Searching
This care bundle describes six actions to ensure the best clinical outcome for patients who have been subject to a personal or environmental search. Care must be delivered in a safe and positive manner to ensure privacy, dignity, spiritual, religious and personal items are respected as well as safely maintained patients. Each described intervention will be required to be delivered, however these do not need to be completely sequentially.
Aim:
Support the Patient and relatives /carers to understand the Health and Safety constraints of NHS property.
What to do:
Confirm (and re-affirm during stay) information regarding storage of items, prohibited and illegal items i.e. Information on admission; ward posters; community meetings; etc.
Consider reasons for bringing items to the clinical environment such as lack of information, lack of understanding, unmet treatment needs, criminal behaviour.
(*Will also be repeated as part of Intervention 3)
Ask patient if they have any items deemed unsafe/suitable.
Ask about current storage arrangements.
Ask patient to hand in items.
Risk assess above information.
Aim:
Ensure timely and accurate record keeping. Develop robust systems for the implementation of Searches and aftercare.
What to do:
Ensure all staff who will Search have completed Search Training. Ensure all staff involved in the use of Searches have access to super-vision and any learning needs are addressed.
Clear documentation on PARIS
- Rationale for the use of Search.
- Discussion with patient/RC re consent/refusal to Search.
- Items found or not, receipt given or recommendations made regarding storage/ dis-posal/ removal of items follow-ing the Search.
Receipts and all other related documents must be scanned into the electronic records.
DATIX to be completed for all incidents involving Search*.
Update and review the clinical documentation regularly in-cluding the care plan and risk assessment.
*LSU may have different arrangements
Aim:
Environmental and Personal Searching which is legally robust, risk informed and safe.
What to do:
Develop rationale for Searching.
Risk assess the need to Search.
Is it safe to search? is it safe not to search?
Define Search plan to team and inform patient.
*Refer back to intervention 1*.
Ask patient for Consent to Search.
Ask RC if they have a clinical objection to Search by Force, if consent refused.
Ensure correct PPE used.
Define immediate management plan, in light of risk assessment, if Search not to be completed at this time.
Consider safety and appropriateness of the environment to complete Search in, taking into account privacy and dignity.
Ensure all staff are trained to Search as per Trust training.
Define clean area to place items found.
Inform patient of any disposal/ removal/storage arrangements (give receipt).
Aim:
Develop a robust system that ensures that the patient’s emotional wellbeing is monitored.
What to do:
Personal body Searches must be completed by staff of the same Gender.
Environmental Searches should be completed by staff of the same gender.
Items considered personal or of religious significance for the person must be treated with due respect.
Contact Chaplaincy Service for advice regarding any items of religious significance that staff are unsure how to handle.
If patient refuses physical health monitoring, visual observation chart should be completed and uploaded.
Aim:
Foster a multi-disciplinary approach to care planning.
What to do:
Clinical review within 24 hours including Nursing staff and medical team to review care plan, rationale for Search and decisions made and future plans to manage risk including alternatives to Searching through proactive strategies.
Feedback from clinical review to be included in care plan and risk assessment.
Formulation of risks to assess the suitability of environment for presentation, and explore possible alternatives.
Assess effectiveness of current care plan – consider diagnosis, formulation, clinical presentation, and environment.
Consider impact of Search on presentation i.e. level of intrusion on paranoia, psychosis, mania etc.
Consider level of support required by staff/patient following any Searches for psychological impact.
Aim:
Support the patient and carer(s) following Search and support all involved to develop under-standing of what happened.
What to do:
Staff to carry out immediate post-incident debrief.
Review circumstances that led to Search procedure with the patient, carer and/or advocate and signpost to additional support.
Review the positive behavioural support plan, advanced directives and other clinical documentation.
Ensure witnesses are given the opportunity to reflect on their experience of the incident.
Feedback from debriefs to be included in care plan and risk assessment.
Ensure all staff involved have access to supervision.
Identify training needs.