Searching of a person, (patients and visitors) and their property procedure

1 Introduction

We search to deter, prevent and detect, unsafe activities, by removing unauthorised items from patients; we may disrupt undesirable activities that limit opportunities to escape, harm others or harm themselves. A search can also gain intelligence in order for the Trust to deliver a higher standard of care.

Ultimately, search techniques provide a systematic procedure for finding articles which may present a threat to the safety of people or property, or which adversely influence the control of a ward area, thus disrupting the hospitals therapeutic task (Elvin 1989).

The searching of a person or their property is not routine and, as such, should only be carried out in exceptional circumstances, for example, where the dangerous or violent criminal propensities of patients create a self-evident and pressing need for additional security (Department of Health 2008). In such circumstances, nursing staff have a statutory duty to provide both a safe and therapeutic living and working environment for patients and staff and to protect the public. Therefore, searches are an essential and justifiable component for safe practice.

This procedural document takes into account guidance issued within a number of documents, including the Short-Term Management of Disturbed or Violent Behaviour in Psychiatric Inpatient Settings and Emergency Departments (NICE, 2005), and the Memorandum of Understanding between the Association of Chief Police Officers (ACPO) and the NHS Security Management Service (2006). It also follows the clear principles laid out within the Code of Practice Mental Health Act 1983 (section 16.11), which are:

to create and maintain a therapeutic environment in which treatment may take place and to ensure the security of the premises and the safety of patients, staff and the public
the authority to conduct a search of a person or their property is controlled by law, and it is important that hospital staff are aware of whether they have legal authority to carry out any such search
searching should be proportionate to the identified risk and should involve the minimum possible intrusion into the person’s privacy and dignity
to undertake all searches with due regard to, and respect for, the patient’s dignity

2 Aim

The aim of this document is to work in line with the Mental Health Act (MHA) code of practice requirements to provide a working procedure on searching patients detained under the MHA 1983, their belongings, surroundings, and their visitors (Code of Practice MHA 1983, section 16.10). This document provides guidance which is specific to the forensic service for all staff who are required to carry out both proactive and reactive searches.

3 Scope

This procedure applies to the searching of a person, (patients and visitors) or their property and is specific to the staff working within the forensic service who may need to undertake proactive or reactive searching.

4 Link to overarching policy, and or procedure

This procedure is overarched by the Forensic services manual and should be used in conjunction with the Rotherham Doncaster and South Humber NHS Trust (RDaSH) policy, searching of a person or their property policy, reducing restrictive interventions (RRI) policy (formerly PMVA policy) and the lockdown of a trust premise, site or building policy and procedures. Reference is required to the Forensic procedural document Prohibited and Restricted Items.

5 Responsibilities, accountabilities and duties

In addition to the overarching responsibilities, accountabilities and duties as detailed in the forensic manual, the following professionals have the additional responsibilities as detailed.

5.1 Senior sisters or ward managers, sisters or deputy ward managers

The managers of the unit have the frontline responsibility for ensuring that:

the principles and practicalities of the procedure are embedded within nursing practice
training is attended by nursing staff where required
care plans around searching are audited and reviewed with patient involvement where appropriate
search equipment is readily available for effective searches to be carried out to deter, prevent and detect unwanted risk on the ward (see information detailed in appendix L, security box inventory)

It is the responsibility of the senior sisters to bring any issues around searching to the modern matron.

5.2 Named nurse

It is the responsibility of the named nurse, where justifiable and appropriate, that search care plans are written with the patient, and include:

level of compliance in searches, both historic and current
the highlighted areas of risk concern, with reference to appropriate risk assessments, for example, HCR20 or SVR20 or RSVP or FACE
any contraband or concerned items found, both historically and more recently
multi-disciplinary team (MDT) involvement in the care plan
the patient’s level of insight into the risks
any religious or cultural guidance for staff, if appropriate to the individual, in relation to searching. This should include consultation with relevant communities
an attached form that highlights the dates and times of previous searches and provides a quick guide for staff. It is important, however, that planned proactive searches (planned randomly) are not added to the chart for patient access

It is important that the care plans are robustly reviewed, and that any concerns are highlighted in the review, for example, volumetric control is fed back to MDT for guidance. It is also important that named nurses are responsible for ensuring that patient inventories (clothing and belongings) are up to date and are reviewed regularly with the patient’s special interest workers. An up to date patient inventory will act as support during a room search if any unknown patient items are found in rooms.

5.3 Shift co-ordinators

Qualified nurses as shift co-ordinators must have an understanding of the current care plans in place, have the knowledge and competence required around the carrying out of searches (both proactively and reactively) and risk, and are to be able to take the lead in organising this in a timely manner. Therapeutically, it is the responsibility of the shift co-ordinator to bring any issues around searches to the notice of the senior sister, sister and responsible clinician, where appropriate.

5.4 All nursing staff

All nursing staff have a responsibility to conduct their practice in line with this procedural document and in accordance with the MHA 1983 and its code of practice. Staff must attend any training which is provided to promote its implementation and bring any issues regarding searches to the shift coordinator, senior sister and sister.

6 Procedure or implementation

6.1 Room search

On occasion, either proactively or reactively, rooms within the building may require searching. The need to search bedrooms and their local environments is, in principle, for the same reason of detecting, deterring and preventing risk. However, the searching of a patient’s bedroom requires a personalised approach, the ability to understand the differing risks that each bedroom may present, and how searching can also provide a means of gathering intelligence or information on a patient during a search.

If when the patient is asked for permission, this is not given, then it is important that a conversation is held with the patient to attempt to seek out the reasons for refusal. If the patient continues to refuse, then the responsible clinician is to be contacted for further advice. In the meantime, unsupervised access to the patient’s bedroom is to be prohibited and, where possible, access locked off.

It is important that a room search is carried out with the correct prior planning. It is essential that staff are professional, approaching and acting in a manner that shows empathy and respect for the patient’s feelings and property.

6.1.1 Room search (with or without patient consent)

It is important, prior to the search being carried out, to ask the patient if they have any restricted or prohibited items in their room, see appendices G and H. Once the room search is organised, the patient is to be advised of the search in an appropriate place, for example, visitors room to allow privacy.

The patient is not to re-enter the bedroom once this information has been handed over. However, where possible, neither should the search be delayed after the information has been passed to the patient.
If they so wish, the patient may be in attendance whilst the room search is carried out. Prior to the room search the patient will have a rub-down search (see section 6.2). The patient will be asked if they have any items of value (including religious items). If yes, these items will be searched first before being handed back to the patient.
If the patient chooses to be in attendance it is important that they remain sat outside of the bedroom, allowing them sight of the search whilst ensuring the search is carried out within the same sterile environment from the point that staff enter the room to begin the search. Staff should also have a clear exit out of the room.
Ensure that the search box is readily available prior to the search being carried out. The inventory of the search box should be checked, in addition to checking that the equipment, for example, torch or search wand, is in working condition. Standard personal protective equipment (PPE) equipment will be readily available in the box, for example, gloves and aprons.
However, the searching staff are to ensure, where appropriate, that extra PPE equipment is available, if any risks are highlighted within the patient’s individual search care plan or if any risk is highlighted either prior to, or during, the search.
The search will be carried out by two members of staff, one of whom will be the same gender as the patient. The other will be a registered nurse.
The registered nurse will be responsible for leading the room search. It is preferable that either the registered nurse, or the same gender staff member, has attended the divisional forensic enhanced search training.
It is essential that, prior to searches being carried out either proactively or re-actively, that individual care plans are read thoroughly and that both searchers have a good understanding of the individual’s current and clinical risk, whilst also taking into consideration any cultural and, or religious beliefs.
The room search is to be carried out in a systematic fashion, for example, starting from top to bottom, left to right, breaking the room down into agreed segments and ensuring that all areas are adequately searched.
It is paramount, however, that the searchers do not check any areas with their fingers which they cannot visibly see, this is to protect them from potential harm. Searchers are to use the search mirror (available in the search box) for these areas.
The staff member leading the search will be agreed prior to the search commencing and will commence the room search, with the second staff member. Identifying areas within each segment or area to be searched will be completed first. The items in each segment, including loose furniture, will be moved (where possible) to the middle of the room and searched prior to being placed back. Reasonable effort is to be made to replace items as they were originally found.
It is important that the room search is continuously carried out by two members of staff, as this will be key if any allegations are made, assaults attempted, or if any damage is reported or found or accidentally caused during the search.
Any issues around search fatigue, for example, if a search is taking over 2 hours, are to be discussed with the lead searcher and, if required, staff are to be given the opportunity to swap. It is important however that wherever possible, one of the original searchers remains, to ensure consistency and continuity.
If any items are required to be removed from a room during a search, the patient or visitor is to be given a receipt for the items removed and an explanation is to be given as to why. Details for ordering a receipt booklet can be found in appendix K.
In circumstances where damage is caused during the room search, this must be reported, with any damages caused maybe being replaced.
If any portable devices, for example, PlayStations, memory sticks, are unable to be checked at the time, then it is imperative that these are removed for checking. If the devices are unable to be checked on area, then the RDaSH IT service are available to support in searching the memory of such items, and should be contacted as follows:
- log the required search as urgent
- the system will confirm and will allocate the search an assignment number.
- the item to be searched will be forwarded to second line desktop at Chestnut View
- Chestnut View will contact the area with a date and time for the device to be delivered
- staff to attend Chestnut View on the date and time given and remain present during the search of the item. Any evidence, for example, printing of the memory contents etc. is to be carried out at this time and the item returned to the ward.
- any contraband or concerns identified within the search are to be fed back to the responsible clinician
At the end of the search it is important, and of therapeutic value, that the patient’s compliance during the search is acknowledged by the searchers. At this point, a post-incident review is to be offered to the patient, both consenting or not.
The outcome of the room search will be conveyed to the responsible clinician, detailing the length of time of the search, the level of compliance from the patient, a general description of the bedroom searched, for example, clean and tidy, a list of items removed (if any), the reasons why and also any intelligence gathered. This information is also to be documented within the patient’s electronic records and updated within the individuals care plan. Any further action required will then be decided by the responsible clinician or ward manager, out of hours the manager on call.

It is noted, and staff are to be mindful when carrying out room searches, that patients restricted mail, for example, tribunal letters and Ministry of Justice correspondence, can be searched but is prohibited from being read.

6.1.2 Full ward search

It may at times be necessary to conduct a full ward search. Prior to this being initiated the nurse in charge will contact the ward manager or out of hours manager on call to obtain authorisation. The ward manager or manager on call will coordinate the implementation of the ward search including procuring any additional resources (including staffing). Please also refer to lockdown of a trust premise, site or building policy and procedures.

6.2 Rub-down search

Rub-down searches can be carried out either pro-actively or reactively.
Proactively with justification around areas of risk that will be agreed and implemented through a care plan.
Reactively in circumstances whereby highlighted risk deems that a search must be completed to prevent harm to the person, others, or members of the public.
As a minimum, two staff are to carry out this procedure, one being a registered nurse and the other being required to be the same gender as the patient or visitor.
It is essential that the person who will be physically searching the patient or visitor is of the same gender as the patient or visitor. If, in extreme circumstances, there is not a male member of staff on the ward, then male staff are to be temporarily redeployed to carry out the search. The role of the second member of staff is to observe the procedure as support for the staff member carrying out the rub-down search.
Prior planning is important before commencing the search. The searching staff are to ensure that the search box is readily available and that all required equipment is in working order.
Where appropriate, the searching staff are to have completed the search training.
The searching staff are to ensure that an appropriate room, for example, the visitors room, is readily available for the search. This is to promote privacy, whilst also allowing an appropriate amount of space to carry out the rub-down search.
When appropriate, the patient should be asked to move to the appropriate area for the search to be carried out. Under no circumstances is the patient to be given prior warning of the search, as this could give them the opportunity to remove any items from their person.
It is essential that, prior to the search being carried out, the patient is asked whether they give permission for the search to be carried out.
Upon permission being given, the individual is to be asked whether they have any contraband items, or items of concern, upon their person. If patient is not consenting, staff are to discuss immediately with the responsible clinician and MDT.
It is important that, from the commencement of the procedure, the staff empathise with the patient, have an understanding of the procedure being carried out upon the patient and, where possible, maintain a therapeutic level of engagement with the individual, to promote both therapeutic working and to minimise the level of risk, where possible.
Once permission is granted and any contraband items discussed, then where relevant, the patient should be asked to remove any watches and outer wear, empty their pockets and remove shoes.
Staff are to ensure that the patient is asked to remove any religious or medical headwear, for example, Sikh turbans or wigs, and that they are encouraged to remove these themselves. Staff should search these items and allow the patient to put them back on at the earliest opportunity, and prior to the rest of the search being carried out.
At this point, the patient can be searched in a systematic manner, using the hand held metal detector from top to toe and section by section, as detailed in the flow chart (appendix J).
Once the search has been carried out using the search wand, it is then to be repeated (again, as detailed in the flow chart appendix J), with the searcher using their hands, as below, rubbing down on the clothed body.
Staff are not to rub-down areas of bare skin, for example, if the patient is wearing a t-shirt, as these areas are visible to the eye.
Once this has been carried out, a thorough search is to be made of any items removed, for example, shoes, watches etc.
The searching staff are to pay particular attention to items such as watches, which can have additional built-in devices, for example, lighter or cameras, recording devices.
Staff are to ensure that receipts are given to the patient if any contraband or items of concern were removed from them.
Outcomes of the search are to be documented within the patient’s electronic record.
If in any situation a patient either refuses a rub-down, or a rub-down has been carried out but staff still have concerns regarding a secreted item which they have been unable to detect during the rub-down, then the responsible clinician should be contacted for further advice at the earliest opportunity.
Currently, the low-secure forensic service staff are not trained to carry out any higher-level searches, for example, body searches. There are occasions, however, when staff will have to carry out a rub-down of a patient under restraint.
All nursing staff are able to carry out this search after completing the mandatory prevention and management of violence and aggression (PMVA) training. This may be deemed necessary, following discussion with the responsible clinician, if the patient does not give permission or during occasions of restraint if a patient requires secluding.
At the end of the rub-down search where permission was given by the patient, the level of the patient’s compliance should be acknowledged by the searchers. A post-incident review is also to be offered to the patient.

6.3 Floor restraint searches

This method of searching should only be used in exceptional circumstances, such as prior to the seclusion of a patient, and will only be conducted after the patient’s early warning scores (EWS) have been completed and the patient is in the supine (face up) position.

Once the patient is in supine restraint, the lead person will ask the patient if they have any items on their person that are illegal, dangerous or restricted.
The patient should then be informed that they will be searched.
A staff member of the same gender as the patient will then begin the search, initially using the metal detector wand or glove.
The search will be conducted in a systematic or logical order, for example, starting at the head and working down one side, and all areas such as pockets, collars, cuffs, hair, waistbands, socks and shoes etc, are to be searched.
Once the search has been completed on one side, the staff member conducting the search will move to the other side of the patient and the staff who are undertaking the restraint will be required to adjust their position to allow easy access to the patient for the search to be completed.
Wherever possible, the staff member conducting the search is to avoid leaning over the patient to search their other side, as this can be intimidating for the patient.
Staff are not to put their hands into any pockets, and should use equipment such as tongs to pull anything out.
If the search is being undertaken prior to seclusion, then the patient’s shoes, socks, belts etc. are to be removed, as per the procedure for the secluded or segregated policy management of a secluded or segregated patient.
Once the metal detector search has been completed, a rub-down search should be conducted over the same areas previously searched, in order to pick up on anything that is not metal and so overlooked in the previous search.
Throughout the search, the lead nurse should be constantly reassuring the patient and keeping them informed as to what is happening and why.
Once the supine search has been completed (this can take as long as it needs to take, do not rush it, as both patient and staff should be safe and secure in this position), the clinical team can consider whether a search of the patient’s back is required.

6.3.1 Action if a search of the patient’s back is felt necessary

The patient should not be turned into a prone position to conduct a search of their back.
The restraint team should turn the patient onto their side to conduct a search of their back (the restraint can still be maintained during this time).
The patient can then be turned onto their opposite side, if required, to ensure that a thorough search is undertaken.
Once the patient is on their side, a full metal detector search can be completed of their back (this may require adjustments from the restraint team) followed by a pat-down search.
It is important that, during the search, staff are mindful of the physical monitoring (EWS) of the patient (as per trust policy) and, if necessary, the search can be halted in order to complete this.

6.4 Documentation

16.18, a comprehensive record of every search, including the reasons
for it and details of any consequent risk assessments, should be made. (Code of Practice Mental Health Act 1983).

In all cases the following action must be taken by the nurse in charge as soon as possible after the search has taken place, and before the end of their period of duty.

Complete and submit an electronic incident form (IR1).
Complete the record for when a search is carried out (see appendix I) and file in the patients clinical records.
Explain to the patient that any illicit or dangerous items will be disposed of and not returned to them upon discharge.
For any other items removed, the patients’ monies and property procedure must be followed.
The nurse in charge is to ensure that the patient or staff debrief be carried out on the template attached within the appendices M and N.

16.26, where a patient’s belongings are removed during a search, the
patient should be given a receipt for them and told where the items will be stored (Code of Practice Mental Health Act 1983).

The nurse in charge will make a decision regarding any level of observation the patient may require if appropriate and record this in the patient’s clinical record once the search has been carried out. This is to be assessed on an individual basis.
The patient’s risk assessment and care plan will be amended accordingly, if appropriate, and if changes are required to be made.
Inform the patient of the listening and responding to concerns and complaints policy (formally complaints handling policy), should a patient wish to make a formal complaint in relation to the search.

6.5 Action to be taken if a visitor is suspected of possessing a dangerous item, drugs or alcohol

The nurse in charge will discuss staff suspicions with the person concerned, explaining why the items are not allowed onto the ward and ask them to hand in anything they may have on them.
If they deny having anything on them, the nurse in charge will ask the person if they will consent to having their baggage and person searched.
If they agree, staff will continue as for rub down search (6.2) search, informing the person that any illicit or dangerous items will be removed, disposed of and not returned to them. Any other items will be removed, a receipt issued and retained until the visitor leaves.
If the person refuses to have their baggage and person searched, staff will deny them access to the ward and ask them to leave, explaining their reasons.
The patient they had come to visit will be informed why the person was not allowed access to the ward.
An electronic incident form (IR1) will be submitted.
The record for when a search is carried out is to be completed (see appendix I) and filed in the clinical records of the patient who was being visited.
The ward manager, responsible clinician and modern matron are to be notified.
A decision will then be taken as to whether the visitor may visit the patient. This will be a multi-professional decision lead by the nurse in charge of the ward or matron, along with the consultant.
When making the decision, due regard must be given to the maintenance of a safe environment for all patients and staff. The decision will be fully documented within the patient’s clinical records and will also have a process for review included.
Inform the visitor of the listening and responding to concerns and complaints policy (formally complaints handling policy).

6.5.1 Disposal of dangerous and illicit items

If the search uncovers evidence of serious criminal activity or where a need arises to preserve evidence then the items should be:

handled as little as possible to preserve and avoid the contamination of any evidence
secured in a place of safety (away from the patients).
the police are to be contacted and the local security management specialist (LSMS) informed
further advice on how to preserve evidence will be given by the Police and, or the LSMS.

6.5.2 Alcohol removed from the patient

This will be disposed of by 2 staff members with the patient present, if they wish.
The alcohol will be poured down the sink and the bottles or cans safely disposed of.
A record is to be made in the patient’s clinical records indicating what was disposed of and by whom.

6.5.3 Prescription or over the counter drugs removed from the patient

Any medicines brought into hospital by a patient remain their property and will not normally be destroyed or otherwise disposed of without their agreement.
In the event that the patient is unable to consent to the disposal or not of these medicines, agreement can be sought from their carer.
If the patient or carer refuses to agree to the disposal of the medicines, they can either be held in a sealed bag in a separate section of the medicines cupboard away from all the stock medicines until discussion with the MDT OR if the patient insists be returned home.
However, the patient and, or their carer must be advised that as the treatment regime will be reviewed whilst the patient is on the ward, it is likely that the supplied discharge medication will be different, and that this may pose a real risk that the wrong medication may be taken in the future.
If there are safety concerns in relation to the medication being returned home, then the nurse in charge, in consultation with the consultant psychiatrist, may make a decision to refuse to return the medicines and have them destroyed.
For the safe disposal of any medicines, staff should refer to the guidelines issued by their supplying pharmacy.
All actions taken should be fully documented within the patient’s clinical record.

6.5.4 Suspected illegal drugs

The trust does not condone the use of illicit substances and in accordance with its duties under the Misuse of Drugs Act (Home Office 1971) will not knowingly permit the use of, or dealing in, illicit substances on its premises.

If any visitors are seen to be in possession of a suspected illicit substance, they will be asked to leave the premises.
If any visitor is seen to, or suspected to have passed illicit substances to a patient or other visitor, they will be asked to leave.
The nurse in charge of the ward will then consult with the matron matron or service manager about the need to report the matter to the police and consider the appropriateness of further visits by this person.
In the event that it is a patient who is suspected to have illicit substances upon their person or within their room or belongings, the nurse in charge of the ward will discuss their suspicions with them and ask that they voluntarily hand over the substance for destruction.
This discussion must be held in the company of another staff member who will act as witness to the handing over and disposal of the suspected illegal drug.
The illicit substance will be:
- placed in an envelope
- an entry will be made in the controlled drug register under the heading of unidentified substance
- the envelope will be labelled with a reference number linking it to the entry in the controlled drugs register
- the envelope will be sealed. Both the nurse in charge and the witnessing staff member will sign and date across the sealed flap of the envelope
- the envelope will then be locked in the ward’s controlled drug cupboard
- in order to maintain patient confidentiality, their name will not be documented in the controlled drug register
- the chief pharmacist, accountable officer for controlled drugs, should be notified of the unknown or illicit substance as soon as it is practicable and arrangements will be made for the removal and safe disposal of the substance by the trust pharmacy department
- if staff involved in the removal of illicit substances from a patient have reason to suspect that the quantity involved is greater than for personal use, advice should be sought from the modern matron with regard to the need for the matter to be reported to the police.

Note, under no circumstances will any suspected illicit substances be returned to the patient. If the patient refuses to hand over the illicit substance for destruction, they are to be placed on 1-to-1 nursing observations and the need for further action, including searching, will be discussed with the modern matron and the patient’s consultant psychiatrist.

All actions taken will be recorded in the patient’s clinical record, or in the case of a visitor, on the ward report.
An electronic incident form (IR1) will be completed and submitted for all incidents.

6.5.5 Weapons

Small sharps can be disposed of in the ward sharps bins, but with regard to any guns, hunting knives or other items that staff are unsure about, the police should be notified, and will collect and dispose of the item. An entry will be made in the patient’s clinical record indicating what was disposed of, when, and by whom.

Note, under no circumstances will illicit or dangerous items be stored and returned. Nor will anyone be compensated for the loss of such items.

7 Appendices

Please see forensic services manual webpage for appendices attached to this procedure.

Appendix G Restricted items
Appendix H Prohibited items
Appendix I Pro-active search record
Appendix J Rub-down search
Appendix K Receipt booklet order details
Appendix L Search box inventory
Appendix M Patient debrief template
Appendix N Staff debrief template

Document control

Version: 2.2.
Unique reference number: 535.
Approved by: Clinical policies review and approval group.
Date approved: 5 October 2021.
Name of originator or author: Forensic ward manager and social worker.
Name of responsible individual: Executive director of nursing and allied health professionals.
Date issued: 13 April 2023.
Review date: 30 April 2024.
Target audience: All staff working in the forensic service.
Description of change: Minor amendment, correction to the review date approved 21 April (originally with 12 month review), this was amended to a 3 year review so corrected to April 2024.

Page last reviewed: April 24, 2024
Next review due: April 24, 2025

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