NHS Security Info – Free Download #2 – This is a short brief on the categories of information that need to be entered on ‘Use of Force’ incident records in the NHS, by Jim O’Dwyer, Senior Consultant at AEGIS Protective Services.
Reporting use of force
The Mental Health Units (Use of Force) Act 2018 is a relatively new Act of Parliament that requires NHS mental health units to keep a record of any use of force on patients by staff (i.e. excluding cases where the use of force is negligible, e.g. light, momentary, touching during re-directing or guiding movement.)
Definitions used in the Act:
“Patient” means a person who is in a mental health unit for the purpose of treatment for mental disorder or assessment.
“Use of force” means: (a) the use of physical, mechanical or chemical restraint on a patient, or (b) the isolation of a patient.
“Physical restraint” means the use of physical contact which is intended to prevent, restrict or subdue movement of any part of the patient’s body;
“Mechanical restraint” means the use of a device which: (a) is intended to prevent, restrict or subdue movement of any part of the patient’s body, and (b) is for the primary purpose of behavioural control;
“Chemical restraint” means the use of medication which is intended to prevent, restrict or subdue movement of any part of the patient’s body;
“Isolation” is defined in the Act as meaning any “seclusion or segregation” that is imposed on a patient.
Note: The Mental Health Units (Use of Force) Act 2018 requires that, where “isolation” has been imposed on a patient, it must be reported i.e. because it is a serious form of ‘restraint’.
“Seclusion” is defined in Chapter 26.103 of the Mental Health Act Code of Practice as: “the supervised confinement and isolation of a patient, away from other patients, in an area from which the patient is prevented from leaving, where it is of immediate necessity for the purpose of the containment of severe behavioural disturbance which is likely to cause harm to others.”
Chapter 26.104 of the Mental Health Act Code of Practice states: “If a patient is confined in any way that meets the definition above, even if they have agreed to or requested such confinement, they have been secluded and the use of any local or alternative terms (such as ‘therapeutic isolation’) or the conditions of the immediate environment do not change the fact that the patient has been secluded”.
Seclusion usually refers to short periods of isolation. When seclusion becomes prolonged it is termed ‘long-term segregation’. Long-Term Segregation (Chapter 26.150 of the MHA Code of Practice) refers to exceptional situations where a multi-disciplinary review, supported by a representative from the responsible commissioning authority, determines that, if the patient were allowed to mix freely in the general ward environment, other patients or staff would be exposed to a high likelihood of serious injury or harm and so the patient should not be allowed to mix freely with other patients on the ward or unit on a long-term basis.
Records of ‘use of force’ must now include the following information:
(a) the reason for the use of force;
(b) the place, date and duration of the use of force;
(c) the type or types of force used on the patient;
(d) whether the type or types of force used on the patient formed part of the patient’s care plan;
(e) name of the patient on whom force was used;
(f) a description of how force was used;
(g) the patient’s consistent identifier (NHS Number),
(h) the name and job title of any member of staff who used force on the patient;
(i) the reason any person who was not a member of staff in the mental health unit was involved in the use of force on the patient;
(j) the patient’s mental disorder (if known);
(k) the relevant characteristics * of the patient (if known);
(l) whether the patient has a learning disability or autistic spectrum disorders;
(m) a description of the outcome of the use of force;
(n) whether the patient died or suffered any serious injury as a result of the use of force;
(o) any efforts made to avoid the need to use force on the patient;
(p) whether a notification regarding the use of force was sent to the person or persons (if any) to be notified under the patient’s care plan.
* Relevant characteristics (k) includes:
- the patient’s age;
- the patient’s status regarding marriage or civil partnership;
- whether the patient is pregnant;
- the patient’s race;
- the patient’s religion or belief;
- the patient’s sex;
- the patient’s sexual orientation.
Is it time to review your NHS Trust’s arrangements for recording ‘use of force’ incidents?
Currently, information required to be reported for ‘use of force’ incidents varies across the NHS.
However, the legal requirement for mental health units to record the information described above sets a basic standard for all NHS Trusts.
Moving into line with the new requirements may require amendments to incident recording forms, i.e. to include the necessary information. It may also require additional training for Healthcare Security Officers.
Note: Recording and accounting for use of force is a topic that is addressed in detail in the new Healthcare Security Officer Training course.
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AEGIS Protective Services
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