Seclusion Policy – Competencies for Healthcare Support Workers

Competence: ‘The state of having the knowledge, judgement, skills, energy, experience and motivation required to respond adequately to the demands of one’s professional responsibilities’.

(Roach 1992)

The following competencies should be completed for all Healthcare Support Workers, new starters to the ward and all bank staff who will be supporting and observing patients in seclusion.

Should the staff member be unable to complete the competencies to the assessor’s satisfaction, they should not be asked to support and observe patients in seclusion and instead should be given an opportunity for re-assessment.

Opportunity should have been given to read the Trust Seclusion Policy before completing this competence assessment.

Ward …………………………………………………………….Date….…………...

Name of assessor………………………………………………Band……………...

Name of staff……………………………………...... Band………………

Question / Criteria to meet / Achieved
Please circle
1 / What is seclusion, and where can it take place? / See definition of seclusion in policy. Seclusion can take place only in a room designated for seclusion, that is used for no other purpose. / Yes / No
2 / De-escalation must be the first response to disturbed behaviour. What approaches to de-escalation might you try? / Articulate process for de-escalation and interventions that that staff member could try. / Yes / No
3 / What sort of things might you consider in order to maintain the patient’s privacy and dignity whilst in seclusion? /
  • Appropriate clothing
  • Gender of observing staff
  • Special instructions for observation (for example, if the patient is sexually disinhibited)
  • Respect for spiritual and religious needs
  • Toilet and washing facilities
/ Yes / No
4 / How often must a patient be observed whilst in seclusion? / Constantly – level 1B observations / Yes / No
5 / Where would you document your observations of the secluded patient? / On the observation record / Yes / No
6 / What would you record? /
  • Date, time of observation and name of observing staff
  • Note physical wellbeing of patient, and what he or she is doing
  • Note mental health symptoms observed
  • Recording to be contemporaneous, i.e. documented at the time, not at the end of a period of observation
/ Yes / No
7 / How often would you document? / At least every 15 minutes / Yes / No
8 / What action would you take if the patient appeared to be asleep? / Inform the nurse in charge, who will review the need for seclusion to continue / Yes / No
9 / What would you do if a member of staff asked you to take on an additional task while you are rotered to observe a patient in seclusion? / Remind the member of staff that you are engaged in level 1B observations and must remain focussed on that task. Escalate any concerns to the nurse in charge. / Yes / No
10 / What might you do if the patient you were observing had taken their clothes off and become sexually disinhibited? / Request support from a colleague of the same gender as the patient. Consider how the patient can be supported with their privacy and dignity needs. / Yes / No
11 / What would you do if you looked through the seclusion room window and the patient was out of view? / Notify the nurse in charge, who will assess the patient’s presentation, and make a decision about the need to undertake a direct observation. / Yes / No
12 / For Agnes Unit, Belvoir and Herschel Prins staff only
How would you explain the meaning of the term ‘long term segregation’? / Longer-term segregation refers to the management (within a designated seclusion room) of a small group of patients (often in high secure services) for whom a risk to others is a constant feature of their presentation.
13 / For Agnes Unit, Belvoir and Herschel Prins staff only
How would you record that a patient had been ‘long term segregated’, and what documentation would you use? /
  • Complete an eIRF
  • Use Trust seclusion paperwork (there is a box to tick on the form to indicate long term segregation
  • Develop a long term segregation care plan
  • Observations must be recorded at least every 15 minutes

Reassessment must take place following review of the Trust’s Seclusion Policy, or sooner at the discretion of the ward matron or supervisor.

I certify that I have assessed …………………………... and he or she has demonstrated a good understanding of the Seclusion Policy and its use.

Signature of assessor………………………………………………Band……………...

Next review date (if applicable):

Roach MS (1992) The Human Act of Caring, Ottawa, Ontario; Canadian Hospital Association Press

Leicestershire Partnership NHS Trust (2013) Seclusion Policy