Safer Environments Policy (Reducing violence and abuse against staff)

1.1 - East Lancashire Hospitals NHS Trust is committed to providing safe, personal and effective care.

1.2 - The Trust will work with NHS England, the Police and Crown Prosecution Service and our contracted Security Staff to provide an environment for those who work in or use the Trust that is properly secure, so that the highest possible standards of clinical care can be provided.

1.3 - This Policy provides guidance and the circumstances in which staff can implement a verbal warning, a written warning letter (Yellow Card) or the withholding of treatment (Red Card Exclusion Letter) procedure to patients who are displaying inappropriate and unacceptable behaviours toward NHS employees.

1.4 - The Policy aims to support the Violence, Prevention and Reduction Standards issued by NHSI during December 2020 and to reduce incidents of violence and aggression by taking action against those who verbally and/or physically assault NHS employees.

2.1 Section 5 Public Order Act 1986 

“A person is guilty of an offence if he/she:

a) uses threatening, abusive or insulting words or behaviour, or disorderly behaviour, or

b) displays any writing, sign or other visible representation which is threatening, abusive or insulting “within the hearing or sight of a person likely to be caused harassment, alarm or distress thereby”

2.2 Criminal Justice and Immigration Act 2008

Section 119 Offence of Causing Nuisance or Disturbance on NHS Premises:

1. “A person commits an offence if:

a) the person causes, without reasonable excuse and while on NHS premises, a nuisance or disturbance to an NHS staff member who is working there or is otherwise there in connection with work

b) the person refuses, without reasonable excuse, to leave the NHS premises when asked to do so by a Constable or an NHS staff member, and

c) the person is not on the NHS premises for the purpose of obtaining medical advice, treatment or care for himself/herself

Section 120 Power to Remove Person Causing Nuisance or Disturbance

1. If a Constable reasonably suspects that a person is committing or has committed an offence under Section 119, the Constable may remove the person from the NHS premises concerned.

2. If an Authorised Officer – (Clinical Site Manager, Matron, Director) reasonably suspects that a person is committing or has committed an offence under Section 119, the Authorised Officer may: a) remove the person from the NHS premises concerned, or b) authorise an appropriate NHS staff member to do so

3. Any person removing another person from NHS premises under this section may use reasonable force (if necessary).

4. An Authorised Officer cannot remove a person under this section, or authorise another person to do so if the Authorised Officer has reason to believe that:

a) the person to be removed requires medical advice, treatment or care for himself/herself or,

b) the removal of the person would endanger the person’s physical or mental health

For the purposes of this policy, the Authorised Officer will be the Clinical Site Manager on duty

3.1 Non-Physical Assault:

“The use of inappropriate words or behaviour, causing distress and/or constituting harassment to others”

3.2 Examples of non-physical assault include but are not limited to:

• Offensive or obscene language (verbal or written for example, social media)
• Discriminatory language that constitutes hate crime, racial abuse
• Verbal abuse and swearing
• Loud and intrusive conversation
• Negative, malicious or stereotypical comments
• Invasion of personal space
• Brandishing weapons or objects which could be used as weapons
• Near misses: (for example, unsuccessful physical assaults)
• Offensive gestures
• Threats
• Bullying
• Intimidation
• Harassment or stalking
• Alcohol or drug fuelled abuse
• Incitement of others and/or disruptive behaviours
• Unreasonable behaviours and non-cooperation such as repeated disregard of hospital policies

3.3 Physical Assault:

“The intentional application of force to the person of another without lawful justification, resulting in physical injury or personal discomfort”

3.4 Examples of physical assault include but are not limited to:

• Spitting on/at staff
• Pushing
• Shoving
• Poking or jabbing
• Scratching and pinching
• Throwing objects, substances or liquids onto, or at, a person
• Punching and kicking
• Hitting and slapping
• Sexual Assault
• Incidents where reckless behaviour results in physical harm to others

4.1 - East Lancashire Hospitals NHS Trust attaches great importance to the health and safety of its employees.

4.2 - Staff working within the Trust should know their safety comes first. They should not be working in situations that make them feel unsafe. However, if they are, they need to know how to deal with them and that they have the full support of the Trust. It should be clearly understood by all concerned that in any situation, the prevention, management and avoidance of conflict is of paramount importance.

4.3 - All employees have the right to operate and deliver patient care and services without fear of violence, aggression, alarm, distress or harassment. Nonphysical and physical assault, therefore, will not be tolerated. Local procedures must recognise that taking action is appropriate where non-physical assault or abusive behaviour or physical assault against our staff is likely to:

• Prejudice the safety of staff involved in providing the care or treatment; or lead the member of staff providing care to believe that he/she is no longer able to undertake his/her duties properly as a result of fearing for their safety
• Prejudice any benefit the patient might receive from the care or treatment
• Prejudice the safety of other patients

4.4 - The Trust recognises that training of staff is fundamental to the effective operation of this policy and that all employees will be required to undertake appropriate training relative to the degree of risk faced within their working environment. As a minimum all staff must successfully complete Conflict Resolution Training.

4.5 - Enhanced training, ‘Understanding and Managing Challenging Behaviour’ has been introduced to the Trust and is accessible via the Learning Hub Webpage. This training is primarily for areas of work where the number of reported incidents of violence, aggression or harassment is deemed to be higher risk, however training is available all staff that may wish to undertake it.

5.1 Chief Executive

The Chief Executive carries ultimate responsibility for safety and security within the Hospitals Trust.

5.2 Trust Board

The Trust Board is responsible for ensuring that the necessary support and resources are available for the effective implementation of the Safer Environment Policy.

5.3 Directors, Divisional Directors and Senior Managers

Trust Directors, Divisional Directors and Senior Managers are responsible for ensuring that this Policy is supported and promoted in their areas of responsibility and that staff are encouraged to use the policy. They should ensure that staff involved in the decision making process required to implement this policy are provided with appropriate support.

5.4 Individual Heads of Service and Service Managers

Individual Heads of Service and Service Managers are responsible for promoting security management within their areas of responsibility. In particular, they will be responsible for:

• Ensuring all incidents of violence, abuse and harassment are reported promptly via the Datix system.
• Ensuring that they and their staff have received appropriate training relative to the degree of risk faced within their working environment.
• Undertaking risk assessments in their areas of responsibility and acting to remove/reduce as far as reasonably practicable any risks identified.
• Ensuring that staff who are subjected to violence, abuse or harassment are provided with the appropriate support.
• Managers will aim to ensure that there will be enough staff trained in either managing actual or potential aggression or breakaway techniques to cope with foreseeable violent incidents. In general, with regard to staffing levels and competence, the manager will review the acceptability of lone working in isolated premises, the length of time where staff work alone, and review cover for breaks, and hand-over periods etc.
• Managers will also review the need to respond effectively to a violent incident while maintaining adequate levels of care for other patients.

5.5 Employees of the Trust

Employees of the Trust have responsibility for:

• Complying with all Trust policies and procedures.
• Ensuring that they have received appropriate training relative to the degree of risk faced within their working environment.
• Ensuring all incidents of violence, abuse and harassment in which they are involved are reported as soon as possible using the Datix system.

5.6 Ward and Department Managers

• Wards and departments will need to adopt an inclusive approach, involving all staff, in identifying, assessing and controlling the risk of violence, abuse and harassment. Whilst controls should be tailored to the specific risks associated with an individual patient, it is possible to identify generic risks and the control measures necessary to reduce them.
• Information obtained from the patient, the medical records, colleagues and other agencies, is vital to the process of risk management. Clear procedures should exist to ensure that relevant information is passed onto colleagues at shift hand-over and to others coming into contact with the patient or visitor.
• The process of risk identification and control should consider issues such as space, lighting, access and exit routes, storage, supervision, observation and the location of staff facilities.

5.7 Divisional Responsibilities

Responsible for issuing informal/formal verbal warnings/written warnings

Responsibility for preparing a Yellow Card Warning Letter following consultation with Ward/Department Managers.

Responsibility for preparing a Red Card Exclusion Letter following consultation with a member of the Trust Executive Team.

Inputting electronic alerts onto the PAS and other relevant Trust recording system following the issue of a Yellow Card Warning Letter or Red Card Exclusion Letter.

Will monitor, evaluate and update or remove the electronic alerts in a timely manner, informing the patient of the outcome.

5.8 Trust Security Manager and/or Deputy

• Will provide advice to Ward/Dept Management, Divisional Management on recommended course of action.
• Will monitor warnings issued to patients via the Trust Incident Reporting system.
• Will provide reports to Staff Safety Group and Health & Safety Committee reflecting accurate data relating to warnings issues/rescinded.
• Will monitor use of this policy.

6.1 - This policy applies to both patients and visitors whose behaviour is unacceptable toward ELHT staff on Trust premises including community locations, for example, Health Centres or within their own homes.

6.2 - Persons who are on the premises other than as patients may be asked to leave Trust premises immediately. Where such persons are existing patients of the Trust, it may be necessary to consider the use of this Policy.

6.3 - This Policy outlines four stages:

Stage 1: Informal verbal and/or informal written warning (raises awareness to patient of inappropriate behaviours and negative impact on staff and others)

Stage 2: Formal verbal warning, followed up by written warning

Stage 3: Issue of Yellow Card Warning Letter (Yellow Card)

Stage 4: Issue of Red Card Exclusion Letter - Withholding of Non-Life Threatening Treatment (Red Card)

The stages are normally intended to be followed progressively. However, where the behaviour so warrants, commencement can begin at any of the stages.

7.1 - In the event an excluded patient presents at the Emergency Department for life threatening treatment, the patient will be treated, if necessary, with Security Staff in attendance. Where possible, the patient should then be treated and discharged as soon as it is clinically safe to do so.

7.2 - If the patient requires admitting to a ward, support to clinical staff should be provided by a Security presence on the ward, the patient to be placed in isolation if a side room is available.

7.3 - Any patient who is being nursed and in receipt of a Red Card Status must be attended to either by clinical staff in pairs, or a clinical staff member and a member of the security team. At no time should the patient be treated by a lone clinical staff member.

7.4 - Following admission, patient to be treated and discharged as soon as clinically possible.

7.5 - In the event Security are deployed elsewhere, it may be necessary to draft in extra Security Personnel at short notice, refer to ‘SOP Requesting Additional Security Staff’.

8.1 - If an excluded patient presents on Trust premises, other than in a medical emergency, the patient should be asked to leave the premises. If the patient refused, contact on-site Security. If the site does not have Security, staff should contact the Police.

8.2 - Any attempt by an excluded patient to seek treatment for non-life threatening issues should be notified to the Trust Security Manager and/or Deputy at the earliest opportunity.

8.3 - Consideration of requesting legal action to stop the patient returning until the exclusion period has ended may be necessary. Further advice can be sought from the Trust Legal Team.

If the patient complies with the terms of the Red Card Exclusion Letter, they can expect:

• To be excluded from clinical care except in the event of an emergency
• Full investigation into all valid concerns raised in any such appeals letter
• To have the exclusion period revoked after the specified exclusion period, unless further episodes of violence, abuse, harassment have been caused by the patient during this period

10.1 - Both Yellow and Red Card Letters will include details of how the individual can appeal the decisions.

10.2 - Should the individual wish to appeal, they may do so in writing via the Trust’s Complaints process.

Measuring and monitoring compliance with the effective implementation of this procedural document is best practice and a key strand of its successful delivery. Hence, the authors of this procedural document have clearly set out how compliance with its appropriate implementation will be measured or monitored. This also includes the timescale, tools/methodology and frequency as well as the responsible committee/group for monitoring its compliance and gaining assurance.

1. In the event of inappropriate behaviour by a patient, the Nurse, Senior Doctor or Department Manager in charge of the relevant area should explain to the patient that the behaviour is unacceptable and that expected standards must be observed in future. Where possible this warning must be given in front of a witness (another staff member).
2. The patient must be informed that they have received an informal verbal warning, this may be followed up in writing.
3. The patient’s Consultant and clinical staff involved in the patient’s care must be informed and an incident report completed on Datix, this must include details of the patient’s behaviours and the informal warning.
4. Details of the incident and warning must be recorded in the patient’s healthcare records. This entry should also be signed by the witness.

Informal Verbal and/or Written Warning issued to the patient

• Senior Manager explains behaviours are unacceptable and how this negatively impacts on the staff trying to help them
• Attempt to ascertain why behaviours were displayed
• Where possible ensure a witness is present if verbally addressing concerns with a patient

Inform patient:

• Details of the informal and/or written warning will be documented in their healthcare records
• Further unacceptable behaviours may result in the issue of a formal verbal/written warning

Use letter template at Appendix 1c

• Log a Datix incident report
• Include details of informal verbal/written warning in a relevant section
• If informal written warning issued, add as a document to the incident report

Dear 

Informal Warning letter - Unacceptable Behaviour 

I have received a report where it is alleged that on (date), whilst you were at the (clinic/dept/site) you were (input details of behaviours). 

These behaviours caused significant distress to staff who were trying to provide you with care. 

East Lancashire Hospitals NHS Trust is firmly of the view that all those who work in or provide services to the NHS have the right to do so without fear of violence or abuse. The behaviours you displayed at the time are unacceptable. 

Such behaviour also affects the care and treatment of our other patients and is upsetting and frightening for our staff. 

I am writing to request that you give consideration to the effects of your behaviour and to give you warning that should there be any repetition of this type of behaviour within any of our hospitals or community settings; consideration will be given to taking action against you. 

Such action may include the following: 

• Seeking an Acceptable Behaviour Agreement 
• Invoking the Trust Safer Environments Policy; issue of formal written warning 
• Exclusion from our premises 
• Reporting to the Police where your behaviour constitutes a criminal offence and fully supporting any prosecution they may pursue 

A copy of this informal warning will be included in your medical records for six months from the date of this letter. 

If you do not agree with what has been set out in this letter or have any comments to make, please write to me within 7 days of receipt of this letter. 

Yours sincerely 

Role/Title 

cc: 

Medical Records 

Trust Security Manager 

File 

1. In the event of inappropriate behaviour by a patient, the Nurse, Senior Doctor or Department Manager in charge of the relevant area should explain to the patient that the behaviour is unacceptable and that expected standards must be observed in future. Where possible this warning must be given in front of a witness (another staff member). 
2. The patient must be informed that they have received a formal verbal warning and that this will be followed up in writing. 
3. The patient is to be made aware the warning will be placed on their healthcare record and that further such behaviours may result in a Yellow Card Warning Letter being issued along with Security and/or the Police being contacted. 
4. The patient’s Consultant and clinical staff involved in the patient’s care must be informed and an incident report completed on Datix, this must include details of the patient’s behaviours and that a formal warning has been issued. 

Formal verbal warning issued to patient by Senior Staff Member

• Explain to patient behaviours unacceptable
• Warning is formal and will be followed up in writing
• Further inappropriate behaviours may result in the Trust instigating the Safer Environment Policy which has the potential of excluding them from further treatment (other than life-threatening) 

*(Where possible, ensure a witness is present when verbal warning issued)

• Log incident on Datix
• Escalate to Divisional Senior Management Team

• Senior Management Team to agree content of letter
• Letter template (Appendix 2c)
• Place alert on PAS system
• Update Datix incident report with warning letter review date

 

Send letter to patient via registered/recorded post

Dear 

Formal Warning letter - Unacceptable Behaviour 

I have received a report where it is alleged that on (date), whilst you were at the (clinic/dept/site) you were (input details of behaviours). 

These behaviours caused significant distress to staff who were trying to provide you with care. 

East Lancashire Hospitals NHS Trust is firmly of the view that all those who work in or provide services to the NHS have the right to do so without fear of violence or abuse. The behaviours you displayed at the time are unacceptable. 

Such behaviour also affects the care and treatment of our other patients and is upsetting and frightening for our staff. 

I am writing to request that you give consideration to the effects of your behaviour and to give you formal warning that should there be any repetition of this type of behaviour within any of our hospitals or community settings; consideration will be given to taking action against you. 

Such action may include the following: 

• Seeking an Acceptable Behaviour Agreement 
• Invoking the Trust Safer Environments Policy 
• Exclusion from our premises 
• Reporting to the Police where your behaviour constitutes a criminal offence and fully supporting any prosecution they may pursue 

• A copy of this formal warning will be included in your medical records for six months from the date of this letter.

If you do not agree with what has been set out in this letter or have any comments to make, please write to me within 7 days of receipt of this letter. 

Yours sincerely 

Role/Title 

cc: 

Medical Records 

Trust Security Manager 

File 

1. Following Stages 1 and 2, any subsequent inappropriate or unacceptable behaviour may result in the issue of a Yellow Card Warning Letter. This may not necessarily arise from the same incident. This stage may be started without following Stages 1 and 2 if the behaviours warrant a yellow card letter. 
2. A careful review of the patient’s condition must be made by a senior member of the patient’s clinical team at Consultant level, to ascertain whether the behaviour is excused by the patient’s mental state at the time. Having consideration of their medical condition and treatment, this review must be documented in the patient’s healthcare records. 
3. If, following such a review, the patient is deemed to have had capacity at the time of the incident, an incident report should be completed immediately recording full details of the incident and consideration of a yellow warning be discussed with members of the patient’s clinical team and senior management within the Division. 
4. Where it is considered appropriate to issue a Yellow Card Warning Letter, the letter will be prepared by a member of the Divisional Senior Management. 
5. A copy of the letter must be filed in the patient’s healthcare record. The letter sent to the patient must be sent out by registered mail. 
6. A Yellow Card Alert (Appendix 7) must be attached to the inside front cover of the patient’s healthcare records. 
7. The Yellow Card Warning Letter will contain details of the appeals procedure. 
8. If the patient complies with the terms of the Yellow Card Warning Letter they can expect that:

• Their clinical care will not be affected in any way. 
• Any formal warning issued will cease after 12 months. 
• Any valid concerns raised by the patient regarding the process will be fully investigated. 

9. The Trust Security Manager and/or Deputy will be responsible for monitoring warnings logged on the Trust electronic recording system 
10. A flowchart detailing the process is attached at Appendix 3b. 

Senior Clinician/Nurse/Department Manager to explain to patient:  

• Behaviours are unacceptable and must cease immediately
• Further unacceptable behaviours may result in withdrawal of non-life-threatening treatment

Senior member of patient's clinical team review:

• Patient's condition
• Mental Health status/capacity
• Record details of the review in the patient's healthcare records

Does the Patient have capacity?  

Yes/No

Affected staff member:

• Complete incident report

Incident Handler (Line Manager):

• Update incident to reflect warning has been agreed with Divisional Management and letter issued to patient by Registered Delivery
• File copy of letter in the patient's medical records
• Attach yellow card alert (appendix 7) to inside cover of medical records
• Attach letter as document to incident report
• Add alert to PAS

Review 

• Division to undertake 12 month review 
• If no further incidents, write to patient rescinding warning 
• Remove yellow card alert from medical records
• File copy of letter in patient's notes
• Send electronic copy to Trust Security Manager

Dear 

This letter is to advise you that as a consequence of your behaviour on date at time, in the department, you are now subject to the conditions outlined in the Trust’s Safer Environment Policy, this Policy that has been implemented to safeguard our staff against violence and abuse. 

Insert details of the incident 

All those that work in or provide services to the NHS, have the right to do so without fear of violence or abuse and the behaviours you displayed will not be tolerated. 

Should you display the behaviours again, you may be excluded from all services provided by this Trust. 

Your medical record will hold an alert and details of your behaviours, this will remain in place for 12 months and your GP will also be made aware. This alert will be reviewed at the end of this period at which time you will be provided with the outcome of the review via letter. 

Should you wish to challenge this warning, you should do so via the Customer Services Department. Your grievance will be investigated, and you will receive a written response. 

Yours ………… 

Senior Clinician Signature 

cc: 

GP 

Trust Security Manager 

File 

1. The withholding of treatment raises a number of ethical as well as clinical issues for clinicians and managers. However, there is a clear indication that it acts as a deterrent to potentially violent and aggressive patients and visitors and ensures that our staff are able to work in a safe environment. The decision to withhold treatment should only be applied where appropriate and always as a last resort. 
2. Red Card status may be invoked where a patient has failed to comply with the agreed terms of their Yellow Card status or where their behaviour has been of such a serious or extreme nature as to warrant immediate exclusion from non-life-threatening treatment. 
3. A careful review of the patient’s condition must be made by a senior member of the patient’s clinical team, at Consultant level, to ascertain whether the behaviour is excused by the patient’s mental state at the time, having consideration of their medical condition and treatment. 
4. Such serious or extreme behaviour should always be reported to the Police. 
5. The issuing of a Red Card Exclusion Letter and subsequent exclusion from treatment within the Trust will be implemented by a member of the Trust Executive Team, who must not be the person who invoked Yellow Card status. 
6. A round table meeting will be convened at the earliest opportunity to discuss the issue of an exclusion letter. Attendees: Security Management Director, Medical Director, Trust Security Manager/Deputy, Clinical Staff involved in the incident, Security/Police, Legal if required. 
7. Divisional Senior Management to prepare the Red Card Exclusion Letter which will require a Trust Executive Team member’s signature. A copy of the letter must be filed in the patient’s healthcare records by Nurse/Department Manager. The Division will send the letter to the patient and a copy to the patient’s GP and CCG by Registered Mail 
8. A Red Card Alert (Appendix 7) will be attached to the inside front cover of the patient’s healthcare records by the Medical Records Manager. The Division will send a copy of the letter to the Medical Records Manager enclosing the red card and will make an electronic flag entry on PAS and other relevant electronic Trust recording system. 
9. The letter sent to the patient will contain details of the appeals procedure. 
10. The decision to withhold treatment will be reviewed after the exclusion period by a representative from the Trust Executive Team, Trust Security Manager and representative from the relevant Divisional Senior Management Team. 
11. If during the exclusion period the patient has attempted to seek treatment for anything other than a life-threatening condition, the patient will be refused treatment and will be asked to leave the premises, refusal to comply will result in Security and/or the Police being contacted to remove the patient. The Trust Security Manager and/or Deputy, is to be notified of this attempt. 
12. A letter reminding the patient of their exclusion will be issued by the Division including information that further attempts to seek non-life-threatening treatment may result in the Trust seeking legal action to restrict them accessing ELHT premises until such time the exclusion period has been reviewed and rescinded. 
13. If, during the exclusion period the patient has not been involved in any further episodes of unacceptable behaviour, the warning will be removed from any electronic records by the Division. The patient will be informed in writing of the result of the review. A copy of the letter will be filed in the patient’s healthcare records and those included in the original Red Card Exclusion Letter shall be informed. 
14. The Division will ensure removal of the red card alert from the patient’s medical records. 
15. A flowchart detailing the process required is attached at Appendix 4b. 

RED CARD status may be invoked:

• Where a patient has failed to comply with agreed terms of their YELLOW CARD status

OR

• Where their behaviour has been of a serious or extreme nature as to warrant immediate exclusion from non-life threatening treatment

Alert Security and contact the police

Senior member of patient's clinical team (Consultant) to conduct review of patient's condition

Does the patient have capacity? 

NO:

• No further action under this policy
• Complete incident report

YES: 

Round Table Meeting to be convened. Joint decision to reached regarding issue of Red Card letter. 

Divisions to raise letter following procedure (Appendix 4a)

 

Completion of exclusion period: 

• Division to raise letter advising patient exclusion period ended
• Division remove electronic alerts and red card alert from medical records. 
• Follow Appendix 4a

Dear 

Re: Withdrawal of Treatment ‘Red Card’ 

This letter is to advise you that as a consequence of your behaviour on date at time, in the department, you are now subject to the conditions outlined in the Trust’s Safer Environment Policy, this Policy that has been implemented to safeguard our staff against violence and abuse. 

Insert details of the incident and any prior yellow card warning letter 

All those that work in or provide services to the NHS, have the right to do so without fear of violence or abuse and the behaviours you displayed will not be tolerated. 

As of (date of letter) you are being excluded from treatment provided by East Lancashire Hospitals NHS Trust, including community premises or private residences. 

If emergency treatment is required this will not be refused; however, should admission to hospital be required, arrangements will be made for your continued treatment in another establishment. 

Your medical record will hold an Alert and details of your behaviours, this will remain in place for 12 months and your GP will also be made aware. This alert will be reviewed at the end of this period at which time you will be provided with the outcome of the review via letter. 

Should you wish to challenge this warning, you should do so via Customer Services Department. Your grievance will be investigated and you will receive a written response. 

Yours ………… 

(Nominated Exec Signature) 

cc. GP 

CCG 

File 

1. In the event of inappropriate behaviours by a visitor/s, the Nurse, Senior Doctor or Department Manager in charge of the relevant area should explain to the visitor/s that the behaviour is unacceptable and that expected standards must be observed in future. Where possible this warning must be given in front of a witness (another staff member). 
2. Should the inappropriate behaviours continue, the visitor/s should be informed that they will be asked to leave the site if they continue. 
3. If visitor/s refuse to comply, Security should be contacted to attend to support staff in their request the visitor/s leave site. 
4. Refusal to leave will result in the Police being contacted. 
5. Nurse or Department Manager to raise an incident report. 

Verbal warning to visitor/s

Nurse/Senior Doctor/Department Manager explain behaviours unacceptable

*(Where possible ensure a witness is present)

Behaviours continue: 

Nurse/Senior Doctor/Department Manager inform visitor/s they will be asked to leave site if behaviours do not cease

No improvement: 

Nurse/Senior Doctor/Department Manager request visitor/s leave site immediately. 

 

If visitor refuses to comply with request:

Contact security or the Police to request assistance. 

Visitor/s left site

Raise incident report via DATIX

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