New guidance given on care record violence markers

The NHS Security Management Service has launched new guidance on the use of markers on patients’ care records, which alert NHS staff to the risk of physical violence or aggression, either from the patient or someone associated with them, when they treat certain individuals. Staff who work in the NHS have a right to work in a safe and secure environment.

Procedures for placing a risk of violence marker on electronic and paper records introduces important safeguards to make sure that personal records are only marked where there has been a reported incident or evidence of violent or aggressive behaviour.

Those who have responsibility for the safety and security of NHS staff can already place a risk of violence marker on an individual’s electronic or paper care record. The size of the NHS and the mobility of users makes efficient information sharing essential. The guidance does not change the need to respect patient confidentiality, and to deliver care without discrimination at all times.

This national initiative offers an effective process that is easily incorporated into existing local arrangements. It acts as an early warning system and complements the existing range of SMS guidance for NHS staff on how to tackle violent and aggressive behaviour. It also helps health providers to meet their health and safety responsibilities, by providing security warnings and handling advice to avoid or minimise the risk of violence. Where appropriate, NHS staff can also contact their Local Security Management Specialists (LSMSs) for further advice and guidance.

Dermid McCausland, Managing Director of NHS SMS, asks all NHS staff to “continue to report any incidents of violence and aggression. The more reports we have, the greater the success of the marking scheme, so that patient care can be delivered in a safe and secure environment. Our Policy team has put a huge amount of work into making care record markers even more effective.”

The guidance has been welcomed by a number of leading health organisations: a British Medical Association spokesperson said: "It is important that anyone who works for the NHS is properly protected against the risk of violence. We therefore welcome this guidance, which clarifies the situation on how markers can be used. We hope all providers of care will use it when reviewing or implementing their own procedures. Nurses, midwives, doctors – all medical staff - are still expected to treat patients, guardians, relatives or friends of patients professionally. When treating patients, nursing staff are not expected to discriminate in any way.”

Nursing and Midwifery Council Chief Executive and Registrar Professor Dickon Weir-Hughes says: "Nurses and midwives should be free to work without the fear of violence or aggression. We hope these markers will improve safety, although nurses and midwives will continue to provide equal care to everyone. The NMC code of conduct clearly states that they must not discriminate in any way against those in their care."

A UNISON spokesperson said: “UNISON welcomes this guidance, which gives providers essential advice on how patient markers should be used. It makes it clear that the safety of staff and the public is paramount to the delivery of services whilst recognising the importance of patient confidentiality. We hope that all healthcare providers will use it to help prevent or reduce the risk of violence to staff.”

Janet Davies, Executive Director of Nursing and Service Delivery, Royal College of Nursing, says: “Nurses and healthcare assistants will welcome this guidance, which will be particularly useful for staff who work alone. Managers need to do all they can to minimise the risks faced by their employees, and sharing information on the risks and how to deal with them is a key part of that.”