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.

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– Threatened by increasingly diverse antibiotic resistance among pathogens– Limited by a shrinking development pipeline (i.e. too few new antibiotics)

• Poor prescribing causes immediate and long-term problems – Clostridium difficile– 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

• 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)

Are antibiotics appropriate for your patient?A check list:

• 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.

When NOT to use antibiotics

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 anti-psychotics

• 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:

Trimethoprim prescribed for patienton Methotrexate (also Methotrexateprescribed by Dr not authorised to

prescribe Methotrexate)

Insulin prescribed with abbreviation "u" instead of word "units" and not

signed by the doctorPatient prescribed wrong dose ofperindopril,80mg instead of 8mg.

Actrapid insulin written as 4U

instead of 4units

Patient takes weekly methotrexate(25mg on Mondays s/c) and has

been prescribed trimethoprim. Hehas received one dose of 200mg

trimethoprim.

Insulin dose changed on existingprescription and dose prescribed

with abbreviated U instead of units.

Ramipril prescribed, patient allergicto this, nothing written in allergy

box at the time of prescribing, onedose given

Patient allergic to penicillin –

prescribed penicillin

Outpatient prescription for'methotrexate 10mg PO daily'prescribed. The prescriber wasnot aware that methotrexate is

given once weekly

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 contra-indications. 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?

For more information please see our pages on the Pink Book:

https://www.wsh.nhs.uk/Extranet/SupportServices/Pharmacy/GuidelinesandInformation/ClinicalGuidelinesandInformationIndex.aspx

(in the relevant BNF section) or contact Medicines Information on ext 3109

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 hypomagnasaemiaIncreased risk of Clostridium difficile infectionIncreased risk of bone fractures

QT prolongation with citalopram/escitalopram – review dose, check for drug interactions & contra-indications

Strontium – increased VTE risk; review in immobilised patients

Title slideMandatory Blood Transfusion Update

for Medical Staff 2012/2013 (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 [email protected] 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

• 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

New reactions algorithm

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 alarmThe location of break-glass call pointsMeans of escape routesEvacuation procedure & fire assembly pointLocation 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:WalkWheelchairsBeds

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 on-call 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 CapacityThis 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)

“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.

MAJAX. What is a major incident?

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

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

Controlled areas continued….

Triage A&E foyer area

Major Treatment AreaA&E Resuscitation area

Intermediate Treatment AreaFracture Clinic

Minor Treatment AreaPhysiotherapy ODP area

Preoperative AreaEndoscopy unit ward

Operating TheatresOperating theatres

Intensive Therapy UnitITU

Admitting WardF6

PorteringEverywhere

Relative ReceptionChapel

Staff HoldingPain Clinic reception (near G8)

Press CentreCommittee room

Discharge AreaMain OT department

DeadMortuary

External DecontaminationFront area of hospital

Apart from the Hospital Control Centre, we set up controlled areas in:

The thing to note is that for the most part, these are things done 24/7 by those who normally do them…..

You need to remember

this!!

You need to remember

this!!

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!

A salutary tale…

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?

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.

On Duty or Not….

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

The key things to remember………

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 ofseverity 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 hazards2, Decide who might be harmed and how3, Evaluate the risks and decide on precautions4, Record your findings and implement them5, 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 monthsAccepted risk assessments are to be reviewed at least every 12 monthsRisk assessments should also be reviewed following an incident to ensure theidentified hazard and associated risk are controlled appropriately. It is good practicewhen carrying out or reviewing assessments to involve the employees who eitherundertake 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 employeescomply 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 itscontents. 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 pointthe reader to where further information on those arrangements can befound. 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 reportingThe 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 pro-active measures to be implemented to ensure similar incidents / accidents do not happen again.

The Trust uses Datix to record all incidents clinical and non-clinical. 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 [email protected] or by phone on 3770.