • Management of ‘Red Alerts’ from the Reliance Lone

Worker Alert System Protocol • Allocation and Usage of the Lone Worker Alert

System guidance • Control of Substances Hazardous to Health Policy • Smoke Free Environment Policy • Management and Prevention of Missing Persons

Policy & Procedure


Page 10 of 30


APPENDIX 1 – GUIDANCE ON SAMPLE CONTROL MEASURES Each department/team should develop local procedures to address the risks specific to their areas, groups of staff and service functions. These should be based on local risk assessment. The Health & Safety department have produced guidance to assist in identifying hazards that staff, including lone workers may be exposed to, assessing the risks they face and developing appropriate measures to reduce, control and manage the risks (Health & Safety Guidance on Developing Local Policies and Procedures to Address Risk). To safeguard individuals we should eliminate the risk completely, or if this is not possible reduce the risk to an acceptable level. There are a number of common control measures used in situations where staff undertake lone working. Local teams may wish to consider the implementation of some or all such precautionary measures, based upon risk assessment. They could include:

• Reducing the need and the likelihood of staff working alone.

• Identifying whether a particular task can be

adequately controlled by one person. • Identifying and providing effective means of

communication. Depending on the location this could be a personal alarm, fixed panic alarm, radio, telephone or mobile phone.

• Adequate supervision of staff. The extent required

will depend on the level of the risks involved and the ability and experience of the lone worker. A few examples of supervisory measures which may be useful in some circumstances could be:


Page 11 of 30


periodic telephone contact with lone workers, periodic site visits to lone workers, regular contact, e.g. telephone, radio, etc, automatic warning devices, e.g. motion

sensors, etc, manual warning devices, e.g. panic alarms, etc, end of task/shift contact e.g. returning keys.

• Assessing the fitness and suitability of particular staff

for working alone. This may involve consideration of health issues but also the knowledge and experience of individuals, particularly young or new workers. Lone workers should be given information to deal with normal everyday situations but should also understand when and where to seek guidance and assistance from others.

• Further detailed risk assessments of individuals,

premises, dwellings/other buildings and working methods may be required.

• Improving the lighting at entrances, exits and in car

parks under ABHB control, or even asking for improvements to be made to a patient’s own home.

• Team discussion and provision of advice as to suitable

responses to different types of emergency situations to ensure the individual acts appropriately. It is also important that supervisors know how to respond in these circumstances, and that their role could be of the utmost importance if their colleague is in need of help.

• Indicating on patient notes if a potential problem

exists. This enables other health care staff to prepare and assists with risk assessments. When home visiting, ensure an adequate assessment is undertaken on the first visit, and if possible review beforehand information from other departments or agencies that have had involvement in the past.


Page 12 of 30


• Ensuring that staff are given all available information that is relevant when dealing with a client and understand the importance of previewing cases.

• Developing processes to ensure that patient/client

referrals contain adequate information to support risk assessment. Where this is not possible staff should not visit alone

• Arranging for difficult patients or clients to be seen at

clinics or hospital outpatients rather than at home, if at all possible.

• Arranging for another member of staff or a reliable

relative of a difficult patient or client to be present during a home visit.

• Adequate training in Personal Safety, management of

violence and aggression techniques. • Ensuring staff are familiar with procedures for

withdrawing their services if they feel threatened in any way, and to be confident in seeking police assistance without recourse to their line manager if a physical threat is real.

• Establishing close working links with the police, social

services, local authorities, ambulance service and any other agencies that may have involvement or information. By sharing information potential risks to staff can be identified, reduced and incidents can be avoided.

• Imposing restrictions on the attendance of community

staff such as where there is domestic violence, overdoses or certain problem locations. These circumstances may warrant a police presence, more than one member of staff, secure access or communication systems etc.


Page 13 of 30


• Removal/ withdrawal of treatment from patient if identified by risk assessment in line with the Handling Violence and/or Aggression (Internal Sanctions) Policy.

• Awareness of driving/parking when away from the

base. For example, parking in well lit areas close to where the visit is taking place and in a position where it is not necessary to reverse out. Keeping car keys close to hand to avoid fumbling for them in a hurry and not displaying any valuable items or equipment in the car when parked.

• Providing an escort in areas where cars might be

vandalised or where staff have to go through unsafe areas to make visits. Police assistance may also be necessary.

• Tracking systems and emergency plans for missing

persons. (see below)

Tracking Systems & Hardware

Ensuring traceability of staff is vitally important particularly when undertaking home visits. There could be, for example, a central (electronic or paper) diary or movement chart held in the main office indicating times and locations of appointments. Procedures that complement this include regular phone-in arrangements and buddy systems so that at least one other member of staff is aware of a person's movements. There also needs to be a well defined, planned response to an overdue return from a visit. This will include contact numbers of clients, family or friends, senior persons responsible in the department and the emergency services. With regard to maintenance work there could be ‘permit to work’ arrangements, key issue/return or for example, regular contact by radio. • Diary Tracking Systems

A list of visits including names, addresses, telephone numbers (home and mobile), vehicle type and


Page 14 of 30


registration and estimated time of return for each lone worker is left at base. This should be monitored by a responsible nominated person. It should incorporate a "Missing Person Procedure" in the event of staff not reporting in at the designated time.

• Log-in/Log-out Systems

Logging systems should be paper-based, backed up by telephone logging. The system should be continuously monitored when lone working staff are on duty (including out of hours) and should incorporate a "Missing Person Procedure" in the event of staff not logging out of the system at the designated time.

• Buddy Systems

Managers may set up a buddy system whereby staff working within a particular team or area contact each other at predetermined intervals throughout their shift. The nominated buddy should:

• Be fully aware of the movements of the lone

worker. • Have all the necessary contact details for the lone

worker, including next of kin. • Have details of the lone workers known breaks or

rest periods. • Attempt to contact the lone worker if they do not

contact the buddy as agreed. • Follow the local escalation procedure if the lone

worker cannot be contacted or if they fail to contact their buddy within agreed and reasonable timescales.

The nominated buddy must be aware of their role and responsibilities. Contingency arrangements should be in place for someone else to take over the role of the nominated buddy if they are not available e.g. annual leave.


Page 15 of 30


• Mobile Phones All staff working alone in the community should have access to a mobile phone. They are essential for logging in and out and for raising the alarm in the event of an emergency. • Personal Alarms/Screech Alarms These produce a loud, piercing noise when activated to raise the alarm, create confusion and buy time to escape. • Panic Alarms These should be provided within premises where staff are made vulnerable by being isolated visually and aurally from other staff who would be able to offer assistance in an emergency. They should form part of an overall hierarchy of control that would try to eliminate and then reduce any residual risk. They must not be relied upon as the only means of reducing the risks to lone workers. The provision of panic alarms must be accompanied by a protocol to ensure that other staff are aware of what to do should an alarm be activated. • Lone Worker Alert System High risk lone workers in the community are provided with discreet devices which allow them to log their location and access support if they are at risk. Lone worker devices are used in addition to existing risk control measures within a service, not as a replacement for these. Staff allocated with these devices are expected to use them in accordance with their training and ensure that any changes to their personal details or escalation contacts are communicated promptly. Further information on device use is available within the Allocation and Usage of the Lone Worker Alert System guidance document.


Page 16 of 30


APPENDIX 2 - STAFF CONTACT INFORMATION (Suggested information to be held securely at base)

STAFF MEMBERS NAME………………………… BASE ……………………… Mobile Tel. No. ……………………… Home Tel. No. ……………………… Person to be contacted in an emergency ……………………………… ………………………………………………………………………………………………… VEHICLE DETAILS: REG. NO……………………………… MAKE……………………………………… COLOUR……………………………… MODEL……………………………………

Example of a staff daily diary (please be aware of patient confidentiality). Alternatively, staff could make use of electronic diaries, ensuring these are

easily accessible by other colleagues.

1st

PATIENT DETAILS:

NAME:………………………

ADDRESS…………………………………

Tel. No.: …………………

Date: ………………………

Expected Arrival Time

…………………………………

Expected Departure Time

…………………………………

2nd

PATIENT DETAILS:

NAME:………………………

ADDRESS………………………………

Tel. No.: …………………

Date: ………………………

Expected Arrival Time

…………………………………

Expected Departure Time

…………………………………

Managers must make sure that the details are kept up to date and accessible for supporting a response in the event

of an incident.


Page 17 of 30


APPENDIX 3 - LONE WORKER PERSONAL SAFETY GUIDANCE 1. On the Spot Risk Assessment Essential to prevention is your ability to assess each and every situation as you encounter it. Assessment can result in improvement to procedures and identification of correct equipment to support you. An identified risk must be reported to your manager so that action can be taken. Following assessment where a member of staff feels that their personal safety is or could be compromised, they must not try to negotiate in these situations but must remove themselves and evaluate later. Team Managers must be kept informed and the circumstances reviewed. Be aware: the Health Board support measures taken that preserve the safety of staff when a risk is identified and discussed with their line manager. 2. Home Visits/Off Site Movements Staff must leave a daily diary (electronic or paper) of visits and movements along with up to date contact details at their base (see appendix 2). Where there is a known or expected risk to personal safety/security, it is advised to attend in pairs. 2.1 Staff Identity Badge All staff while on duty must carry their ID badges. Staff should wear their ID badge but use discretion and keep their ID in a non-visible place for security reasons if they are in a vulnerable or potentially vulnerable situation. Staff must always show ID if requested.


Page 18 of 30


2.2 First Appointments/Assessments and Appointments where there is a Known Risk to Personal Safety/ Security

All first appointments/assessments, where possible, should be seen at team base. Where this is not possible, arrangements must be made for two members of staff to carry out the appointment/assessment and take the following precautions, the same applies in ongoing care situations where there is a known risk to safety: • It is advisable that a mobile phone is available on an

individual basis or at each base for use where appropriate. In some services, provision of lone worker devices may be appropriate.

• Consideration should be given for joint visits to be

carried out with other professionals: Social Services, GPs etc

• Staff members must have the correct details about the

individual and family prior to the visit taking place, including as much background information as possible. Priority must be given to any concerns arising from the information before the visit takes place.

• Staff member must ensure they inform a nominated

person when attending an appointment and expected length of time they will allow for the call.

• If necessary where a call becomes difficult, staff must

leave immediately and contact their nominated person. If aggression / violence is encountered, they should contact the police.

• Staff members must inform a designated person when

they have finished the visit. Where this does not happen the senior manager must be informed and local procedures initiated.

• Staff member must inform a designated person after


Page 19 of 30


finishing all visits at the end of the day. If this does not happen the designated person must initiate local procedures, alert relevant parties, e.g. senior managers, police as appropriate.

• If a visit is a regular occurrence, staff are advised to

vary the time and day of the visit to avoid becoming a target, e.g. the perception that drugs are being carried.

2.3 First Appointments/Assessments where there is No

Known Risk to Personal Safety/Security The person carrying out the visit should assess the call using his or her own professional judgement and experience. If there is any apprehension either on assessing the visit or on arrival the process as described in Appendix 3, section 1 above should be implemented. 2.4 Potentially Difficult Patients / Problem Relatives and

Associates Any relevant knowledge of a potential risk to staff presented by a patient or any other person who may be at the home must be made available to all ABHB employees that visit. This information must be centrally co-ordinated by the responsible manager and must be held at the base from where the care package is delivered. Links with other agencies must be established and a protocol agreed on how to best protect staff by an exchange of relevant information. Although confidentiality requirements must be considered, where there is an ongoing risk to personal safety, this should not prevent the release of relevant risk assessment information and subsequently jeopardise staff personal safety. 2.5 Escorting Patients • A full risk assessment of the patient must be completed

prior to leaving the unit. • Consideration must be given to the most appropriate

mode of transport to meet the individual patients’


Page 20 of 30


needs. • A mobile phone must be taken with staff when they

accompany patients off any unit. • A suitable member of staff as agreed by the person in

charge must accompany patient off the unit. • Male staff must be present if male patients are

escorted and vice versa for female patients. • If patient’s case notes are with the patient, staff must

ensure that both the safety and confidentiality of the case notes are maintained at all times.

• Where escorting by car always sit patients behind

passenger seat (with seat belt on). Staff always to sit behind vehicle driver.

• If patient becomes aggressive/ violent, pull over and

leave the vehicle (always remove keys). Contact the police as soon as possible.

2.6 Dealing with the Threat Posed by Animals

• In all cases where animals are present in the premises

visited by lone workers, the occupants should be asked to secure the animal(s) before staff arrive.

• Any clinical procedures within the home may provoke a

reaction from a pet so it is recommended they are not present during this time.

• First home appointment/visits, if you attend and are

confronted by a dangerous pet i.e. aggressive dog, do not put yourself at risk, contact line manager inform them of the situation and abandon the visit if necessary.

• Due consideration should be given to possible pet

allergies


Page 21 of 30


• If you feel uneasy with any animal present, ask for it to

be removed whilst you are there under health and safety guidelines.

3. On-Site Precautions 3.1 Office/Clinic Room Layout The overall aim in office/clinic room design must be to make the atmosphere as non-oppressive and conducive to relaxation as possible. At the same time consideration for your personal safety is vital. Whenever possible, prepare adequately for interviews or consultations, the physical design can always be in place as can a contingency plan or procedure. Don’t be afraid to move any furniture. Awareness of the following points will lessen the risk: • Ensure that you can reach an escape route without

being obstructed. • Arrange furniture so that it cannot be used against you. • Remove objects that can be used as weapons or

missiles i.e. plant pots, glass objects etc. • Prevent any door locks from being activated. • Direct visitors to a chair in the position of your choice. • With dangers such as glass keep your distance to a

maximum i.e. windows, doors etc. • Consideration should be given to fitting safety glass

where ever possible. 3.2 Safety Strategies • Inform others when you have someone present. • Have another person present if apprehensive.


Page 22 of 30


• Prepare an urgent call sign in the event of an emergency and make sure your colleagues know how to respond.

• Recognise hot drinks or china as a risk, they could be

used as a missile or weapon. • Allow access for others to enter swiftly. • Consider the need for a person to leave quickly when

they get angry. 3.3 Alarm Systems • Alarms must be located in a position that is easily

accessible for staff. • All staff must be made aware of the sound the alarm

will make. • Alarm tests must be held regularly at a set time (i.e.

weekly). • The sound of the safety alarm must be distinct and

avoid confusion with any other alarms in use in the area, i.e. door bell, fire alarm etc.

• The alarm must sound in an area where staff are

readily able to respond/assist. • Remain alert and avoid complacency. 3.4 Reception/Outpatient Areas When members of staff are experiencing difficulty, there must be a system in place to summon assistance. 3.5 Clinics A list of clients/patients must be obtained prior to the session. It is recommended that clinics are not run by


Page 23 of 30



Page 24 of 30

people in isolation, however where this is unavoidable, the following must be observed: • Local policy and procedures developed for lone workers

in place following risk assessment. • The lone working staff member must have access to a

telephone. • Another team member must be aware of the clinic start

and finish time and be responsible for implementing local procedures if and when clinics pass their expected finish time and no notification has been received from the lone working staff member.

3.6 Interview Rooms

All rooms that are used for patient/family interviews should consider having an alarm system with appropriate procedures in place.

Aneurin Bevan Health Board ABHB/Health & Safety/0434 Title: Lone Working Policy and Guidance Owner: Health & Safety


Page 25 of 30

APPENDIX 4 - CHECKLIST FOR HOME OR ON-CALL VISITS

Minimise the risks - think ahead 1. Before leaving

a) Check: Are you up to date with your prevention of violence to staff

training? Do you know your department’s lone working safety

procedures and how to report incidents? records: anything known?; route and location: be sure you know where to go and how

to get there; vehicle, fuel, tyres OK? Equipment – torch, personal alarm, radio/phone. Does

everything work? Check batteries and carry spare

b) Let others know: where you are going and how long you will be; ring at regular intervals and arrange for them to contact

you if your call/return is overdue ensure list of car registration numbers are at base

c) Difficult visits:

ring in prior to and after visit

d) Stand-ins: brief colleagues on difficulties

e) Accompanied visits:

do you have a local policy on when you request other staff to assist?

NB some police forces will try to provide an escort where imminent danger is threatened, subject to resources available

f) Doubts:

if in doubt, double check address, telephone number; check the telephone directory or ask the operator to

confirm, consider ringing back to confirm verify information about previous treatment; ask caller to

be visible at house window or door as you arrive and to leave light on/curtains drawn back at night

do not become a victim assess the situation and needs before you leave base



Page 26 of 30

2. En Route a) Consider:

the time the location the route

b) Procedure:

lock car - whilst driving if necessary do not leave medical bag on view being followed? uneasy? uncertain? remain with or return to your vehicle, drive away for a

short while; drive to a safe place if your suspicions are confirmed, contact the police

3. On arrival

be alert be aware be safe Control your tone and body language to appear calm If you have a Lone Worker Alert device, perform your

status check and leave an amber alert

a) Consider Car Security park with care - ensure you can pull straight out from

parking position close the windows do not leave any property on view do not leave medicines/prescription pads on display do not advertise Dr or nurse on call unnecessarily fit and use security locks lock it do not leave registration documents in car

b) If in doubt:

do not enter premises seek advice seek assistance plan your action

NB If violence is threatened, leave immediately unless medical requirements make this impossible.

c) On return to car: do have the keys ready do check the interior before getting in lock the door immediately as you get in



Page 27 of 30

4. General Personal Safety

park in well-lit area do not take short cuts do walk facing oncoming traffic do avoid groups of rowdy people do carry a torch - if dark do have a personal alarm readily at hand if provided, ensure mobile phone is readily available

5. Additional Advice for On-Call Staff

Where staff are attending a site on an on-call basis and they are likely to be reporting to a department or area where they may be alone, steps should be taken to inform the site manager who is in work and on site at that time. Appropriate arrangements should be agreed to ensure that the person called out can enter their place of work safely.



Page 28 of 30

APPENDIX 5 - HOME VISITING CHECKLIST FOR MANAGERS 1. Are your staff who visit:

fully trained in strategies for the prevention of violence? briefed about the area where they work? aware of attitudes, traits or mannerisms which can annoy

clients etc? given all available information about the client from all

relevant agencies? 2. Have your staff who visit:

understood the importance of previewing cases? reviewed the risk measures needed for that day’s visits? left an itinerary? made plans to keep in contact with colleagues? the means to contact you - even when the switchboard may

not be in use? got your home telephone number (and have you got theirs)? a sound grasp of your organisation’s preventive strategy? authority to arrange an accompanied visit or use of taxis?

3. Do your staff who visit:

know how to report incidents? appreciate the need for this procedure? actively report incidents? know your attitude to premature termination of

interviews/visits? know how to control and defuse potentially violent situations? appreciate their responsibilities for their own safety? understand the provisions for their support by the Health

Board?



Page 29 of 30

APPENDIX 6 - ACTION TO BE TAKEN IF A LONE WORKING STAFF MEMBER IS BELIEVED TO BE MISSING.

For staff based on ABHB premises, please also refer to the Management and Prevention of Missing Persons Policy & Procedure. 1. Inform line supervisor / manager. Supervisor / manager to initiate the following action: 2. Ring staff members mobile phone leave message (if possible)

asking staff member to contact you ASAP. Message should state your concerns for staff members safety and leave your contact number for staff to contact, if message is picked up.

3. Contact missing staff member’s colleagues. 4. Ring staff members home number, asking if staff member has

been in contact/ been seen, explain to suitable person (i.e. next of kin) of concerns of whereabouts of staff member and to contact you at ASAP, if staff member arrives home or gets in contact (leave your contact numbers).

Questions to be asked: A. When was the last time colleague was seen? B. When was colleague last spoken to? C. Check staff daily diary, ascertain where staff member should

be / was? D. Leave your contact details and advise staff to contact you

ASAP if staff member is traced. 5. Gwent Police advise to contact them within 1 hour,

depending on the circumstances to initiate their missing persons operation.

The Police may need the following information:

• Staff members name & date of birth. • Description of staff member. • Home address & contact details of staff member and next of

kin. • Vehicle details: make, colour, registration. • Last place seen (staff daily diary may be of use) • Does the staff member have any serious health problems?



Page 30 of 30

The Health & Safety department can be contacted for advice and support (01633 623454/01633 623456/01873 733120/01633 623437).

Association of Chief Police Officer’s missing person risk assessment levels: - Low: There is no apparent threat of danger to either the person or another person and it is thought likely the person is either at home or with friends/relatives or is on their way back to base. Medium: The risk posed is not immediate, but over time is likely to pla the person in danger or render them a threat to ceothers. High: The risk posed is immediate and there are substantial grounds for believing that the subject is in danger because of their own vulnerability or mental state or the risk posed is immediate and there are substantial grounds for believing that the public is in danger through the subject’s mental state.

lone working policy and guidance - nhs waless... · title: lone working policy and guidance owner:...

Documents