Preparing For Lone Working in the NHS

PREPARING FOR LONE WORKING IN THE NHS

Lone working is not unique to community-based staff; it can (and often does) occur within different healthcare settings.

For example, a receptionist in a GP surgery can frequently be the only member of staff in a waiting room full of patients who may be getting frustrated and agitated if they’re not seen on time.Similarly, a hospital porter may find themselves in a remote part of the building or escorting a patient to another site by themselves. As a result, lone working policies and procedures need to reflect the situations where lone working is likely to occur in the organisation.There should be a clearly documented risk assessment process in relation to lone workers within the healthcare or community setting to:

identify risks in relation to lone working,

assess the risks to lone workers,

implement measures to reduce the risks to lone workers, including appropriate staff training to minimise these risks, and

evaluate the control measures and ensure that risks to lone workers are mitigated.

IDENTIFICATION OF RISKS FOR LONE WORKERS

The risk identification process is necessary in order to make decisions on how to manage those risks and ensure that any action taken is proportionate.
The identification of risks to lone workers relies on using all available information in relation to lone working.This includes learning from operational experience of previous incidents and involving feedback from all affected members of staff. Therefore, it is essential that staff are encouraged to report identified risks to managers as well as any near misses.Arrangements also need to be made to monitor and review the findings.

Lone worker risk identification should consider:

the possibility of an increased risk of violence from patients due to alcohol or drug abuse,
staff carrying equipment that makes them a target for theft or less able to protect themselves,
staff carrying prescription forms and medicines – particularly controlled drugs,
working conditions: any abnormal or hazardous conditions such as poor lighting, dangerous steps or unhygienic locations,
having to deliver unwelcome information or bad news,
working in, or travelling between, certain environments and areas, and
the staff member’s capability to undertake lone working – for example, being inexperienced, pregnant or having a disability.

RISK ASSESSMENT

The key to any risk assessment is to identify hazards, understand how and why incidents occur and learn from that understanding to put controls in place or make improvements to existing controls to reduce the risk. The process is no different when assessing the risks to lone workers.

Healthcare organisations need to consider:

the type of risk (e.g. person, environment or task);
the likelihood of an incident occurring; and
the severity of the incident if it happened in terms of human and financial cost to the organisation.

Once all the risks have been assessed, it’s imperative that next steps are recorded to ensure that improvements are made and risks reduced.

MANAGING RISK

Measures to manage, control and mitigate risks to lone workers have to be implemented. These should be proportionate to the level of concern highlighted in the risk assessment.

Before a lone worker visit, it would be advantageous to have a log of known risks being kept that records the location and details of patients that may be visited by staff where a risk is present.If a documented log isn’t kept, where legally permissible, information concerning these patients and addresses should be communicated internally to all relevant staff who may also work with them and externally within the health, social care and other public sectors.Some NHS organisations may operate a violent patient indicator (VPI) process, whereby the records of patients who present a known risk of, or potential for, violence are marked.The VPI should outline the nature of the risk and practical advice for lone workers such as being able to recognise specific triggers and known signals. It may not be appropriate for lone workers to visit VPI patients in their homes; however, if there is a clinical need, a separate risk assessment should be conducted with necessary measures put in place beforehand.Lone workers could be provided with personal equipment such as a mobile phone or a lone working device to mitigate risks they may face. Training should be delivered for any equipment issued to staff working alone, incorporating scenarios they are likely to encounter.

Key preventative measures to tackle violence against NHS staff were introduced to ensure every worker had the necessary skills to be able to recognise, de-escalate and manage potentially violent situations.

2004
A national syllabus in conflict resolution training for the NHS introduced
2005
A separate syllabus for mental health and learning disability settings implemented
2007
Training standards for ambulance settings came in to being

EVALUATE CONTROL MEASURES

In order to provide a safe working environment for lone workers, a crucial part of the risk assessment process is evaluation.

Regular reviews of control measures and arrangements should take place to ensure that they are effective and continue to minimise, control or remove the risks being faced. In addition, risk assessments should be reviewed and revised after each incident.

It is advisable to review risk assessments after near misses as well.