Guidelines for Record Keeping It is a legal requirement for all staff to report any incident in which their safety is compromised. (RIDDOR) Where the agency policy makes it clear that staff are expected to report violent incidents, staff could be held to account by courts and tribunals for any breach and they could find compensation or insurance claims may be affected. PAMOVA Cymru (GS) Ltd

Guidelines for Record Keeping Cont... The content and style should be……… Factual, consistent and accurate. Written as soon as possible after an incident. Written clearly in terms that staff and clients understand. Written not to include abbreviations, jargon, meaning phrases irrelevant speculation or subjective statements. PAMOVA Cymru (GS) Ltd

If an agency seeks support of a health and safety approach to handling violence involving the use of disengaging and immobilising techniques, then every part of the jigsaw must be present and in it’s proper place. In the event of something going wrong, of a compensation claim being made against agency and / or staff, or of a criminal investigation of possible assault, both the agency and the member of staff would be required to demonstrate that agency policy, including proper reporting and recording, has been followed from A to Z. PAMOVA Cymru (GS) Ltd

National Minimum Standards State Made within 24 hours Include the name of the child The date and time The location of the intervention The lead up and behaviour requiring the use of restraint The technique used The duration of restraint Name of staff members involved PAMOVA Cymru (GS) Ltd

National Minimum Standards State Name of staff members involved Names of any persons witnessing the intervention/restraint The effectiveness of the restraint Any injuries to child or staff/others The signature of staff member recording the incident If injuries are sustained these should be recorded in the accident book PAMOVA Cymru (GS) Ltd

National Minimum Standards State Witness Statements’ should be recorded and submitted along with the ‘Incident Report’ by all staff involved and/or present during the incident The child/children involved in the incident should be given the opportunity to discuss the incident and express their views/feelings PAMOVA Cymru (GS) Ltd

Childs File Follow the same format as the ‘Witness / Incident form’. However, disregard the advice on: where you work; where you are based and your hours of work; PAMOVA Cymru (GS) Ltd

To Summarise Record keeping is a vital part of your work and the mark of a skilled professional. Assume that any documented work can or will be scrutinised by professionals at some point. Be factual, concise and accurate. Relay the incident so clients/patients and like minded professionals can understand. Or 12 randomly selected individuals from your community to understand ! PAMOVA Cymru (GS) Ltd

The Witness Statement Introduce yourself and where you work. State the day / date and hours of work you were working and what staff were on shift with you. State the time (approximately) your attention was brought to the incident and where you were situated. PAMOVA Cymru (GS) Ltd

The Witness Statement State where the subject was located and what he/ she /they were doing e.g. note down their behaviour (body language/actions); Quote the subject directly, if possible. State what action from the subject prompted you to intervene. State what action you employed and state which staff were assisting you; State what time (approximately) your intervention had come to an end. PAMOVA Cymru (GS) Ltd

The Witness Statement Note down any injuries sustained by yourself/staff/subject. (Note down if there were no injuries sustained to either parties involved); State the after-care rendered to yourself/ staff/subject, e.g, first-aid, de-briefing; Sign at the bottom of the witness statement together with your job title and date. PAMOVA Cymru (GS) Ltd

The Witness Statement If the witness statement is not completed on the same day as the incident, state as to why ! PAMOVA Cymru (GS) Ltd

Client/Patient Notes Follow the same format as the ‘Witness Statement’. However, disregard the advice on: where you work; where you are based and your hours of work; PAMOVA Cymru (GS) Ltd

To Summarise Record keeping is a vital part of your work and the mark of a skilled professional. Assume that any documented work can or will be scrutinised by professionals at some point. Be factual, concise and accurate. Relay the incident so clients/patients and like minded professionals can understand. Or 12 randomly selected individuals from your community to understand ! PAMOVA Cymru (GS) Ltd

Any Questions? PAMOVA Cymru (GS) Ltd

Associated Risks Within Restraint Blood Born Infections Substance Misuse Associated Behaviours Excited Delirium Positional Asphyxia PAMOVA Cymru (GS) Ltd

Associated Risks Within Restraint HIV rates amongst injecting drug users are low 1 – 2% needle stick injuries. Be aware of unsheathed needles about the person that can pass on HIV and hepatitis. PAMOVA Cymru (GS) Ltd

Associated Risks Within Restraint Hepatitis rates are high up to 50% of drug users. If you come into contact with any fluids from service users you should be vaccinated against the risks, and cover any open wounds you may have as a matter of course. PAMOVA Cymru (GS) Ltd

Associated Risks Within Restraint Some substances of misuse can induce paranoia stimulants such as amphetamine, cocaine, crack cocaine and cannabis can induce paranoia. Anabolic steroids to can cause paranoia and irritability and unfortunately lots of muscles too. PAMOVA Cymru (GS) Ltd

EXCITED DELIRIUM PAMOVA Cymru (GS) Ltd

Definition Excited delirium is a rare form of SEVERE MANIA sometimes part of the spectrum of manic-depressive psychosis and chronic schizophrenia PAMOVA Cymru (GS) Ltd

Excited Delirium Cocaine induced psychosis Acute exhaustive mania Also known as: Agitated delirium Cocaine induced psychosis Acute exhaustive mania PAMOVA Cymru (GS) Ltd

It is characterised by purposeless, often violent activity coupled with incoherent or often meaningless speech and hallucinations with paranoid delusions PAMOVA Cymru (GS) Ltd

Excited Delirium can be caused by Psychiatric illness (combined with Drink and or Drugs) Drug intoxication (Cocaine is the best known cause of excited Delirium) Alcohol PAMOVA Cymru (GS) Ltd

Effects of Excited Delirium Abnormal Strength High tolerance to pain Skin may be hot to touch Quick to fatigue - especially after a violent struggle Hypothermia is often associated with this syndrome PAMOVA Cymru (GS) Ltd

Symptons of Excited Delirium Violence towards others Unexpected physical strength A diminished sense of pain Sweating, fever, heat intolerance Sudden tranquillity after frenzied activity PAMOVA Cymru (GS) Ltd

Death can occur Before a struggle During a struggle During restraint After restraint PAMOVA Cymru (GS) Ltd

Identifying Excited Delirium Bizarre and or aggressive behaviour Impaired thinking Disorientation Hallucinations Acute onset of paranoia Shouting Strange behaviour such as smashing windows stripping down to the waist tolerance to incapacitant sprays should the police be called to the scene PAMOVA Cymru (GS) Ltd

BE AWARE OF Sudden Passivity Pulse rate Breathing Temperature PAMOVA Cymru (GS) Ltd

POSITIONAL ASPHYXIA PAMOVA Cymru (GS) Ltd

POSITIONAL ASPHYXIA What is ‘Positional Asphyxia’ Positional asphyxia is a syndrome, which may be the sole or contributory factor in death, which may occur as a result of restraint being used Breathing is a mechanical process involving the chest wall, rib cage, diaphragm and abdominal muscles, and if the movement of all, or any of these are significantly impaired for any length of time, then death may occur (as a consequence of hypoxia which may disturb the heart rhythm). PAMOVA Cymru (GS) Ltd

What are the risk factors Positional asphyxia has been associated with a number of deaths during physical restraint, more usually during mechanical restraint but also during ‘hands on’ techniques, which physically restrict the person’s freedom of movement . The available evidence suggests that a combination of factors may place individuals at risk of positional asphyxia:- Respiratory disorders Cardiovascular disorders Prescribed drugs Obesity Position during restraint Prolonged struggle Drug & Alcohol intoxication PAMOVA Cymru (GS) Ltd

Cause of death / or serious injury When we are presented with a threat to the neck , the sympathetic nervous system is activated -basic survival mechanism/personal defence. Sudden increase in blood pressure or pressure on the neck causes artificial stimulation of the nervous system, slowing down the heart rate. Reduction in blood pressure could cause fainting/blackouts and in the worst case scenario cardiac arrest leading to death. PAMOVA Cymru (GS) Ltd

WHAT YOU SHOULD NOT DO Bed Restraint: During restraint within a bedroom staff may be tempted to use the bed as a more comfortable option for restraint. This may however exacerbate the potential for positional asphyxia as staff may be more prone to adding extra pressure onto the upper torso without realising. PAMOVA Cymru (GS) Ltd

WHAT YOU SHOULD NOT DO Floor restraint (hog tying) The individual is being restrained in the prone position restraint hold, with hands on the upper back and also feet held in a figure four leg lock. PAMOVA Cymru (GS) Ltd

WHAT YOU SHOULD NOT DO State the Dangers PAMOVA Cymru (GS) Ltd

WHAT YOU SHOULD DO Chair restraint: Using an appropriate fore arm hold (finger & thumb) patient is securely held without any immediate risks to staff or the clients safety. PAMOVA Cymru (GS) Ltd

WHAT YOU SHOULD DO Rest position: Arms are held in the rest position (triangular fix) by the side of individuals body. Legs are kept straight out and wrapped around the ankles. NO PRESSURE MUST BE PUT ON THE TORSO EVEN IF THE INDIVIDUAL CONTINUES TO STRUGGLE. PAMOVA Cymru (GS) Ltd

After Individual needs to be observed, watching vital signs, for overheating and/or dehydration. Care and attention is vital, especially where the patient is secluded or left resting in bed. where has been prolonged struggle, potential exacerbated by a hot environment or heavy clothing need to be aware of the risk of overheating/dehydration. Loosen/remove clothing, enable the individual to drink where possible ( not too hot or cold, sitting position) stopping and resting. Need to know as much as possible about the history of the individual. ?pre-existing cardiovascular/respiratory problems, have they just eaten/drank,medication pre/during/post If the individual is sleeping, the recovery position should be effected. PAMOVA Cymru (GS) Ltd

Summary Be aware: that no pressure is to be put onto the individual’s torso during any restraint that heart rate, respiration and body temperature can be affected during restraint after restraint vital signs must be observed if there is any indication of risk Pre during and post incident awareness of medication caution must be observed in administering medication PAMOVA Cymru (GS) Ltd

Any Questions? PAMOVA Cymru (GS) Ltd