Despite even the most rigorous risk management, serious incidents can still happen in services. Providers should develop appropriate policy and procedures for dealing with serious incidents. This section outlines some good practice considerations in sensitively and effectively responding to a serious incident.
Minimum Standards | Necessary policies | Procedures | Written guidelines | Investigating and reporting | Involving the police | Legal responses | Reporting | Criminal | Post-incident support | Follow up | Good practice checklist | Links
In addition to the risk assessment policy and procedure, but linked to it, services should have clear policies, procedures and guidelines for dealing with serious incidents, such as:
The policy should define 'serious incident' - some providers call it a critical incident - and give examples. For example, some providers say that any incident that necessitates the use of emergency services must be considered a serious incident.
Written guidelines covering foreseeable serious incidents should be readily available to staff. These guidelines should describe the circumstances in which they should be followed and the roles of the staff on duty. They should also include:
The guidelines should set out when staff would be expected to involve the police or other emergency services.
Any serious incident should be the subject of an investigation. The findings of this should be written up in a report and a copy kept. The investigation and report should be completed as soon as possible after incident.
Incident forms should include:
Incidents should be recorded as soon as possible after the event, with those involved agreeing and signing the record. Organisationally, it is a good idea to set a maximum time frame - eight working hours, 24 hours, within three days, but certainly the sooner the better - for describing the incident and the immediate action taken. Further maximum time frames need to be set for the discussion and recording of decisions on what can be learned, and changes that need to be made to policy, procedure, training requirements, etc.
Good practice tip
Use a pro forma to record incidents. This goes some way to standardising what is written and how it is seen and used. The alternative, that each incident is recorded according to who happened to be involved in it, perhaps on a blank sheet of paper, lends itself to too much scope for difference. Pro formas give more protection to service staff as, if they are following recognised procedure, they can be less open to individual criticism or claims of bias and malpractice in the event of any subsequent enquiry.
When describing an incident, a clear distinction between fact and opinion should be maintained at all times. For example, saying that someone was being sexist is an opinion; saying exactly what they said and then saying that you felt this to be sexist are two distinct facts. Saying someone was drunk is an opinion; saying that their unsteady movements and slurred speech led you to conclude that they were intoxicated is a fact. As a general principal, record everything as though you were going to read it out in court - how would you justify each statement?
Two people should go over any incident together, to make sure nothing relevant has been left out. The report should be signed by each person involved and countersigned by line or duty managers. After a little time has elapsed it will be important to talk about what can be learned so as to minimise the risk of such an incident happening again - policy, procedure, training, etc. It will be vital for managers to strike a balance between supporting individual members of staff and making sure that poor practice is challenged and eradicated.
Sometimes there will be a build up to an incident. If so, do as much as you can to enable a discussion between the people who are going to try to deal with it. Discussions should feature; how the individuals are feeling; who will take the lead and who support; likely scenarios. Immediately after an incident, or certainly within the same working day all of those on shift need to have a debrief to talk things through - even if the people involved say they don’t want it, as people’s reaction to things will often be delayed.
Over time these records will allow service management to build up a picture of trends and will inform future risk assessment. Where services are members of larger organisation any serious incident forms need to be collated centrally
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There will be all sorts of different things to consider in terms of involving the police in incidents in your project. Sometimes people see involving the police as a failure in itself and worry about the effect on trust, etc., when people in uniform enter the project. However, the police are paid to deal with situations that you are not, and often it will be the only way of addressing a situation.
There’s not much point in telling people that you are going to call the police unless you are actually prepared to do so. If you do ring them, try to tell people that you have done so.
A manual produced by CRISIS on running winter shelters is relevant here: ‘If all else fails don't be afraid to call the police. While it is important not to blow situations out of proportion it is equally important to be very clear about what behaviour will be tolerated within the project. Your actions will have to find a balance between being objective about the incident, providing a visible deterrent for the future, and reassuring other residents that their safety will be protected throughout their stay.’ Carter, M (ed) (1996) (Name of publication?)
Services have experienced both the extremes of 40-minute waiting times on emergency calls and van-loads of police turning up and rushing into the centre. One way of overcoming this problem is to make contact with the police prior to incidents, telling them what you do and, on the whole, what type of support you might require. A little bit of police liaison can go a long way, in terms of how sensitively and quickly they will react to situations. Some projects have clearly benefited from good working relationships with their local police. It also helps to discuss notions of confidentiality, the circumstances where you would co-operate with the police and those that might be less straightforward, might help clear up any confusion. Protocols should be set up via the local inspector of sector responsible for management of the locality. A positive working relationship should also cover how you can help the police for example so they know who they can refer individuals to your services
The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 requires employers to report and keep records of certain violent assaults on their employees. See the information on RIDDOR in the Health and Safety Overview in this section. Beyond this, internal reporting should capture information on a wider range of less serious incidents and 'near-misses'. This will help in evaluating the precautions being taken.
If someone assaults another person in the service, should they be prosecuted? This varied greatly from service to service and is an area which should be discussed as a team prior to such a situation arising. It also should be discussed with individuals involved if such a situation arises. It can produce very different perspectives and, if a person has been assaulted and decides either to press charges or not to do so, they can feel very isolated and unsupported if their colleagues take a different view. If the incident included a criminal act against a service user or a member of staff, the provider should assist the victim in pursuing criminal charges and getting support through, for example, victim support organisations and the criminal injuries compensation fund.
The aftermath of a serious incident can have a profound impact. Both service staff and service users involved should be given support and offered counselling when appropriate.
Stress levels will be higher perhaps creating risk of further incidents. Service users may themselves have been traumatised by a violent or other serious incident, even when they have not been the direct victims of it. They may feel that their safety is at greater risk and will have greater anxiety and stress. Consider addressing these issues in one-to-one sessions. These could be informal session to gauge the service users reactions, or more specially arranged sessions if it appears appropriate.
It is not just witnesses to serious incidents that can find themselves feeling traumatised. It is important that support is offered to people who work in a similar role who may not have been there at the time. Your local Victim Support scheme will be able to help you with information on services available.
De-briefing in a supportive manner is important as staff involved may be defensive if they feel their professionalism is being questioned. An atmosphere of mutual trust, respect and support in the team will be important.
It is important that serious incidents are used as opportunities to learn. Constructive assessment of what happened will be impossible if there is a culture of blame and fear among staff. People do make mistakes, especially when they are under stress, but learning from them will be impossible if there is a lack of honesty about what happened.
Bringing staff together has two functions:
In cases of very serious incidents, for example where there have been deaths or serious physical harm, the service manager should consider accessing professional counselling for those who had to deal with the incident. Help in coming to terms with the incident will be invaluable and will probably reduce the chances of sickness through stress or trauma.
Procedures after an incident need to take into account different individual needs. It may be that some people will want to talk it through immediately, others will feel much more like talking about what has happened after some time has elapsed. It may be that the worker who has been in the firing line wants to go home, but they may later feel that they are isolated and have been sent away without much needed colleague support. It may require continued support from other staff to get people to talk at all about how they feel. However, a de-brief, no matter how short at this point, should take place immediately after the event, with a longer one or more one-to-ones later on if necessary. Several staff interviewed as part of this research, spoke about bouncing back immediately afterwards and not acknowledging what had happened, only to feel really shaky several days later. Other staff have to be made aware and remember that there may be a delayed reaction and have the mechanisms in place to respond to that. If the incident has had a particularly profound impact, projects should also be able to offer some form of external support or counselling
Good practice tip Managers should be trained in supporting staff after serious incidents
www.doh.gov.uk/violence/taskforce for National Task Force on violence against social care staff, established 1999
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