Contents
1 Introduction
The Management of Health and Safety at Work Regulations 1999 require employers to carry out risk assessments of all hazards that pose a risk to staff and service users including the assessment of the risks from hot water temperatures being too high and presenting a scalding risk to vulnerable people who use health and social care services.
Those at risk from scalding include service users who: lack capacity; have learning disabilities; sensory impairments and, those who cannot react appropriately or quickly enough to prevent injury due to mental and, or physical health problems or mobility problems.
Where it is considered that service users are vulnerable to scalding, the health and safety executive (HSE) recommends that:
- water temperature to the bath or shower outlet is no more than 43C (plus or minus 1C) for baths, wash basins and showers
- water is prevented from being discharged above this temperature from taps that are accessible to vulnerable people, especially where there is a risk of total body immersion
Water temperature is controlled by thermostatic mixer valves (TMV’s). However, in health centres and clinics where TMV’s are not fitted, all outlets have fixed notices indicating ‘very hot water’.
The trust has a separate water systems policy, the purpose of which is to make sure as far as possible that the trust is exposed to minimum risk in relation to water systems.
The policy for the prevention of scalding and drowning supplements the water safety policy.
2 Purpose
The purpose of this policy is to raise staff awareness of the risks of scalding and drowning to vulnerable people in in-patient and, or residential areas and the arrangements and procedures in place to minimise those risks.
3 Scope
The policy covers the risk to vulnerable people of scalding from hot water outlets and the risk of drowning and is applicable to staff working within in-patient and residential areas. This is a trust wide policy and is relevant to all members of RDaSH staff, RDaSH employees based within RDaSH premises or service provision, students, contractors and visitors.
4 Responsibilities, accountabilities and duties
4.1 Board of directors
The trust has a duty under the Health and Safety at Work Act 1974 with regard to the risk to vulnerable people who use health and social care services of scalding from hot water and drowning. The board of directors is responsible for having in place suitable arrangements to minimise these risks as far as is reasonably practicable.
4.2 Matrons or residential area managers
Matrons or residential area managers are responsible for:
- risk assessing and reviewing service user’s needs regarding scalding or drowning risk, on admission services will utilise the seizure checklist V1 (or equivalent clinical risk assessment procedures) and have in place suitable care plan arrangements
- making sure their staff are aware of and comply with the policy, through local induction, instruction, supervision, audit etc.
- monitoring adherence to the policy and taking immediate action where non-adherence is identified
- bringing to the attention of estates staff any issues to do with the regulation of water temperature
- immediately restricting the use of any hot water outlet where problems with temperature regulation arise, until such time as estates staff have dealt with the problem
- reporting all incidents via the Safeguard electronic (IR1) incident reporting system
4.3 Staff in in-patient or residential areas
Staff in in-patient or residential areas are responsible for:
- risk assessing and reviewing service user’s needs regarding a scalding or drowning risk.
The learning disability services, and Magnolia ward will utilise the seizure checklist V1 which should be completed on admission. On the other wards the checklist will be completed if there is a history of seizures or at the point of a risk being identified. The management of the risk will be included in the patients care plan and suitable care plan arrangements will be in place.
- The patients care plan will reflect if there have been any episodes or incidents that indicate a seizure may have occurred including the same observation needs as if epilepsy were present until a definite diagnosis is established.
- Care plans must reflect the NICE guidance standards. NICE clinical guidelines are recommendations on how healthcare and other professionals should care for people with specific conditions. The recommendations are based on the best available evidence. Clinical guidelines are also important for health service managers and those who commission NHS services, (30 Nov 2012).
- Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible (NG86) (2018) (opens in new window).
- Monitoring and recording hot water temperatures weekly by nursing staff. These are carried out on a weekly basis by estates.
- Bringing any issues in relation to the regulation of water temperature to the attention of the manager. Ensuring that with immediate effect the use of any hot water outlet where problems with temperature regulation arise is restricted until such time as Estates have dealt with the problem.
- Reporting all incidents via the Safeguard electronic (IR1) incident reporting system.
4.4 Estates department the estates department
Estates department the estates department are responsible for:
- responding urgently to requests from managers or staff to review any issues to do with the regulation of water temperatures and completing any remedial action required
- making sure that any new buildings or those which undergo change of use where service users who may be vulnerable to scalding will be cared for comply with the HSE recommendations
5 Procedure or implementation
5.1 Hot water temperatures
All hot water outlet temperatures must be monitored weekly and recorded on the trusts formal ‘recording sheet for hot water temperature’ (see appendix A). The process of how to test the water temperature will be covered during the local induction process for staff.
5.2 Estates department
If the water temperature does exceed 43C (plus or minus 1C) the estates department contact must be notified immediately, and a visible sign displayed informing others that it must not be used until further notice (in areas where the service users may be unable to read a notice, the area must be made in accessible, or the hot water tap disarmed).
5.3 Initial and subsequent assessments
All staff must familiarise themselves with the service user’s individual needs and abilities as identified in their initial or subsequent assessments. The findings of which must be recorded in all the service users care plans which cover any activity that presents a scalding or drowning risk. This information should be identified to the team via the handover and all departments should have appropriate recording arrangements in place to evidence that this information has been communicated.
5.4 Risk
Service users who have been assessed as being at risk and are using bathrooms must be supervised according to their assessed need as identified in the care plan. Staff must be conscious that any health risks, for example epilepsy, outweigh other considerations, for example, individual’s privacy.
5.5 Checking the temperature
Where a service user has been identified as being at risk, staff must check the temperature of the bath water using a bath thermometer prior to the patient entering the bathroom.
5.6 Security of bathroom area’s
Baths should not be filled and left unattended except in exceptional circumstances, and in such cases the room should be secured to prevent unauthorised access.
5.7 Appropriate risk assessments
Risk assessments which are determined by the manager as appropriate must be undertaken when other premises are accessed, for example, leisure centres or service user holidays.
5.8 Hot surfaces
Health and social care providers often care for people who are vulnerable to the risk of scalding or burns. Contact with surfaces above 43°C can lead to serious injury. Prolonged contact often occurs because people have fallen and are unable to move or are trapped by furniture. Incidents often occur in areas where there are low levels of supervision, for example in bedrooms, bathrooms and some communal areas.
You should assess potential scalding and burning risks in the context of the vulnerability of those being cared for. A risk assessment of the premises should be carried out to identify what controls are necessary and how the systems will be managed and maintained.
6 Training implications
The requirements for temperature monitoring will be included during local induction, and new staff informed how to access the policy. Awareness of the policy will also be made at the following:
6.2 Community life support or moving and handling, staff working in in-patient or residential areas
- How often should this be undertaken: Annually CLS.
- Length of training: 3 hours.
- Delivery method: Face to face.
- Training delivered by whom: CLS trainer.
- Where are the records of attendance held: Electronic staff record system ESR.
6.2 Community life support or moving and handling, staff working in in-patient or residential areas
- How often should this be undertaken: Moving and handling.
- Length of training: 2 hours.
- Delivery method: Face to face
- Training delivered by whom: Moving and handling.
- Where are the records of attendance held: Electronic staff record system ESR.
- 1-to-1’s
- Team meetings.
- Team talk.
- Daily e-mail bulletin.
7 Monitoring arrangements
7.1 Hot water temperature
- How: Weekly monitoring (see appendix A).
- Who by: Designated member of staff.
- Reported to: Matron or area manager.
- Frequency: Weekly.
7.2 Incident reports where water temperature is highlighted as a contributing factor
- How: On-going review of incidents.
- Who by: Health and safety lead and patient safety lead.
- Reported to: Senior manager where concerns arise from incident report.
- Frequency: As incidents are identified.
7.3 Incident reports where water temperature is highlighted as a contributing factor
- How: Quarterly report.
- Who by: Health and safety lead.
- Reported to: Health safety and security forum.
- Frequency: Quarterly.
8 Equality impact assessment screening
To download the equality impact assessment for this policy, please follow this link: Equality impact assessment.
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
A plan will be in situ to ensure that patients with disabilities have any risks minimised and care is delivered to them with privacy, dignity, and respect. The wishes of patients for same sex staff will be accommodated. Easy read information will be available.
Toilet signage in public areas to read as non- gender specific. Most in-patient areas are single room with en-suite facilities.
8.2 Mental Capacity Act
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).
9 Links to any other associated documents
10 References
- Health and Safety Executive (2012) Scalding Managing the risk from hot water and surfaces in health and social care (opens in new window).
- National Institute for Health and Care Excellence (NICE) (2012) Patient experience in adult NHS services: improving the experience of care for people using adult NHS services (CG138) (opens in new window).
- National Institute for Health and Care Excellence (NICE) (2018) People’s experience in adult social care services: improving the experience of care and support for people using adult social care services (NG86) (opens in new window).
- NHS England (2015) Independent Review into issues that may have contributed to the preventable death of Connor Sparrowhawk 2015 (opens in new window).
11 Appendices
11.1 Appendix A Recording sheet for hot water temperatures
11.2 Appendix B Seizure admission checklist and risk management plan
Document control
- Version: 13.
- Unique reference number: 404.
- Approved by: Clinical policy review and approval group.
- Date approved: 26 July 2021.
- Name of originator or author: Community nurse.
- Name of responsible individual: Clinical policy review and approval group.
- Date issued: 13 August 2021.
- Review date: July 2024.
- Target audience: Staff working in in-patient areas or with estates functions and responsibilities.
- Description of change: 3 year review amendments and updates.
Page last reviewed: April 22, 2024
Next review due: April 22, 2025