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					Document name:           Guidance for the bathing of
                         vulnerable service users


Document type:           Clinical practice guidance



Version number:          2



Staff group to whom it   All clinical staff
applies:

Distribution:            The whole of the Trust



How to access:           Intranet and internet



Issue date:              April 2010



Next review:             September 2012



Approved by:             Director of Nursing, Compliance and
                         Innovation


Developed by:            Ann Hargate, Assistant Director of
                         Nursing and Clinical Risk


Director leads:          Director of Nursing, Compliance and
                         Innovation


Contact for advice:      Relevant Modern Matron/Clinical
                         Leader, Ann Hargate, Assistant
                         Director of Nursing and Clinical Risk
  GUIDANCE FOR THE
BATHING OF VULNERABLE
    SERVICE USERS
TABLE OF CONTENTS                                                                                                    PAGE
Introduction ................................................................................................................ 1
Purpose and scope of the guidance ........................................................................... 1
Definition of a vulnerable service user........................................................................ 1
Procedural guidelines ................................................................................................. 1
Incident management ................................................................................................. 2
Duties………….….. .................................................................................................... 2
Development process................................................................................................. 3
Equality impact assessment ....................................................................................... 3
Dissemination and implementation arrangements ..................................................... 3
Process for monitoring compliance and effectiveness................................................ 3
Review and revision arrangements ............................................................................ 4
Other relevant documents .......................................................................................... 4
References ................................................................................................................. 4


Appendices
Appendix A
Equality impact assessment tool ................................................................................ 5
Appendix B
Checklist for the review and approval of procedural document .................................. 6
Appendix C
Version control sheet.................................................................................................. 8
1.      Introduction

        Following a Health and Safety Inspection in April 2005, the Health and Safety
        Executive Report recommended that ‘a clear system of work should be
        provided for persons involved in the bathing of vulnerable patients’.

        This guidance has been written to ensure safe practice when bathing/
        showering vulnerable service users within the in-patient areas of South West
        Yorkshire Partnership NHS Foundation Trust (SWYPFT) and has been written
        for all SWYPFT staff who provide care for this client group. The guidance
        does not cover those individuals in local authority owned buildings that
        provide rehab and recovery services. SWYPFT staff who work in these areas
        should refer to the local authorities health and safety guidance.

        When assisting a vulnerable service user to bathe/shower, staff should work
        within existing Health and Safety, Moving and Handling and Infection Control
        Policies/Procedures. Further reference material can also be found in The
        Royal Marsden Hospital Manual of Clinical Nursing Procedures, Chapter 33,
        Personal Hygiene: Skin Care (2008).

2.      Purpose and scope of the guidance

        The guidance will support staff to undertake the bathing/showering of vulnerable
        service users in a safe and effective manner thus ensuring the welfare of those
        within their care.

3.      Definition of a vulnerable service user

        For the purpose of this guidance a vulnerable service user is a person who is
        unable to take care of him or herself or unable to protect him or herself against
        significant harm or exploitation. (No Secrets 2000).

4.      Procedural guidelines

        Service users who require assistance when bathing and showering within the
        in-patient areas of SWYPFT should have an assessment of their personal
        hygiene and moving and handling needs (SWYPFT Moving and Handling
        Policy - Moving and Handling Risk Assessment), the outcome of which should
        be care planned. This care plan should consider the privacy and dignity needs
        of the service user, balanced with the need to manage any identified risks.

        Within the in-patient areas of SWYPFT, hot taps are set at a temperature of
        43C, however, to prevent scalding, water temperature should be checked
        with a bath thermometer prior to bathing.

        Where a shower is being used, ensure the water temperature is stable and at
        the service user’s preferred temperature.




Guidance for the bathing of vulnerable service users                                   1
        If it is necessary for a member of SWYMHT staff to assist service users with
        bathing and showering in their own home, then an assessment of risk should
        be completed by a professionally qualified member of staff and a care plan
        developed that describes both the health and safety checks required and the
        specific needs of the individual e.g. ‘requires two staff to be present’.
        Supporting service users to bathe and shower in their own home should not
        be undertaken without a completed risk assessment/care plan.

        If a person lacks mental capacity, it can never be in that person’s best interest
        for them to not receive personal care. Staff should seek advice from the
        appropriate specialist adviser when dealing with complex situations.

5.      Incident management

        Any adverse incident which occurs in relation to bathing/showering vulnerable
        service users (as described in this document) will be reported and
        investigated in accordance with the Trust’s incident management and related
        policies available on the intranet. In addition, failure of any water temperature
        control device needs to be reported to the appropriate facilities/works
        department.

        Service users must not use any bath/shower equipment where the
        temperature control device may be faulty.

6.      Duties

        a. The Executive management team

             The Executive Management Team will be responsible for approving this
             policy.

        b. Director of nursing, compliance and innovation

             The Director of Nursing, Compliance and Innovation is the lead director for
             clinical practice in the Trust supported by the Medical Director. The lead
             director will be responsible for engaging with stakeholders in the
             development of this guidance and ensuring the most current version is in
             use and obsolete versions have been drawn from circulation.

        c. Clinical governance and clinical safety committee

             Responsible for scrutinising the implementation and effectiveness of this
             guidance and providing assurance to the Trust Board.

        d. Health and safety trust action group (TAG)

             This group will be responsible for reviewing and amending the framework
             at the direction of the lead director.




Guidance for the bathing of vulnerable service users                                     2
        e. Service delivery groups (business delivery units)

             Service delivery groups are responsible for ensuring that staff within their
             sphere of influence implement the guidance in clinical practice.

        f. General managers, service managers, ward/unit and team managers

             These are responsible for ensuring that staff are aware of the content of
             the guidance and its application to clinical practice. The above group are
             also responsible for ensuring that any training requirements identified by
             themselves or staff within their team are documented in the annual
             Training Needs Analysis.

        g. Professional leads

             Professional leads will be responsible for providing advice and support to
             clinicians on the content and implementation of the framework.

        h. All clinical staff

             All staff are responsible for using the guidance in clinical practice.

7.      Development process

        The guidance was reviewed and updated by the Health and Safety TAG,
        professional and clinical leads, specialist advisors and circulated to the ward
        managers network for comment.

8.      Equality impact assessment

        The guidance has no differential impact on equality, as identified by the
        equality impact assessment tool (Appendix A) as included in the Policy for the
        development, approval and dissemination of policy and procedural
        documents.

9.      Dissemination and implementation arrangements

        Once approved, the Integrated Governance Manager will be responsible for
        ensuring the updated version is added to the document store on the intranet
        and is included in the staff brief.

        The guidance will be cascaded from the clinical directors (service delivery)
        through their service delivery groups and thence by general managers
        through their management structure. Any training needs related to this
        guidance should be identified as part of the KSF/appraisal system.

10.     Process for monitoring compliance and effectiveness

        The use of the guidance in clinical practice will be monitored via the incident
        reporting procedure which will highlight any incidents involving water


Guidance for the bathing of vulnerable service users                                        3
        temperature. Planned maintenance checks on the water temperature control
        devices are undertaken on a 6 monthly basis by staff within SWYPFT facilities
        department.

11.     Review and revision arrangements

        The guidance will be reviewed by the agreed review date in line with the
        Policy for the development, approval and dissemination of policy and
        procedural documents, or earlier if required. Responsibility for initiating a
        review lies with the Assistant Director of Nursing and Clinical Risk who will
        forward the revised guidance to the Director of Nursing, Compliance and
        Innovation for approval.

        The integrated governance manager is responsible for placing the new
        version of the policy in the electronic document store, for ensuring the
        document being replaced is removed from the document store and that an
        electronic and paper copy, clearly marked with version details, are retained as
        a corporate record.

12.     Other relevant documents

        a. SWYPFT infection prevention and control policy

        b. Moving and handling policy, client handling risk assessment

        c. Clinical risk assessment, management and training policy

13.     References

        SWYPFT Health and Safety Policy

        SWYPFT Moving and Handling Policy

        SWYPFT Infection Prevention and Control Policies

        SWYPFT incident management and related policies and procedures

        The Royal Marsden NHS Foundation Trust, (2008). The Royal Marsden
        Hospital Manual of Clinical Nursing Procedures, (7th ed). London. The Royal
        Marsden NHS Foundation Trust.

        No Secrets – Guidance on the developing of multi agency policies and
        procedures to protect vulnerable adults from abuse DoH (2000).




Guidance for the bathing of vulnerable service users                                    4
                                             Appendix A
                                  Equality Impact Assessment Tool

To be completed and attached to any policy document when submitted to the Executive Management
Team for consideration and approval.

                                                             Yes/No                 Comments

 1.     Does the policy/guidance affect one group
        less or more favourably than another on the
        basis of:

         Race                                                  NO

         Ethnic origins       (including   gypsies    and      NO
          travellers)

         Nationality                                           NO

         Gender                                                NO

         Culture                                               NO

         Religion or belief                                    NO

         Sexual orientation including lesbian, gay             NO
          and bisexual people

         Age                                                   NO

         Disability - learning disabilities, physical          NO
          disability, sensory impairment and mental
          health problems
 2.     Is there any evidence that some groups are              NO
        affected differently?
 3.     If you have identified potential                        NO
        discrimination, are any exceptions valid,
        legal and/or justifiable?
 4.     Is the impact of the policy/guidance likely to          NO
        be negative?
 5.     If so can the impact be avoided?                       N/A
 6.     What alternatives are there to achieving the           N/A
        policy/guidance without the impact?
 7.     Can we reduce the impact by taking                     N/A
        different action?

If you have identified a potential discriminatory impact of this policy, please refer it to the Director of
Corporate Development or Head of Involvement and Inclusion together with any suggestions as to the
action required to avoid/reduce this impact.

For advice in respect of answering the above questions, please contact the Director of Corporate
Development or Head of Involvement and Inclusion.




Guidance for the bathing of vulnerable service users                                                     5
                                     Appendix B
           Checklist for the Review and Approval of Procedural Document

To be completed and attached to any policy document when submitted to EMT for consideration and
approval.

                                                           Yes/No/
        Title of document being reviewed:                                    Comments
                                                           Unsure

 1.     Title

        Is the title clear and unambiguous?                 YES
        Is it clear whether the document is a guideline,    YES      The document is a framework
        policy, protocol or standard?
 2.     Rationale

        Are reasons for development of the document         YES
        stated?
 3.     Development Process

        Is the method described in brief?                   YES

        Are people involved in the development              YES
        identified?
        Do you feel a reasonable attempt has been           YES
        made to ensure relevant expertise has been
        used?
        Is there evidence of consultation with              YES
        stakeholders and users?

 4.     Content

        Is the objective of the document clear?             YES

        Is the target population clear and                  YES
        unambiguous?

        Are the intended outcomes described?                YES

        Are the statements clear and unambiguous?           YES

 5.     Evidence Base

        Is the type of evidence to support the              YES
        document identified explicitly?
        Are key references cited?                           YES

        Are the references cited in full?                   YES

        Are supporting documents referenced?                YES
 6.     Approval

        Does the document identify which                    YES
        committee/group will approve it?
        If appropriate have the joint Human                 N/A
        Resources/staff side committee (or equivalent)
        approved the document?



Guidance for the bathing of vulnerable service users                                               6
 7.     Dissemination and Implementation

        Is there an outline/plan to identify how this will   YES
        be done?

        Does the plan include the necessary                  N/A
        training/support to ensure compliance?
 8.     Document Control

        Does the document identify where it will be          YES
        held?
        Have archiving arrangements for superseded           N/A
        documents been addressed?
 9.     Process to Monitor Compliance and
        Effectiveness

        Are there measurable standards or KPIs to            N/A
        support the monitoring of compliance with and
        effectiveness of the document?

        Is there a plan to review or audit compliance        YES   Via incident reporting
        with the document?                                         procedure
 10.    Review Date

        Is the review date identified?                       YES

        Is the frequency of review identified? If so is it   YES
        acceptable?
 11.    Overall Responsibility for the Document

        Is it clear who will be responsible for              YES
        implementation and review of the document?




Guidance for the bathing of vulnerable service users                                        7
                                             Appendix C
                                        Version Control Sheet

This sheet should provide a history of previous versions of the policy and changes made

 Version        Date              Author               Status             Comment / changes
 1           July         Chief Operating                       Original guidance developed following
             2007         Officer                               H&S executive visit in 2005.
 2           07.04.10     Assistant Director of                 Changes reflect policy for the approval and
                          Nursing and Clinical                  dissemination of policy and procedural
                          Risk                                  documents. Information related to local
                                                                authority owned premises and guidance
                                                                for bathing service users in their own
                                                                homes has been added




Guidance for the bathing of vulnerable service users                                                    8

				
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