Wound care study day 1 for Health Care

Wound care study day 1 for Health Care Support Workers Lynne Powell RN. MSc. IP Pg. CEd

Accountability, competence & consent Lynne Powell RN. MSc. Pg. CEd

Objectives § Discuss the health care support worker code of conduct § Briefly define accountability, competence & consent § Briefly identify the issues and your responsibilities surrounding accountability, competence & consent § Define consent § Discuss the legal issues surrounding accountability, competence & consent

Code of Conduct for Healthcare Support Workers in Wales (2011) & Code of Conduct for Employers in Wales (2011)

Codes of Conduct (2011) Code of Conduct for Healthcare Support Workers in Wales Code of Conduct for Employers in Wales § The purpose of both codes is to ensure a high quality service that focuses on the needs & experiences of individuals § The basic principle is service user safety and public protection

7 Standards As a health care support worker in Wales you must; 1. Be accountable for your actions & omissions 2. Promote and uphold privacy, dignity, rights and wellbeing of service users 3. Work in collaboration with colleagues and as part of a team 4. Communicate in an open and effective way 5. Respect a person’s right to confidentiality 6. Improve quality of care by updating your knowledge, skills and experience through personal & professional development 7. Promote equality

Words to describe accountability § § § § Answerability Responsibility Liability To be held to account Authority Autonomy Open Transparency

Accountability To make a decision and be held responsible for the decision made Things to consider: § Do you have the knowledge and skills to perform the task? If not – don’t do it, you must be competent § Are you working in the best interest of the patient? § Dressings are classified on the drug tariff as appliances § If you’re unsure ASK § Ensure to keep up to date

Accountability Nurse/HCSW NMC Law Employer Patient

Competence Specific knowledge, skills, judgments and personal attributes required to practice safely

Competency Assessment Scale I do not know the knowledge and skills required I know the knowledge and skills required but I don’t have them. 3. I know and I am developing the knowledge and skills 4. I have the knowledge and skills, but I don’t use them. 5. I have the knowledge and skills, and I use them regularly 1. 2. (Wi. PP /NHS UNIT 3 – Competence from a HCA’s perspective)

There are National standards to describe the performance level expected of someone doing a particular task. To find out more, access; § Working in Partnerships Programme (Wi. PP) – NHS. § Skills for Health (competencies for the healthcare workforce) (http: //www. skillsforhealth. org. uk)

Consent Permission for something to happen or agreement to do something

Informed consent § Informed consent is based on a clear appreciation and understanding of the facts, implications and future consequences of an action § Patients have the right to make decisions about their own health and medical care § Balance of risks and benefits of treatment § Consent must be voluntary § Failure to obtain consent can be viewed as assault § Implied consent

Code of Conduct for Employers in Wales (2011) • Employers have to provide mentoring, supervision, monitoring and assessment for the HCSW • HCWS should have a named mentor Employers must: 1. Employ suitable individuals who understand their roles, accountability & responsibilities 2. Ensure HCSW are able to meet the requirements of the Code of Conduct (2011) 3. Provide education and training 4. Promote the HCSW Code of Conduct

Employers § Employers are legally responsible for the actions you carry out during the course of your employment. This is known as vicarious liability, and your employer will have insurance for this purpose. Vicarious liability is not optional and employers cannot choose to opt in or out. (RCN) § Vicarious Liability – (English Law) imposes a strict liability on employers for the wrongdoing of their employees while conducting their duties § Lister v Romford Ice and Cold Storage Co[81] created a controversial principle at common law that entitled an employer to recover the indemnity from the employee

The Legal System of the United Kingdom § The United Kingdom of Great Britain and Northern Ireland (UK) consists of four countries: England, Wales, Scotland Northern Ireland. Some law applies throughout the whole of the UK; some applies in only one, two or three countries. § The four principal sources of UK law are legislation, common law, European Union law and the European Convention on Human Rights. There is no single series of documents that contains the whole of the law of the UK. § For practical purposes, the most significant distinction is between civil law and criminal law. § Civil law covers such areas as contracts, negligence, family matters, employment, probate and law. § Criminal law, which is a branch of public law, defines the boundaries of acceptable conduct. A person who breaks the criminal law is regarded as having committed an offence against society as a whole.

How CRIMINAL LAW is enforced in England Wales § A person who believes that a crime has been committed contacts the police, who conduct an investigation. If, after arresting and interviewing a person, the police believe that he or she committed the crime, that individual is charged. A report of the case is then sent to the Crown Prosecution Service (CPS). § If the CPS believes that the case has a reasonable prospect of success, and that it would be in the public interest to do so, it will start criminal proceedings against the suspect, who becomes the defendant in the case. In court, the CPS bears the burden of proving, beyond reasonable doubt, that the defendant committed the crime.

How CIVIL LAW is enforced in England Wales § A person who believes that another individual or organisation has committed a civil wrong can complete a claim form and send it to the appropriate court. § The person who starts a civil case is called a claimant, and he or she has the burden of proving that, more probably than not, the other party (the defendant) committed a civil wrong. If the claimant is successful, the usual remedy is damages: a sum of money paid by the defendant to the claimant.

Negligence The law of negligence § This allows a civil action to be taken to financially compensate the person who has suffered unwarranted harm, or damage at the hands of another. Negligence has been defined as : § The omission to do something which any reasonable man would do, or to do something which a reasonable man would not do

For a case of negligence to be proved by the claimant, three elements must be satisfied. § The defendant owed a duty of care to the claimant § There was a breach of that duty of care § Harm occurred as a direct result of that breach in duty of care

Case Study 1 Joe 24 yrs old attended surgery after having clips removed from a wound on her right mastoid process. Operation to renew stent to relieve a build up of pressure on the brain which was causing headaches. Mother is a health visitor who took out the clips over the weekend. After the clips were removed the wound broke open. Wound was about 6 cm long and 2. 5 cm wide and gaping. Scalp and stent visible. Wound not inflamed but slight exudate present. Clips removed 3 days before. Reported that she had attended casualty twice in the last 2 days and told to attend at GP. On 2 nd course of antibiotics Have any offences been committed (criminal/civil) IS THERE A CASE OF NEGLIGENCE AND WHO WOULD BE TO BLAME – discuss

On further investigation she had attended at Out of Hours not casualty. Neurosurgery contacted patient advised to go to Casualty at once for management

Personal Development Plan (PDPs) Up to date job description

Personal development plans § Helps identify own training and development needs § Demonstrates personal development and career progression § Can be used as a tool for annual performance review/appraisal § Assists employers and managers to identify areas that need improvement in the practice § http: //www. wales. nhs. uk/sites 3/home. cfm? orgid=739

Record keeping

Aim To discuss; § Why we need to keep accurate records § Identification of the patient and the appropriate management § Issues of confidentiality § The principles of of good documentation and communication of information § The implications of poor record keeping

Why keep records? § Greater involvement of patients in making choices about care § Patient centred care § Patients having access to their own records § Technology § Clinical audit § Clinical negligence

Record keeping Good record keeping is an integral part of nursing practice, and is essential to the provision of safe and effective care. It is not an optional extra to be fitted in if circumstances allow. (NMC 2009)

Record Keeping § Record keeping is regarded as a legal duty of care, it is an integral part of your role § Anything written as part of your job description could potentially be used in a court of law § If something hasn’t been documented then it hasn’t been done § Accurate documentation helps protect you and the welfare of your patient § Accurate documentation assists in monitoring the patient through the management/treatment pathway

Patients records should be; § Be factual, consistent and accurate § Be written as soon as possible after an event has occurred § Provide current information on the care and condition of the patient § Dated, timed and signed with the signature printed alongside the first § § entry, records need to follow a logical sequence with clear milestones and goals Be written in terms the patient can understand, and when possible with the involvement of the patient Not include abbreviations, jargon, meaningless phrases, irrelevant speculation or offensive subject terms Be readable on any photocopies- you should therefore write in black ink Alterations must be crossed out with one line, dated and signed. Ensuring the original entry can still be read

Poor record keeping § Inappropriate remarks § Abbreviations § Undermines patient care § Makes you vulnerable to legal and professional problems § Increases your workload § Vague comments – “reasonable”, “adequate”

Key Principles of record keeping All records must be signed, timed and dated if handwritten. If computer held, they must be traceable to the person who provided the care that is being documented. Records must be clear and accurate, and provide information about the care given and arrangements for future and ongoing care. Jargon and speculation should be avoided.

Key principles cont. When possible, the person in your care should be involved in the record keeping and should be able to understand the language used. Records should be readable when photocopied or scanned. In the rare case of needing to alter a record the original entry must remain visible (draw a single line through the record) and the new entry must be signed, timed and dated. Records must not be destroyed unless you have been authorised to do so.

Identification Implications of mis-identification § Unnecessary tests performed § Wrong procedure performed § Wrong results given § Wrong medication § HARM TO PATIENT

Patient Identification § Full name § Date of birth § Address § NHS number All these are used to identify a patient – remember if this information is lying about others can identify the individual and confidentiality may be breached

Confidentiality § You have a duty to protect the patient’s information. § It is generally accepted that information provided by patients is given in confidence. § The Data Protection Act (1998) § Caldicott Report § The Human Rights Act (1998)

Data protection Act (1998) In March 2000, the Data Protection Act 1998 became law and applies to all organisations. It covers computer and manual records across all departments where patient information may be collected and used. The principles in the Act state that information must be: § Held securely and confidentially § Obtained fairly and efficiently § Recorded accurately and reliably § Used effectively and ethically § Shared appropriately and lawfully

The Caldicott Report § Caldicott Report provides a number of principles & recommendations aimed at supporting the NHS in improving the way it handles identifiable information. § Access to patient information is granted on a strict need to know basis. § Staff have a responsibility to keep information confidential and ideally should have a confidentiality clause in their contract of employment.

The Human Rights Act 1998 Article 8 – The Right to Respect for Private and Family Life § § § The right to respect for private life The right to respect for family life The right to respect for one’s home The right to respect for correspondence The Act can be used only against a public body therefore the NHS are subject to the Act

Failure to comply with either the The Human Rights Act or The Data Protection Act could lead to litigation

Good record keeping § meets legal requirements. § protects staff in legal situations. § meets professional statutory requirements. § supports clinical audit.

Good record keeping helps to protect the welfare of patients by promoting: § High standards of clinical care. § Continuity of care. § Better communication and dissemination of information between members of the inter-professional health care team. § An accurate account of treatment and care planning and delivery. § The ability to detect problems, such as changes in the patient’s condition, at an early stage.

Record keeping § § § § § ENSURE YOU HAVE THE CORRECT PATIENT Remember the patient’s record is a legal document. Remember patients have the right to access their medical records. Record information as soon as it is obtained to minimise the chance of mistakes. Involve the patient in the compilation of their records. Enter recordings into the correct Read codes. Record the facts. Avoid abbreviations as they can be confusing Avoid duplication.

Remember § Careful and accurate records may assist if you are defending claims of negligence § It is important that you record the reason for decisions, as well as the actual intervention undertaken

During legal proceedings § The first thing they ask to see is the records § Patient records are often the deciding factor in whether or not a legal case proceeds § If they find shoddy records, they assume shoddy practice and are more inclined to go ahead with a claim

Infection control and safe waste disposal

Why hand washing is so important? Good hand hygiene is one of the single most effective measures for preventing the spread of infection § Our hands move germs from one place to another § By hand washing, we remove transient micro- organisms acquired by recent contact with infected patients, or with the environment § Hand washing protects both patients, and staff

What Lives on our hands? § Transient flora – acquired by contact these micro-organisms survive on the skin for less than 25 hours and can be removed by hand washing. § Resident flora – part of our normal skin flora these micro-organisms survive and multiply on the skin, they rarely cause infections (other than skin infections) except when introduced into the body through invasive procedures

When to decontaminate hands. Every healthcare worker should conduct a risk assessment to determine when to decontaminate § Before contact with a patient § After completing tasks where hands may have become contaminated with micro-organisms § When hands are visibly dirty or soiled § Between different types of cleaning procedures

Types of Hand Washing § Social § Hygienic (aseptic) § Surgical scrub

Social Hand Washing § Soap and Water § Reduces the numbers of transient micro- organisms upon hands. § Renders hands socially clean § Sufficient for most daily activities

Social Hand Hygiene with Alcohol Gel • Visibly Clean Hands • Utilise approx 3 mls • Allow hands to dry prior to patient contact. • NOT in cases of D&V • Hands must be dry prior to patient contact

Hand Drying Micro-organisms transfer most effectively from wet surfaces so always dry hands thoroughly with disposable paper towels.

Skin Care Frequent hand washing can cause long term changes in the skin. • Always put soap onto wet hands. • Apply hand cream regularly to protect skin • Report any skin irritation/ abnormality to occupational health advisor.

Other Measures • Wear Short Sleeves • Do not wear wrist watches • No jewellery to hands or wrists other than wedding band • Short Nails • No False nails/ Nail Extensions • Moisturise Hands

Protective clothing § It is appropriate for practitioners to wear non-sterile disposable gloves and disposable apron § Wearing gloves does not protect against needle-stick injury but will protect against splashing or spillage § Always ask about latex allergy if gloves are worn – use latex free gloves

Waste disposal § Hazardous Waste Regulations 2005 § Defined with the European Waste Catalogue (EWC) § Doesn’t include domestic waste § Regulated by the Environment Agency § Failure to comply can incur fixed penalty notices, fines and even terms of imprisonment § Duty of care applies to everyone in the management chain; from the person who produces it to the person who finally disposes of, or recovers it.

Use and disposal of sharps § needle-stick injuries lead to increased exposure to blood- borne viruses. This can cause pain and anxiety. Sharps injuries can be prevented by careful adherence to good practice. § Needles should never be re-sheathed § All sharps should be disposed of at point of use

Needle Stick Injuries § Bleed the site and wash under running water § Inform the patient § Take the patient’s full details and contact number § Report the incident and give patient’s details to Clinical Governance lead for risk assessment. § Incident report

Environment § Check that the area where venepuncture is to be carried out is clean and tidy. § Ensure that all equipment is easily accessible, sterile where necessary, intact and in-date. § Ensure good lighting. § Tourniquets can be a source of infection.