Choice lifestyle & Responsibility Service user involvement and policy development Responsibility contracts

Risk assessment & management Policy - RAMP Establish what areas of care delivery / items that have the potential to increase risk. Principal; Procedural security managed in the most normal / least restrictive way possible. Individualised additional risk management

Responsibility contracts Not punitive - informative Where risks are relevant to others on the ward. Service user identified responsibilities  What I need to do !  What the staff have to do !  What will happen if it doesn’t happen

6 - Responsibility contracts 1.Mobile phones 2.Room (key) access 3.Ceramic cup 4.Pornography 5.Computer / Laptop 6.Lighter access

Risk item 3 Room Key Potential increased risk  Social isolation  Non compliance - disengagement. Thornhill Ward  Authorisation of a bedroom key is subject to an agreement between the service user and the Multi Disciplinary Team (MDT) about an appropriate therapeutic activity and engagement schedule.  This agreement must include o Attending the clinic room for receipt of prescribed medication at correct time with no or minimal prompts. o The service user attends / follows their own agreed therapeutic time table. P/N session – MDTM – OT – leave - individual and ward based activity program. o General levels of informal social interaction.  Attends community meetings where appropriate to the effective running of the ward.  All Service users must vacate their bedroom by 9.30am and 3pm unless room key access is agreed.  The wards normal day time hours are 6am until midnight.  No access to bedrooms between midday and completion of cutlery count and 5.00 pm and completion of cutlery count even with key access.  The service user must hand in his key prior to taking leave off the unit. Bedroom keys must not leave the unit.  The bedroom is maintained in a clean tidy manner with easy access to the floor for cleaning and hygiene purposes.  No rubbish is kept in a service users bedroom.  If a service user is unable to adhere to ward protocol room key access should be withdrawn at the next MDTM or immediately if an increase in risk is evident. Service users signature ………………………………………………………… Primary Nurse signature………………………………………………………... Date ……………………………………………………………………………. Increase risk management interventions  No room key access

Risk item 4. Lighters Potential increased risk  Fire setting  Smoking in undesignated areas  Self harm  Lighter being given or found by another service user with out lighter access. Thornhill Ward  Access to a lighter is dependant on an agreement between the MDT and the service user that all protocols and procedures for the safe management will be adhered to.  Service users are permitted 1 lighter.  The lighter will be supplied by Thornhill Ward.  The service users name will be clearly identifiable on the lighter with either permanent marker or tipex or a name sticker covered in selotape.  Lighters must not be given to another service user except to light a cigarette in approved smoking areas.  The lighter must be kept on the service users person at all times (day) or stored in the safe in their bedroom.  The lighter must be handed to staff over night and re issued in the morning in line with permitted smoking times. 6am – midnight.  The security nurse day shift is responsible for allocating lighters in the morning, they must record on the daily security sheet when a lighter has been handed out.  The security nurse on the night shift is responsible for ensuring that all lighters are handed back in no later than midnight. Lighters must be recorded in on the daily security sheet.  The service user must only smoke in approved outdoor smoking areas.  The service users will adhere to smoking courtyard protocols and take his turn cleaning the courtyard and using the ashtrays bins to dispose of cigarette butts.  Failure to adhere to any of the protocols around safe management of lighters will lead to lighter access being suspended until reviewed at the next MDTM. Service users signature………………………………………………………………… Primary Nurses signature……………………………………………………………… Date……………………………………………………………………………………. Increase risk management interventions  Lighter access controlled in a tighter time frame for example 1 hour at a time to assess compliance with protocol.  No lighter access

Principals – Risk managed items Jointly establish what the risks are pertaining to that item / care issue. Jointly establish the least restrictive (normal) procedural security measures for that item –relevant to that ward. Establish additional interventions for individuals where the normal procedures might not be sufficient.

Principals – Responsibility contracts 1.Clearly identify; –Staffs responsibility Procedural security procedures –Service user individual responsibility What has to be done When it should be done –Consequences of not doing it Not punitive Review of contract Learning from mistakes