Lone working policy

1 Introduction

The trust has a legal duty under the Health and Safety at Work Act to ensure the health, safety and welfare of its staff. In addition, the management of health and safety at work regulations requires the identification and control of health and safety risks. This policy sets out how the trust will comply with these requirements in relation to lone working.

Clinical staff who carry out ‘lone working’ in a community setting owe a duty of care to their patients which may only be withdrawn in exceptional circumstances. In exceptional cases, this duty of care to the patient has to be balanced against the potential risks to staff associated with visiting the patient in their home setting. It is also recognised that increasingly hybrid working has meant that there are fewer staff in non-clinical areas and an increased likelihood of staff lone working in office environments.

The trust policy is to adopt a proactive and systematic approach to risk management. The trust aims to reduce the risks to personal safety, as far as is reasonably practicable. The trust is committed to the improvement in working lives of staff as reflected in the trust’s core values and this policy sets out how the trusts duty of care is met in relation to ‘lone working’

1.1 Definitions

1.1.1 Incident

Incident, n unplanned or uncontrolled event or sequences of events that has the potential to cause injury, ill health or damage.

Non-physical assault (verbal abuse) as defined by NHS Protect is:

“the use of inappropriate words or behaviour causing distress and, or constituting harassment”

This definition replaces any other definition that may currently be in use..

The Crime and Disorder Act 1998 opens up to both public, and, or private prosecution the use of verbal assault on racial or religious grounds.

1.1.2 Violence

The term violence covers a wide range of incidents not all of which involve physical harm. Based on the health and safety commission’s and the NHS zero tolerance campaign’s definition of work related violence the trust defines violence as:

“any incident where staff are abused, threatened or assaulted in circumstances related to their work involving an explicit or implicit challenge to their safety, well-being or health”

Using this broad definition the range of issues will include, but not be limited to, those incidents which involve:

a threat, even though no physical injury results
verbal abuse, for example, intimidating and or abusive language
non-verbal abuse, for example, gestures or stalking

1.1.3 Lone working

The trust recognises that any member of staff may spend a limited amount of their working time ‘alone’. Lone working is defined as:

“any work activity, which is specifically intended to be carried out by people regularly working on their own, or in isolation, without immediate access to other staff or team colleagues”

For staff working in an isolated situation the trust recognises that they may not always be working alone. An isolated situation is therefore defined as a situation where:

“staff are engaged in regular or occasional work (either outdoors or indoors) where there are no other people who could reasonably be expected to come to their immediate aid or contact help on their behalf in the event of an incident or emergency”

2 Purpose

The purpose of this policy is to set out the trusts arrangements for managing the risks associated with lone working. These arrangements include:

complying with appropriate legislation
acknowledging the NHS zero tolerance campaign
complying with improving working lives requirements
providing a system of safe working practices for managers and staff

3 Scope

This policy applies to all trust staff who carry out ‘lone working’ including those employed on bank, agency and temporary contracts and volunteers.

Lone working includes, but is not limited to, health professionals on home visits, ancillary staff working in buildings on their own, maintenance staff working in ducts or in plant areas and staff working out of hours or returning to duty when on-call. This policy:

provides measures to Increase staff awareness of safety issues relating to lone working
provides a systematic methodology for assessment of the risks of ‘lone working’ to enable safe systems of work to be put in place and therefore eliminate or reduce the risks to the lowest practicable level whilst ‘lone working’
outlines appropriate training for staff in all areas of lone working and equips them to recognise hazards and provides practical advice on safety measures which can be taken when working alone
outlines appropriate support measures for staff who carry out ‘lone working’
encourages full reporting and recording of all incidents relating to lone working
outlines measures to reduce the number of incidents and injuries to staff related to lone working
outlines how the trust will comply with relevant health and safety legislation, best practice and relevant secretary of state directions

4 Responsibilities, accountabilities and duties

4.1 The chief executive

The chief executive has overall accountability for ensuring that responsibilities for health and safety are effectively assigned, accepted and managed at all levels in the trust, consistent with good practice. In practice the chief executive will discharge these responsibilities by delegation to executive directors and then through the line management structure.

4.2 Security management director

The executive director of finance fulfils the role of security management director.

(SMD) within this trust. Duties of the SMD in relation to ‘lone working’ include:

promote security management advice at board level
challenge, scrutinise and ensure accountability in respect of security management
promote the health and safety of staff and the safety of lone workers

Support the local security management specialist (LSMS) in their role.

4.3 Directors, deputy care group directors, or corporate heads of service

Duties of the directors and of deputy care group directors and corporate heads of service in relation to lone working include:

the implementation and monitoring the effectiveness of this policy within their care group
prioritising resources to meet identified needs arising from the assessment of risks to personal safety
reviewing incident trends and incidents relating to personal safety and ensuring that staff under their control have the appropriate resources to implement control measures to reduce the risks of lone working

4.4 Local security management specialist (LSMS)

Duties of the LSMS in relation to ‘lone working’ include:

receiving reports of violence and aggression and providing advice to managers and staff on any further action that may be required
providing managers with advice on measures to prevent or reduce violence, aggression, and abuse, appendix D refers
monitoring the reports of violence and aggression to recognise trends
providing advice about lone working and completion of risk assessments (see appendix D for contact details)

4.5 Managers and supervisors

Duties of managers and supervisors in relation to ‘lone working’ include:

ensuring that a lone working risk assessment is carried out where a significant risk to personal safety has been identified
as far as is reasonably practicable, implementing any control measures identified to minimise or avoid the risk to personal safety and identify to directors and heads of service any resource requirements which are required
ensuring that staff attend appropriate training on personal safety
ensuring that all incidents relating to violence and personal safety are reported in accordance with the trust policy
providing advice and guidance on the suitability and sufficiency of the assessment of risks and associated control measures in relation to personal safety
providing access to services who may provide support to staff following an incident of violence or threat to personal safety

4.6 Prevention and management of violence and aggression trainers

Duties of the trainers in relation to ‘lone working’ include:

providing a training program for staff on the prevention and management of work-related violence, including ‘promoting a safer therapeutic service (PSTS)’ and personal safety
reviewing all reports of violence and aggression and, in liaison with the Safety team, providing advice and guidance as appropriate

4.7 Staff

Duties of all staff in relation to ‘lone working’ include:

taking responsibility for their own health and safety whilst ‘lone working’, and the safety of others who may be affected by their actions
implementing and complying with control measures and safe systems of work
completing risk assessments where there is a risk to personal safety from ‘lone working’, appendix E refers’. In particular, staff who carry out high risk activities such as visits to patients homes must take responsibility for ensuring that they have received training in the process of dynamic risk assessment and the range of control measures which are set out in this policy
reporting hazards and incidents using the trust’s reporting procedures, recording relevant information on the trusts clinical information system and sharing information with managers and other members of their team
attending appropriate training on lone working

4.8 Health, safety and security forum

The purpose of the health, safety and security forum includes:

actively championing security, promoting incident reporting, learning from experience and best practice to develop a culture of safety and security
reviewing incident reports, trends and themes identified by the Health and Safety team and facilitating learning and improvement through appropriate action
monitoring risk assessments of the physical security of premises and assets and taking an organisational overview of these, making recommendations as appropriate
monitoring the completion of the trust lockdown profiles across the trust premises list and the effectiveness of the lockdown procedures
reporting to the estates and facilities department any significant premises issues that require action
any significant security issues are escalated to the quality committee

5 Procedure and implementation

5.1 Risk assessment

5.1.1 Introduction

An assessment of risk is simply a careful examination of anything that may cause harm to staff or others during the course of their work.

A risk assessment is the first step in deciding what prevention or safe working arrangements need to be taken to protect staff from harm. All staff whose work contains an element of lone working must have a risk assessment in place. Lone workers may need extra measures put in place to control specific risks associated with lone working.

The risk assessment process should commence as early as possible. Each appointing officer or manager is responsible for ensuring that the recruitment process for staff who will work alone embraces appropriate procedures that assist in ascertaining the suitability of staff to carry out their duties in such circumstances.

The risk assessment should provide an indication as to whether control measures are required for lone working. If the risk assessment indicates unacceptably high levels of risk then the work should not be undertaken unless further safe working arrangements are implemented, which for example, may mean two members of staff carrying out a home visit together.

5.1.2 Step process

Staff who carry out visits to patient’s homes must be trained in the process of dynamic risk assessments and the range of control measures that are available. Risk assessment should take account of changes in circumstances such as escalating violence or aggression control measures such as provision of a lone worker alarm or working in pairs may be required. The format of the assessment will become a written record and will show any significant findings for staff who may be at risk.

The 5 step process, outlined below, should be followed when assessing risk:

identify any hazards
decide who may be affected or harmed and how
evaluate the risk
record the findings and eliminate the risk or put control measures in place to reduce the level of risk to the lowest level as practicable
review the assessment on dynamic basis or when circumstances change

Risk assessments must be carried out for all areas where working alone poses an actual or potential risk to staff.

Risk assessment should be carried out by competent persons, be recorded: and evaluated by managers and communicated to all whom may be affected.

5.1.3 Factors to consider for risk assessments

Factors to consider when carrying out the risk assessment should include the following:

5.1.3.1 Trust premises, non-patient facing roles

Does the activity need to be carried out alone?
Does the activity need to be specially authorised before lone working can commence?
Does the location present a special risk to the lone worker?
Is there a safe way in or out for one person?
Can the location or building be secured to prevent entry but still maintain sufficient emergency exits?
Can the equipment, substances or goods involved be safely handled by one member of staff. Are they medically fit and suitable to work alone?
What training is needed to make sure the staff member is competent in relation to lone working safety measures?
Have staff received the training which is necessary to allow them to work alone?
How will they be supervised?
Are staff of a particular gender especially at risk if they work alone?
Are new or inexperienced staff especially at risk if they work alone?
Are younger workers especially at risk if they work alone?
What happens if a member of staff becomes ill, has an accident, or if there is an emergency?
Are there systems in place for contacting and tracing staff who work alone?

5.1.3.2 Patient facing roles, including community staff

Does the activity need to be carried out alone?
Does the activity need to be specially authorised before lone working can commence?
Does the location present a special risk to the lone worker?
Is there a record or history of violence, aggression, verbal and physical abuse or racism at the location, either from the patient, relatives or neighbours?
Is there a potential risk of violence or aggression?
Does the task being undertaken with the patient have the potential to cause them to become angry?
Is the area being visited a known trouble spot?
Is there a safe way in or out for one person?
Can the location or building be secured to prevent entry but still maintain sufficient emergency exits?
Are there any known drug, alcohol or mental health issues, which need to be considered?
Can the risks be adequately controlled by one person?
Can the equipment, substances or goods involved be safely handled by one member of staff. Are they medically fit and suitable to work alone?
What training is needed to make sure the staff member is competent in relation to lone working safety measures?
Have staff received the training which is necessary to allow them to work alone?
How will they be supervised?
Are staff of a particular gender especially at risk if they work alone?
Are new or inexperienced staff especially at risk if they work alone?
Are younger workers especially at risk if they work alone?
What happens if a member of staff becomes ill, has an accident, or if there is an emergency?
Are there systems in place for contacting and tracing staff who work alone?
Will the visit or meeting be taking place out of hours?

5.1.4 Recording the assessment

Details of the risk assessment should be recorded and should include:

the extent and nature of the risks
factors that contribute to the risk including job content and specific tasks and activities
the safe systems of work to be followed to eliminate or reduce the risk
the numbers of staff and others affected by the activity
any changes, recommendations, training, policy and procedural reviews necessary
who is responsible for ensuring the identified actions in the risk assessment are followed through to a logical conclusion
environmental factors, lighting, temperature, noise floor conditions etc

It is, of course, unrealistic to complete a risk assessment for each particular scenario, but managers should, initially, complete a general risk assessment for the following hazards (not all of the risks will apply in non-patient facing roles):

physical or sexual assault
verbal abuse or threatening behaviour
robbery
theft or criminal damage
road traffic accidents, breakdowns and punctures
slips, trips, and falls

This assessment should be reviewed when:

there is any change to the system making it no longer fit for purpose
there is a significant change to the number of staff involved
after any incident involving a lone worker, assessments should be kept by managers, made available to all staff in the team and copies sent to the Safety team

5.1.5 Managing risk

The risks that lone workers face should be reduced to the lowest reasonably practicable level. Using safe working arrangements depends largely on local circumstances, local procedures and protocols. Local procedures and protocols should be put in place to provide staff with specific local guidance in relation to lone working and the associated risk reduction techniques.

Issues to consider in developing safe systems of work include:

having in place reporting systems so that the whereabouts of staff are known
consider working patterns and hours of work which at certain times of day or night could reduce risks
joint working with others for high-risk activities
improvements to security arrangements in buildings
security lighting in parking areas
communication systems for sharing information on risk with colleagues in other disciplines and agencies
training to increase staff awareness of risk and the precautions to be taken
supervision and auditing of working practices
using personal lone working devices or mobile phones and personal alarms
removing identification from cars
joint communications meetings with other services (police, social services, probation service etc)

Arrangements for managing risk should include:

guidance for lone workers on assessing risk, including dynamic risk assessment
details of when to stop and get advice
the safe working arrangements for ensuring that staff can be traced and located when working alone out in the community
the procedures to be followed in the event of an incident or emergency
ensuring that staff are familiar with these local protocols and procedures
lone working devices where required

There may also need to be detailed guidance to tackle specific areas of risk such as:

lone workers travelling alone on work-related business
home visits
working outside normal office hours
transporting patients

5.2 Types of lone working

Lone working can take place when individual staff:

work at a building or location and are separate from others, for example, working alone in buildings or interviewing patients alone in interview rooms
work alone away from base, for example, home visiting, community services, deliveries, etc
work outside normal working hours, for example, alone in isolated buildings or working alone in the community (for example, clinics, doctors surgeries, and village halls etc.)
travel alone as part of their work, for example, travelling to meetings or travelling to patient homes (for example, managers, community nurses etc.)

Some lone workers may fall into more than one of the above categories.

5.3 Hazards of working alone

Staff who work alone face the same hazards in their daily work as other workers. However, for lone workers, the risk of harm is often greater.

Hazards facing lone workers include:

fire, it may be difficult for an isolated worker to evacuate a building when the fire alarm activates
violence and personal safety, the nature of the work of trust staff often involves visiting patients in their home or in clinics which can lead to an increased risk to staff personal safety
obtaining a response to any security alarm which is raised

In practice this procedure will apply to a small number of staff, especially when they are working in isolated locations and or when carrying out known high risk activities. High risk activities may include:

working with people who have known risks, for example, violence and or aggression
undertaking work within isolated areas
undertaking work within known high risk areas
working or visiting patients in their own home on first visit
when staff are carrying medication, equipment or valuables. Travelling between site or home or office
staff who are handling cash

5.4 Methods of reducing risk

In order to meet the aims of reducing the risk to personal safety and improving the working environment the following methods can be adopted:

the elimination or avoidance of situations, which pose a risk to personal safety. Avoidance will always be the preferred option where elimination is not possible. Where it is not possible a risk assessment must be carried out, appendix E refers
providing training for staff on hazard identification and risk assessment, both static and dynamic
where a risk assessment indicates a significant risk to personal safety a detailed written risk assessment should be made which aims to reduce the risk as far as reasonably practicable. Detailed assessments of risk should be copied to the Safety team
training of staff to enable them to recognise hazards. Providing practical tips to implement when exposed to the risks of ‘lone working’. Providing training for staff on de-escalation and how to extract themselves from situations where they feel threatened
provision of a lone working device. Over the last few years the trust has used the Skyguard ManDown (people safe) device, which acts as a means of communication in an emergency. Staff should contact their manager in the first instance if a device is required. Further information may be obtained from the trust LSMS

5.5 Safeguarding lone workers

The following points can also be used by teams to collectively assist lone workers and provide further safeguards to ensure ‘lone worker’ safety:

notification to team or manager of visiting arrangements to patients and any changes to these
notification to team or manager at end of visit or end of shift

5.6 Supervision

It is not reasonably practicable for lone workers to be subject to direct supervision, however the trust has a duty of care to ensure the safety of staff as far as is reasonably practicable. Managers should ensure that staff are provided with training and instruction to help them understand the risks associated with lone working and enable any necessary safety precautions to be implemented. Supervisory staff can also provide guidance in situations of uncertainty.

Supervision is needed when checking compliance with existing or new control measures that have been put in place as a result of the risk assessments.

Procedures will need to be put in place to monitor staff who are lone workers and to provide for their safety, these procedures may include:

supervisors periodically visiting and observing staff working alone
regular contact between the lone worker and their supervisor or team
regular checking and practicing of procedures designed to raise the alarm if contact is lost with a lone worker
regular checking of other safety devices to maintain their functionality
providing details of where guidance can be sought out of hours, such as managers on call rotas

5.7 Mobile phones

The trust provides a number of staff with mobile phones. Whilst these can provide substantial benefits for staff, current legislation relating to their use whilst in a vehicle must be followed.

On occasions, staff may need to make discrete calls when using a mobile phone, so as to not draw attention to themselves or the phone and therefore avoid the risk of theft or mugging.

5.8 Information sharing

It is important that staff have access to information on any risks relating to individual patients and or areas where they may visit.

Where information is obtained which could have an immediate and or serious effect on the safety of staff, the appropriate manager or, if out of hours, the on call manager must be informed immediately.

Managers must create an appropriate flow of information across trust services, especially where there is a higher risk of assault from a patient, relative or carer.

Staff should obtain as much information as possible from a wide variety of sources, for example GPs, Local authorities, consultants, clinics, police and other healthcare organisations.

The Data Protection Act allows organisations to supply or obtain information where there are reasonable grounds to believe that staff may be at risk from coming into contact with a particular person or on entering a particular area, building or premise. The Act allows organisations to retain and store this information, provided the information was:

obtained and processed fairly and lawfully
held for specified lawful purposes
not used or disclosed in a way incompatible with the purpose(s)
adequate, relevant and not excessive for purpose(s)
accurate and up to date
not kept longer than necessary available to the data subject
kept secure

Relevant information should be made available to all staff that may care for patients or attend a particular area, building or premise where a risk has been identified.

Staff must also be aware that if, at any stage during a visit, they feel unsafe, they should report this to their manager who should update the relevant records as necessary.

The trusts information governance team can be contacted for further information on the storage and sharing of records.

5.9 Patient contact

Staff should never give out any of their personal details, including their home telephone number, personal mobile number or pager number to a patient, relative or carer.

Staff should ensure wherever practicable, that all patients, relatives and carers are aware of the proper channels of communication through which all requests of attendance must come.

5.10 Risk assessment, advice to staff

Where staff plan to enter a lone working situation, they should carry out an initial risk assessment and information gathering exercise. This can range from a very short process, to a prolonged liaison and planning process.

Most, but not all, of the difficult situations will come from clinical visits to patients homes. Lone working in office or non-patient facing roles is generally considered to be a lower risk activity, although the type of activity undertaken and the individual carrying it out may alter the level of risk. To assist in the risk assessment a prompt sheet for the initial assessment is provided in appendix B.

Once at the location, staff should complete a dynamic risk assessment of the situation. Appendix C provides a prompt sheet for a dynamic assessment upon arrival at the location.

If staff feel unsafe at any time, they have the right to vacate the area and seek advice from the manager and if staff suspect physical or verbal abuse may occur, then they may call the police for assistance.

All incidents should be reported on the trust’s incident reporting system.

5.11 Incident reporting

Staff should make themselves familiar with the contents of the trust’s incident management policy and must complete an incident report for all incidents including near misses.

Managers must fully investigate all incident reports and complete any appropriate actions in accordance with the incident management policy.

Managers should be aware that if necessary, counselling is available for staff through occupational health services.

5.12 Disciplinary procedure

All members of staff are reminded that it may be a disciplinary matter if they persistently fail to follow reasonable instructions which have been provided relating to lone working.

Staff who are issued with mobile telephones, and or attack alarm systems, are to use these devices in line with the instructions and any training provided. These devices are issued for work related use and as such must be used correctly.

6 Training implications

The training needs in relation to this policy are incorporated within the training needs analysis (TNA) for the prevention and management of violence at work policy.

7 Monitoring arrangements

7.1 Arrangements for making sure lone workers are safe

How: Annual health and safety report.
Who: Safety team.
Reported to: Estates and facilities sub committee.
Frequency: Annual.

Monitoring arrangements as set out in the policy prevention and management of violence at work policy.

8 Equality impact assessment

Link to equality impact assessment: Lone working policy EIA.

8.1 Privacy, dignity and respect

The NHS constitution states that all patients should feel that their privacy and dignity are respected while they are in hospital. High Quality Care for All (2008), Lord Darzi’s review of the NHS, identifies the need to organise care around the individual, ‘not just clinically but in terms of dignity and respect’.

As a consequence the trust is required to articulate its intent to deliver care with privacy and dignity that treats all service users with respect. Therefore, all procedural documents will be considered, if relevant, to reflect the requirement to treat everyone with privacy, dignity and respect, (when appropriate this should also include how same sex accommodation is provided).

8.1.1 How this will be met

There are no additional requirements in relation to privacy, dignity and respect

8.2 Mental Capacity Act 2005

Central to any aspect of care delivered to adults and young people aged 16 years or over will be the consideration of the individuals capacity to participate in the decision making process. Consequently, no intervention should be carried out without either the individual’s informed consent, or the powers included in a legal framework, or by order of the court.

Therefore, the trust is required to make sure that all staff working with individuals who use our service are familiar with the provisions within the Mental Capacity Act(2005). For this reason all procedural documents will be considered, if relevant to reflect the provisions of the Mental Capacity Act (2005) to ensure that the rights of individual are protected and they are supported to make their own decisions where possible and that any decisions made on their behalf when they lack capacity are made in their best interests and least restrictive of their rights and freedoms.

8.2.1 How this will be met

All individuals involved in the implementation of this policy should do so in accordance with the guiding principles of the Mental Capacity Act (2005) (Section 1).

9 Links to any associated documents

10 References

10.1 Legislation

Management of Health and Safety at Work Regulations 1999 Health and Safety at Work etc. Act 1974

10.2 Guidance

Violence in Health and Social Care, Health and Safety Executive webpage (opens in new window).

‘Protecting NHS Staff from Violence’ leaflet issued by NHS Protect. The Health Services Advisory Committee of the Health and Safety Commission (HSAC) recommendations.

Protecting Lone Workers: How to manage the risks of working alone, INDG73 (rev4), 03/20 HSE Books (opens in new window).

11 Appendices

11.1 Appendix A Guidance on lone working on Trust premises

11.1.1 Guidance on lone working on trust premises

Staff working alone within a department during office hours should:

be near to a telephone to call for help if needed
secure valuables in an appropriate place
store keys so that they are secured and not accessible to visitors
If they become anxious regarding their safety, call the emergency services for help
avoid meeting people if they are alone in the workplace
if they are meeting someone, let other people know who they are meeting, when, where and telephoning them to let them know that Mr X has arrived and that they will get back to them at a certain time
not tell anyone that they are alone in the workplace
report any incidents to the relevant manager as soon as practical after any events
never assume it won’t happen to them, plan to stay safe

From time to time, staff may need to carry out their office-based work outside of normal office hours, such as weekends and evenings. The following precautions must be taken to protect their health and safety:

11.1.1.1 Staff working alone within a department outside office hours should

Always let another person know if you are staying behind in the office at the end of the normal working day or if you are working at weekends or very late at night or early in the morning. Always let a friend or relative know your whereabouts and the time that you are expected back. Contact them at regular intervals to verify that you are ok. If you change your plans, let your contact know immediately. In addition to the measures set out above to the measures set out below should be considered:

secure all windows and doors to prevent unauthorized access, so that the working environment is as safe as possible
do not open the doors to any strangers no matter what identification they have. If they are meant to be there, they will either have keys or another means of access
never give security codes or keys to any stranger. Again there are channels they can use to gather information if they are legitimate and are meant to have access
make sure your fire escape routes are available to you and not locked (as may happen outside working hours)
do not use lifts at these times, as you may become trapped inside and unable to gain assistance or attention
should the fire alarm activate whilst you are in the office alone, you must leave the building immediately by the nearest fire exit. Make your way to the front of the building, a safe distance away and wait for the emergency services to arrive
should you discover any problems with equipment whilst in the office, do not attempt to repair or tamper with the controls. If it is not serious, report it to your manager the following working day
on leaving the area close and lock all windows and doors
park as close to the building as you can, in a well-lit area. Move your car closer to the building if necessary, to reduce the risks if leaving the building on your own
liaise with security (if applicable), who in turn should liaise with anyone else in the building about estimated exit times, their whereabouts during extended hours and when they plan to leave the building
if possible, when it is clear there are only two persons left working both parties should agree that when one is ready to leave the other will also be required to cease working

11.1.2 Guidance on lone working during visits to unfamiliar sites

Staff making visits should communicate with others about their intentions during their working day and should use a lone working device or follow the following procedure.

Inform a colleague of:

the location of the visit or meeting
a contact telephone number
the time of the appointment
the likely or estimated length of the meeting or visit
the time when you are expected to return to the office or base or call in
if not returning to the office, the time and location of your next visit or the time when you are due to arrive home
if driving, car make, registration and model

Staff should ascertain as much information as possible about the appointment, use the list below as a reference:

have you checked with other colleagues for any issue that they are aware of?
do you need physical support from another colleague during the visit?
do you need to carry a personal attack alarm (panic alarm) with you
is your mobile phone fully charged and does it have good signal reception?
can you park your car (if using one) close to the visit address without putting yourself at risk, say in a darkened road or cul-de-sac?
is it necessary to have an exit strategy in the event of an emergency arising?

11.1.3 Guidance on visiting patients in their own homes

Visits to a patient’s home represents a series of particular risks to which a lone worker should be trained to recognise. Before making a home visit alone, the member of staff should assess the risks and visit first to ascertain whether it is safe enough to attend alone. If they have any serious concerns regarding the safety of a particular home visit, they should either take a colleague with them, or rearrange it for a time when the risks can be reduced.

11.1.3.1 Prior to a home visit taking place the staff should

Carry out a risk assessment and explore whether the patient is high risk or potential high risk.
Consider whether it would be appropriate to arrange to have a second staff member present for the duration of the visit.
A second staff member should be present if a particular safety risk has been identified or if this has been identified within a risk management plan.
Inform colleagues where you are. Details should include, expected time of return, names and addresses of the patients being visited and time of appointments when visiting alone, mode of contact (for example, mobile phone numbers).
Make sure that you carry appropriate personal identification, for example, name badge or Identification card to verify your authenticity.
Dress appropriately for the area or patient to be visited, particularly when the patient’s culture demands that women are covered and do not wear expensive-looking jewellery items.
Wear shoes and clothes that do not hinder movement or ability to run in case of an emergency.
Check that the means of communication and any personal alarms are working and accessible. Programme the work base number into mobile telephones so they can be ‘speed dialled’.
Obtain as much information about the patient, their families, location to be visited as possible.
Review existing information regarding the patient such as case notes, GP records, previous referrals, etc.
Review the last documented risk assessment, or if this is unavailable, contact the referrer to ascertain whether or not there are any relevant risk factors present and, or whether there is any reason why it would be unadvisable to visit the client alone.
Double-check the address and telephone number.
In the event that no records or information is available, consider whether or not it would be more appropriate to invite the patient to a safe place therefore avoiding the need to make a home visit.

Before setting off to the home visit, check that:

the vehicle is well maintained and has sufficient fuel
bags, medication and equipment are concealed and cannot be seen
you only take equipment that is needed for this patient

On your journey and on arrival consider:

the time, the location and the route
park with care, as near to the address as possible, in a lit area away from subways and waste ground, lock your car
remain with or return to your vehicle, drive away for a short while or to a place of safety
be alert, aware, safe
do not leave clinical equipment or valuables in your car or on show

At the premises:

assess the situation on approach and be prepared to abandon or postpone the visit if in there is a concern for safety
have identity badges available on request
after knocking on the door or ringing the bell, stand back at a safe
if the person answering the door makes you feel uneasy about entering then an excuse should be made not to enter; for instance when the patient or relatives are drunk or ‘high’ on non-prescribed drugs
you should follow the occupants in when entering and not take the lead
be aware of locked doors, is there a key in the main door? Can you escape reasonably easily?
remain alert while in the house look for anything that may present a problem
when taking a seat within the property, sit near an exit route, sit on the edge of the seat to ease movement
be aware of any obstacles that may prevent one from exiting the premises quickly

If in doubt:

do not enter premises, seek advice or assistance
plan your actions
if violence is threatened, leave immediately, if this is not possible head for the safest area, normally the bathroom because they often have locks

Personal safety:

do not take short cuts
walk facing oncoming traffic
appear confident in your demeanour
avoid groups of rowdy people
carry a torch in the dark
have a personal alarm readily at hand

On return to the car:

have your keys ready
check the interior before getting in
lock the doors as soon as you get in
check back with the team following a home visit
if for whatever reason you find you will not be back at the expected time you must ring and let colleagues know of any alterations
if you have to make a first visit at the end of a shift, check that you have a mobile phone, and report back to base or to another designated person
try to avoid working on laptops in your vehicle due to the risks of theft and patient data being viewed by members of the public

11.1.4 Known high risk home visits

If any visit is deemed to be a potential high risk, it may be necessary to visit in pairs. The need for such additional support should be discussed with your manager so that appropriate arrangements can be made.
For such visits it is recognised as good practice for staff to report back to their work base to confirm that the visit has ended and that they are safe. A record must be made of the times entering and leaving the patient’s home.

11.1.5 Interviewing patients in a consultation room

In addition to advice already given earlier in this document when interviewing patients in a consultation room consider the following:

use consultation rooms with panic buttons and widows in the doors where possible
sit nearest the exit
staff should make themselves aware of locks, bolts etc. on exit doors and observe how they work
inform colleagues that an interview is taking place
if there is ever a need to take a patient or visitor through a coded security door make sure that the client or visitor cannot see the code or knock on the door and be let through to maintain security

11.1.6 When a colleague does not return as expected

If one of your colleagues has not returned back to the office or rung in to confirm their whereabouts, then the first and most important thing is to remember not to panic! It may be that they have genuinely forgotten to let you know of changes to their plans or have been delayed.

In the first instance ask your other colleagues whether they have heard from that person or have been properly notified of changes to their plans.

If not, ring their mobile phone number and check to see that they are safe.

If you receive no answer, or if they answer but sound distressed, then you should notify their manager immediately. If they are not available, notify the most senior person on the premises and, or the Senior Manager on-call.

If it has not been possible to obtain an answer from their mobile, the Manager should, if suitable, then try to contact the person at home or through their next of kin before contacting the police.

In cases where the person answers but appears to be in distress, indicate they need assistance or other indicators of immediate risk or danger, the police should be called immediately (or other emergency service if appropriate).

If at any time you have immediate concerns for the safety of the member of staff, contact the police.

11.1.7 Immediate support following an incident

In the event of an incident, the manager should ensure that affected staff receive any necessarily medical treatment and, or advice. If an incident occurs out of hours the on-call manager should be contacted.

Managers should be sensitive to the need to talk about the incident and offer any assistance possible. If staff are a member of a trade union or professional association, they may find this an appropriate source of practical and emotional support. The importance of colleague support should not be underestimated; they may be seen as primary emotional support.

Staff should be made aware of the confidential counselling service offered by the occupational health department. Appointments can be made directly by the member of staff, or on their behalf by their manager.

11.1.7 Involving the police

If a situation arises which requires Police attendance, they should be contacted immediately.

The trust will actively explore the option of taking legal action in all cases of physical violence and in specified cases of verbal violence, if deemed appropriate, in line with the Directions to the NHS Bodies on Tackling Violence Against Staff (2003) and guidance of 2004 issued by NHS Protect.

The victim of the assault will be kept informed of the investigation’s progress and offered such support as is necessary or desirable in the circumstances.

11.1.9 Debriefing

After an incident of violence against a member of staff (whatever the severity from verbal abuse to physical assault) it is important that there should be an opportunity for the staff member to discuss the incident with their manager as soon as possible after the incident.

The purpose of debrief is to:

discuss the incident in order to support the member of staff
discuss the need for expert or further counselling for the member of staff.
check that the lone working policy has been followed
examine the details of the incident and if the policy and protocols worked.
recognise any protective factors or actions that may need to be implemented following the incident to protect staff or property.
Ultimately learn lessons from the incident to prevent recurrence, and that the learning is spread throughout the trust

11.2 Appendix B Initial home visit risk assessment

This information could be printed on a pocket-sized laminated card, which can be used as a reminder by staff when contacted and asked to make a visit.

Consider printing it as a wall poster for the office.

11.2.1 Risk assessment part 1

Did the request come from a recognised referral point?
Have you been made aware of any issues surrounding the patient or address concerned?
Have you checked all reasonable records to gather a relevant history?
Are you happy to attend on your own?
Does the purpose of your visit alter the risk assessment (are you going to impart difficult information or carry out a painful procedure or make the patient angry etc.)
If risk assessment indicates it, do you have your mobile phone or lone working device or pager or personal attack alarm with you? Ensure that they are switched on.
Do you know where you are going? Have you checked the map or asked colleagues, so that you do not get lost?
Does your car have sufficient fuel to make the return journey?
Can you park reasonably close to the visit location?

If any issues arise from these assessments, the staff should raise the issue with their line manager or the referrer.

Staff must also be aware that if, at any stage, they feel their safety may be compromised, they have the right to leave the area and ask to discuss their concerns with their manager in order to agree the best course of action.

11.3 Appendix C Risk assessment on arrival at patient’s home

This information could be printed on the reverse of the laminated part 1 assessment card, which can be used as a reminder by staff when contacted and asked to make a visit.