1. Security protective marking
1.1. Not protectively marked.
2. Summary of changes
2.1 The following changes have been made to this policy on 18 October 2012:
- Narcain has been replaced with Naloxone (5.4);
- Guy's Poisons Unit has been replaced with National Poisons Unit and new telephone number 0844 8920111;
- 9.12 now has reference to the FNP being contacted for guidance before returning to the custody suite
- 10.2 now states a mental health assessment should be carried out by a FNP, FME or CPN if available.
2.2 This policy is scheduled for review in June 2015.
3.1. This policy applies to:
- Forensic nurses;
- Force Medical Examiner;
- Custody Staff;
- Patrol Officers.
4.1. This policy is introduced to:
1) Ensure the safe management and regime of care is implemented when a detainee is suspected to or has actively taken an overdose, either accidentally or deliberately. This overdose may have been taken prior to the detainee’s arrival in custody but not disclosed. It must be remembered that certain drugs have a long half-life and may not take effect for several hours after ingestion.
2) To ensure that any person detained in custody, which either the Forensic Nurse Practitioner (FNP) or Custody Sergeant (Sgt) or both, believe to have a life threatening illness and/or injury and are refusing clinical treatment, may be transferred to hospital without their consent for preservation of life.
NOTE: This policy is designed for use by FNPs, however it can be used by the Custody Sergeant, for decision-making and transfer orders in the absence of a FNP. In these circumstances Custody Sergeant’s only need consult paragraph 7.2 and paragraphs 9.5 to 9.14 for guidance.
5. First Aid
5.1. Shout for help and call 999 asking for an ambulance if the detainee has a reduced level of consciousness.
5.2. Administer immediate first aid treatment. Oxygen therapy and cardiac monitoring should be applied.
5.3. Obtain baseline observations – blood pressure, pulse, temperature, blood sugar and pupils’ size and reaction.
5.4. If it is suspected that the overdose is opiate based then naloxone should be injected inter-muscularly as soon as possible.
5.5. Ensure the detainee is not left unattended. Advise constant supervision.
6. National Poisons Unit
6.1. Telephone National Poisons Unit for further guidance on the management of the detainee on: 0844 8920111.
6.2. Give National Poisons Unit as much information as you have regarding the type and quantity of tablets taken, the time they were taken, the detainee’s current symptoms and condition, the detainee’s age, gender and past medical history and if any alcohol or other substance has been consumed.
6.3. National Poisons Unit will require the following information: your name, where you are calling from, your job title, the detainee's custody number as their reference and the postcode of the police station you are in.
7. Activated charcoal
7.1. Where indicated, National Poisons Unit will advise the administration of activated charcoal. This should be carried out as soon as possible and documented on the nursing assessment sheet and custody record.
7.2. Every effort should be made to ensure the detainee drinks the charcoal. If the detainee declines this treatment after having made an informed choice then this is to be recorded on the custody record and witnessed by the Custody Sergeant.
8. Transfer to hospital of detainee accepting treatment
8.1. If National Poisons Unit suggests further assessment and treatment in hospital and the detainee is accepting this treatment then they are to be transferred to the nearest hospital Accident & Emergency Department (A & E).
8.2. Transfer should be by 999 ambulance in all cases.
8.3. The nurse in charge of the A & E Department should be telephoned and informed of the detainee’s attendance and the guidance National Poisons Unit has advised.
8.4. A copy of the forensic nurse notes including any history, observations and treatment administered should accompany the detainee to hospital.
9. Transfer to hospital of detainee refusing treatment
9.1. Follow the guidelines for transfer to hospital following refusal by the detained persons of treatment as below.
9.2. Ensure the patient is lawfully detained. If not, offer medical assistance, if this is refused make a note of it. If the patient is unconscious proceed using normal medical principles administering first aid.
9.3. If the Forensic Nurse Practitioner is of the opinion that the detainee requires treatment they should ensure that the Custody Sergeant is aware of all the potential risks.
9.4. If the Custody Sergeant confirms that they are of the same opinion as the Forensic Nurse and that treatment is necessary and the detainee has given informed consent for immediate hospital treatment then the Forensic Nurse should sign the custody record to acknowledge consent for the transfer. If the Custody Sergeant decides that treatment is not necessary, this should be recorded on the custody record and counter signed by the Custody Sergeant.
9.5. If the detainee is not giving consent, document any reasons given.
9.6. If the detainee will not sign a disclaimer, this should be documented on the custody record.
9.7. If the detainee is willing to sign a disclaimer then obtain this and place with the custody record.
9.8. Contact the nurse in charge of A & E asking for instructions where to transfer the patient to.
9.9. Transfer the patient to A & E or to where instructed, using reasonable and appropriate force, maintaining the security of the detained person at all times. If transfer by ambulance is not acceptable to the patient or the ambulance staff then the patient is to be transferred in a secure police vehicle with the forensic nurse and ambulance escorting. Police are to ensure the safety of the forensic nurse during escort.
9.10. On arrival to the designated location notify medical staff of the patient’s refusal to accept treatment and whether they are under arrest. Provide details of the overdose, illness or injury and the reason why it is considered treatment is needed.
9.11. If the hospital is willing to give treatment, give details on the custody record with any hospital records given.
9.12. If the hospital is not willing to give treatment, then the FNP must be contacted for guidance before returning to the custody suite and document any reasons on the custody record. If no disclaimer has been signed, request this again, the forensic nurse must reassess the detainee as clinical condition dictates and liaise with the A & E department re returning the detainee, if necessary.
9.13. Constant supervision is advisable and the Custody Sergeant should be made aware of this.
9.14. The Forensic Medical Services Manager is to be informed as soon as possible of this situation.
10. Detainees not requiring hospital treatment
10.1. In some cases National Poisons Unit may advise hospital treatment is not necessary due to non toxicity of the drug taken. In this situation a care regime is to be implemented with the agreement of the Custody Sergeant and reviewed by the Forensic Nurse Practitioner as advised by the Poisons Unit.
10.2. If the overdose was deliberate consider constant supervision care regime, discuss with Custody Sergeant and document on the custody record. A mental health assessment should be carried out by a FNP, FME or CPN if available.
11. Clinical incident recording
11.1. In all cases of overdose in custody an Adverse Incident (positive intervention) form must be submitted. Remember - detainees may withhold information; always act on the clinical findings and if in doubt transfer out.
12. Authorised Professional Practice
12.1. For further information on the management of alcohol and drugs within custody please see the Authorised Professional Practice guidance by clicking on the subheadings 'Detainee Care - Health Provision' and then 'Alcohol and Drugs'.
13. Appendix one
14. Appendix two
15. Appendix three
15.1. The disclaimer is form 3817 and is available under Word.
16. Equality impact assessment
16.1. This policy has been assessed with regard to its relevance to race and diversity equality. As a result of this assessment the policy has been graded as having a low potential impact.
16.2. Attached is the latest equality impact assessment that forms part of the policy review process.
|Policy reference:||H10 The management of detained persons following overdose|
|Policy owner:||Chief Superintendent. Head of Central Investigation Command|
|Contact point:||Policy Unit, 01622 653298|
|Date last reviewed:||18 October 2012|
|Document last saved:||24 October 2012