Substance use amongst inpatients on mental health wards: practical guide for mental health services

14. Appendix B - Responding to suspicion of substances on the ward

At each stage of the process staff should explain to the patient what is happening and why, providing reassurance and support to the patient who may be distressed. In cases where other patients are distressed by the events on the ward staff should take steps to reassure them and provide information whilst respecting everyone’s right to confidentiality.

Nursing staff will:

Management of the patient

1. Request the patient agrees to a personal and room search in line with local policy. If permission withheld or refused, refer to the police.

2. Request the patient provide a urine sample for drug screening.

3. Obtain details about what substances have been taken, if any.

4. Check clinical observations (e.g. NEWS) and escalate, if appropriate.

5. Consider the need for enhanced nursing observation to limit risk to the patient and others.

6. Make the environment safe - attempt to limit the negative impact of substance use on others.

7. Ensure the patient has no time out.

8. Do not give medication and seek advice for medication plan.

Escalation

1. All cases of substance use or possession of substances on the inpatient wards must be reported to Police Scotland on 101.

2. Contact the duty doctor to review the patient.

Documentation

1. Carefully note what was found (description), where it was found and by whom.

2. Complete the Police Statement Form .

3. Record the police incident number or crime reference number.

4. Complete an Incident Report (Datix or Safeguard).

5. Gather additional information about what the patient may have taken or have in their possession from other patients, family/friends/NOK.

6. Provide an update on the patient’s condition to NOK/carers where there is concern (whilst respecting the usual grounds of confidentiality).

Duty Doctor or ANP will:

Management of the patient if Doctor/ANP is on-site

1. Review the patient’s physical state.

2. Perform a mental state examination.

3. Formulate a medication plan.

4. Liaise with nursing staff to create a workable management plan.

Management of the Patient if Doctor/ANP is not on-site

1. Remotely review the patient – considering NEWS score etc.

2. Discuss a medication plan.

3. Liaise with nursing staff to create a workable management plan.

Escalation

1. Have a low threshold for discussion with the Consultant/duty Consultant.

Documentation

1. Clear examination of mental state/presentation.

2. Concerns of the clinical team.

3. Views of the patient / carers.

4. Agreed management plan.

5. If the patient is discharged earlier than planned, the decision making about this should be clearly documented and record who was involved in making the decision. The discharge plan must include details of follow-up and evidence consideration of referral to specialist substance use services.

Consultant will:

Management of the patient

1. Review the patient as soon as is possible and within 48 hours of the incident.

2. Consider specialist substance use service input or advice.

3. Provide statements to the police.

4. Consider the need for ongoing hospital care. As far as possible this should be a MDT decision.

5. Consider the use of Specified Persons for detained patients.

Escalation

1. Work with Service Managers and Clinical Directors on complex cases.

Documentation

1. Clear examination of Mental State/Presentation. Specifically describe the patient’s capacity regarding:

• Substance use
• Antisocial behaviour
• Treatment
• Fitness to be interviewed by the police

2. Statement form from Police Scotland.

3. Documentation of discussions with colleagues and the outcome of decisions with regard to treatment and the need for hospitalisation.

Police will:

Management of the patient

1. Attend the ward where there is a suspicion that there are individuals in possession of substances.

2. Take statements.

3. Utilise local search policy if there are ground to suspect the patient of having substances.

4. Attend to retrieve substances and take statements (though not necessarily on the same day).

Escalation

1. Submit a report to the Procurator Fiscal where appropriate and in accordance with current policy and practice.