Standard Operating Procedure for Clinical Holding in Mental Health Services, Study notes of Decision Making

Download Standard Operating Procedure for Clinical Holding in Mental Health Services and more Study notes Decision Making in PDF only on Docsity! 1 Clinical DMI Clinical Holding Standard Operating Procedure Document Control Summary Status: New Version: v1.0 Date: July 2017 Author/Title: Owner/Title: Gary Firkins – De-escalation Management & Intervention Service Lead Liz Lockett - Associate Director of Quality & Risk Approved by: Policy and Procedures Committee Date: 19 July 2018 Ratified: Policy and Procedures Committee Date: 19 July 2018 Related Trust Strategy and/or Strategic Aims Value - People who use our services are at the centre of everything we do. Aims - Provide high quality recovery focused services. Deliver regulatory, financial, performance and quality standards Implementation Date: September 2018 Review Date: December 2020 Key Words: Physical Interventions Associated Policy or Standard Operating Procedures Trust Policy on the Use of Restrictive Practices, Trust Policy DMI Clinical Holding 2 Contents Pre-intervention Care 3 Intervention 3 Post Intervention Care 4 Appendix1 – Procedure for Clinical Holding Appendix 2: Ethical Decision Making Tree Appendix 3 Flowchart for decision making Appendix 4 Duty of Care Decision Making Tool Appendix 5 Mental Capacity Act Appendix 6 Mental Capacity Act Checklist Appendix 7 DMI Care Plan Template Appendix 8 Guidance on clinical holding procedures within LD services (Including venepuncture) 5 • Allowed to highlight concerns., as well as any wishes regarding the procedure, should be ascertained and time should be taken to internalise the information • Given time to reflect The necessary time should be taken to: • Ensure the person understands the risks and benefits of the proposed intervention before consent is sought. • Ascertain the necessary psychological preparation to support appropriate behavioural strategies aimed at reducing anxiety. This should include play therapists. • Discuss and agree on the positions to be maintained during the intervention period. • This may include a planned period of desensitisation Where necessary, consideration should be given to pharmaceutical strategies such as the use of conscious sedation, which should be prescribed, administered and monitored by experienced medical and nursing staff. Assess the risk of, and anticipate, situations that may arise during the procedure (Mohr et al 2003) The pre-intervention phase must include: • Preparation of the environment; • All necessary equipment to ensure that once the care, treatment or intervention is commenced it is carried out as quickly and efficiently as possible; • A care plan for the intervention and pre-intervention strategies must be written up and signed up to by the care team, involved in the persons care. Intervention If a restrictive intervention has to be used, it must always represent the least restrictive option to meet the immediate need. If restrictive intervention is used, it must not include the deliberate application of pain. People who use services, families and carers must be involved in planning, reviewing and evaluating all aspects of care and support. (DoH, 2014) Agreements made during the pre-intervention period should be adhered to as far as is possible and should include: • Sensitive support for child, young person or vulnerable adult when unaccompanied by family member. During clinical holding you must use the Trust approved DMI© Physical Principles: During the procedure it is important to ensure that all involved in carrying out the treatment or care adopt the appropriate posture with the individual, and that the procedure is thoroughly explained throughout. Post Intervention Care The following should be considered in the post intervention phase: • Immediately inform the child, young person or vulnerable adult when the care, treatment or intervention is complete 6 • Consider giving praise and give rewards for having endured a difficult or painful procedure • Ensure the individual is made comfortable and provide appropriate follow up support and necessary information • Monitor for complications that may arise as a result of physical or psychological effects of the intervention • The assessment, care plan and evaluation of the care, treatment or intervention should be carefully documented • A Trust monitoring form for the use of Restrictive Practices must be filled in on the RiO Clinical System. • Staff must complete an AMEWS form on RiO recording the physical observations of the service user. • It would be good practice for staff to make a note of the response and efficacy of the principles when applied with the person. So an ongoing report of the effectiveness and maintenance of the People emotional and physical well being can be recorded. • Staff involved in the process should be offered Post Incident Support 7 Appendix1 – Procedure for Clinical Holding. 1. Procedure for Clinical Holding. 1.1 The guidance detailed in the flowchart (Appendix 2) should be followed by staff when considering the need to hold a person for a clinical procedure. i. Talking and listening to the person ii. A judgement will need to be made by the healthcare professional as to whether the person is competent to give their own consent. iv. Procedure should be explained to the person in language that can be understood, to enable the provision of informed consent. v. Consent is obtained for all procedures except in an emergency situation (Appendix II) vi. If the person objects to the procedure, explore alternative methods, for example play, distraction, local anaesthetic cream sedation, or general anaesthetic. vii. Agree the method of intervention with the person and set a time limit. viii. If holding is required and consent cannot be obtained, the agreement of two professionals involved in the person’s care is obtained and this is documented in the person’s medical record. ix. If consent has not been obtained, the person will be comforted and debriefed, with a clear explanation of why holding was necessary. x. All staff are professionally accountable for their actions and will need to report any untoward incident via the Trust’s Incident Reporting form. 10 Appendix 4 Duty of Care Decision Making Tool Best Interests Least restrictive Option Foreseeable Risk of Injury because of Actions or Omissions Balance the Risks Time DO NOTHING ACT 11 Appendix 5 Mental Capacity Act Mental Capacity Act (2005) The conditions for a person to have capacity to consent are that they: (a) Understand the information relevant to the decision, (b) Retain that information long enough to make the decision, (c) Use that information in the decision-making process, (d) Communicate their decision (by any means) The Mental Capacity Act places an obligation on us to maximise a person’s decision-making abilities as much as possible. 12 Appendix 6 Mental Capacity Act Checklist Section 4 Checklist  No decision should be made solely on the basis of a person’s age, appearance or other aspect of behaviour that might lead others to make unjustified assumptions.  Consider all relevant circumstances  Consider the likelihood of regaining capacity – could the decision be delayed?  As far as possible, encourage the person to participate.  If life-sustaining treatment is involved, then the decision must not be motivated by a desire to bring about their death.  Consider whether it is possible to ascertain the person’s past and present wishes and feelings.  Consider whether it is possible to ascertain their beliefs and values.  Seek the views of other people, in particular anyone formerly named by the person to be consulted, those involved in caring for the person, those interested in their welfare, donees of a lasting power of attorney or any court deputy.  Consult an Independent Mental Capacity Advocate if one is required 15 If yes, do they have capacity? ______________________________________________________________ ______________________________________________________________ Date capacity assessed___________________________________________ Does the persons capacity to make this decision require YES / NO further assessment? If yes who will conduct the assessment and by when? Following assessment does the person have the capacity to YES / NO make this decision? Is there an advance directive in place? YES / NO Is an IMCA required? YES / NO If the answer is yes who will arrange requesting an IMCA? Reason for Procedure/Intervention 16 POSITIVE BEHAVIOURAL SUPPORT/DMI CARE PLAN Summary of Mental Capacity Assessment and Best Interests Decision Date capacity assessment and decision date put on RIO: ____________________ Where possible the views of the service user to the agreed intervention or reasons why service users view not included. Cost Benefit/ Implications to Service User and Service 17 Things you might need to know about me This information should be gathered from known assessments, from the person themselves and those people closest to the person who know them well. This information may be helpful in developing primary strategies to reduce problem behaviour occurring. Have I had this procedure before and how did I respond? Things I find Reinforcing/Distracting How best to support me The best way to communicate with me is If I get angry, anxious, frightened or upset I will (Warning signs) If I get angry, frightened or upset you can help me by. You need to be aware that I may (actual behaviours) if held by others…. Do I have sensory issues and have these been assessed? Have alternatives been considered? Please list with the reasons why this has not worked: 20 Pre Intervention Plan This plan could include: Details of who will be involved in holding, what training will be provided, where and when procedure will be undertaken. If medication is to be used what medication will be given, time medication should be given prior to procedure, equipment required, etc. (Advice to service user about the proposed intervention). Intervention Plan Include: - who will be responsible for taking lead role and directing the procedure; a description of the procedure; agreed plan to end procedure if causing significant distress to the person or previously agreed reason for ending procedure. (Advise client of procedure). Post Intervention Plan The following should be considered in the post intervention phase: • Immediately inform the child, young person or vulnerable adult when the care, treatment or intervention is complete • Praise and give rewards for having endured a difficult or painful procedure • Ensure the individual is made comfortable and provide appropriate follow up support and necessary information • Monitor for complications that may arise as a result of physical or psychological effects of the intervention • The assessment, care plan and evaluation of the care, treatment or intervention should be carefully documented • A Trust monitoring form for the use of Physical Interventions and/or Rapid Tranquillisation must be filled in and kept with the patient’s notes (and enter on RIO) • Please refer to the Post Incident Support Policy. It would be good practice for staff to make a note of the response and efficacy of the principles when applied with the patient. So an ongoing report of the effectiveness and maintenance of the patient’s emotional and physical wellbeing can be recorded. 21 Post Incident Review Plan Review and evaluation of what has been learned and adjust the Intervention Plan for next time. Care Plan was devised by/following discussions (entered on RIO) Name Position Discussed with Location Date Care Plan was agreed by (MDT meeting) Name Position Location Date 22 REVIEW This person centred physical intervention care plan should be reviewed on Date: Subsequent Review Dates for Multidisciplinary Team (MDT) Review 2 Date Review 3 Date Review 4 Date Discontinuation Date Intervention plan discontinued by the MDT Date: Staff Signature: Family: