Setting

This audit is particularly relevant to forensic in-patient services, psychiatric intensive-care units, general in-patient settings and the emergency departments of general hospitals.

Background

The undertaking of necessary and lawful searches of both patients and visitors as well as ward searches by appropriately trained staff can make a valid contribution to the safety of in-patient settings.

Standards

The National Institute for Health and Clinical Excellence (NICE) (2005) has produced a guideline on the conduct of searches as part of the short-term management of disturbed or violent behaviour in in-patient psychiatric settings and emergency departments. The guideline states that each facility should have an operational search policy in place and this should cover the following:

ᐅ searching patients, their belongings and the environment in which they are accommodated

ᐅ searching visitors

ᐅ ‘rub down’ or personal searching, together with procedures for authorisation in the absence of consent

ᐅ the circumstances in which a service user physically resists being searched

ᐅ the routine and random searching of detained service users. The standards relating to how searches are carried out are as follows:

ᐅ Searches should be undertaken by appropriately trained staff of the same gender as the patient.

ᐅ A comprehensive record of every search should be made, including of what is found on the search.

ᐅ All aspects of the management of disturbed/violent behaviour should be monitored on a regular basis.

Method

Data collection

Searches should be documented on incident forms (e.g. NHS IR1 forms) and these were cross-referenced with multidisciplinary patient notes. The notes and forms were examined to find entries documenting any of the following for each search in a specified time period:

ᐅ how many searches were conducted within the time period and, where applicable, the reason for the search (categorised as random or triggered by an event)

ᐅ who conducted the search, whether they were of the same gender as the patient and whether a witness was present

ᐅ what was found on the search

ᐅ what management plan was put in place as a result.

Data analysis

The proportion of patients subjected to searches for which the following standards were met were calculated:

ᐅ documentation of the dates and reasons for the searches

ᐅ documentation of who conducted the search and any witness present

ᐅ documentation of what was found

ᐅ documentation of resulting management plan.