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Hydrotherapy Health & Safety Risk Assessment Policy Sept14 Page - 2 -

Document Details

Title Hydrotherapy Health & Safety Risk Assessment Policy

Trust Ref No 1935-25565

Local Ref (optional)

Main points this document covers

This policy is intended to support clinical staff at Shropshire Community Health NHS Trust to carry out a risk assessment of patients using the hydrotherapy pool under the supervision of physiotherapy staff.

Who is the document aimed at?

All staff caring for patients using the hydrotherapy pool.

Author Claire Strickland

Approval process

Approved by (Committee/Director)

Clinical Policies Group notified to Quality and Safety Committee

Approval Date 8th September 2014

Initial Equality Impact Screening

Yes

Full Equality Impact Assessment

No

Lead Director Steve Gregory Director of Nursing and Operations

Category Clinical

Sub Category

Review date September 2017

Distribution

Who the policy will be distributed to

SCHT Physiotherapy Staff.

Method Policy alert, Heads of department, Physiotherapy Staff Meeting and Quality and Safety Group notification.

Document Links

Required by CQC

Required by NHSLA

Other

Amendments History

No Date Amendment

1 Sept 14 New policy

2

3

4

5


Contents Page

1. Introduction 5

2. Purpose 5

3. Definitions 5

4. Duties 5-6

5. Hydrotherapy Health & Safety Risk Assessment Policy 6-10

5.1 Moving and Handling

5.2 Slipping Hazard

5.3 Drowning/unexpected submersions

5.4 Deterioration of Health in the pool

5.5 Epilepsy

5.6 Procedure to manage seizures in the pool

5.7 Fatigue/dehydration

5.8 Rest after the session

5.9 Skin rash/Irritation

5.10 Faulty equipment

5.11 Need for fast evacuation

5.12 Infection Prevention and Control

5.13 Verruca

5.14 Water fouling 6 Consultation 10

7 Dissemination and Implementation 10

8 Monitoring Compliance 10

9 Associated Documents 11 10 References 11 11 Appendices 12-21


Appendix 1 Patient consent form Appendix 2 Hydrotherapy referral form Appendix 3 Hydrotherapy pre-pool health screen Appendix 4 Hydrotherapy discharge form Appendix 5 Hydrotherapy leaflet Appendix 6 Hydrotherapy outcome measures Appendix 7 Hydrotherapy risk assessment Appendix 8 Pool evacuation procedure & training log Appendix 9 Hydrotherapy Water Testing at Bradbury Day Centre Hydrotherapy Pool


1. Introduction

This information is to ensure that Physiotherapy staff undertake appropriate risk assessment and ensure the safety of all patients whilst in the hydrotherapy pool at the Bradbury Day Centre, Whitchurch. 2. Purpose The purpose is to support staff in maintaining health and safety of patients, staff, carers and students whilst at the Bradbury Day Centre hydrotherapy pool. 3. Definitions Hydrotherapy is “a physiotherapy programme utilising the properties of water, designed by a suitably qualified physiotherapist. The programme should be specific for an individual to maximise function, which can be physical, physiological, or psychosocial. Treatments should be carried out by appropriately trained personnel, ideally in a purpose built, and heated hydrotherapy pool”

HACP (2007) 4. Duties

Chief Executive The Chief Executive Officer has overall responsible for maintaining staff and patient safety and is responsible for the governance and patient safety programs within the organisation. Directors Directors of Services are responsible for ensuring the safe and effective delivery of services they manage; this includes securing and directing resources to support the implementation of this policy. They are also responsible for ensuring a process is in place to effectively manage patient falls and that the organisation is compliant with the Care Quality Commission (CQC) and National Health Service Litigation Authority (NHSLA). Line Mangers and Service Leads Managers will ensure that a system is in place within the services they are responsible and the implementation of this policy, monitoring its effectiveness.

Team Leaders Team leaders must ensure team members have access to policy guidelines. This would include education, supervision, to ensure safe practice.

5. Hydrotherapy Health & Safety Risk Assessment Policy for use at Whitchurch Hydrotherapy Pool


5.1 Moving and Handling

Prior to moving and handling ensure that the floor is dry, the environment is free from clutter and there is enough space available.

Refer to and adhere any individual moving and handling risk assessment completed by the physiotherapist on referral documentation.

Always follow instructions from the physiotherapist/assistant on individual client’s hydrotherapy programmes.

Moving and handling in the changing area to be carried out with supervision/assistance from a member of the physiotherapy team as required.

All staff and students must wear either overshoe covers, indoor only shoes or be barefooted when in the designated pool area.

All staff must have read and understood the Trust policies on health & safely and manual handling, be up to date with manual handling mandatory training, hydrotherapy pool evacuation training and aware of their own limitations and safety.

5.2 Slipping Hazard

Floors can be wet on the poolside and changing area. Always walk with caution taking responsibility for your own safety. Use wall hand rails as appropriate and take extra care if using walking aids.

Do not wring out swimwear on the floor at the pool. Do this in shower area.

Take care when entering and exiting the pool using the steps and handrails. Seek assistance from staff as required. Do not jump or dive into the pool.

Patients should not enter the pool until instructed to do so by a member of the physiotherapy team.

5.3 Drowning/Unexpected Submersion

Staff, students and patients to be made familiar with the layout and depth of the pool and the safety procedures prior to entering the pool.

Staff members to use the hoist as required and have appropriate training to use such equipment safely.

Supervise patients at all times, providing physical support and assistance as directed by the physiotherapist/assistant.

Use floatation aids as directed by the physiotherapist/assistant.

Be aware of other pool users. Avoid collision with others.


Maintain patient head support at all times as required to avoid submersion. 5.4 Deterioration of Health in the Pool

Staff, students and patients who are unwell must not enter the pool.

Patients who have been unwell less than 48 hours prior to attending their appointment must inform the physiotherapy staff. The physiotherapist will assess the risk for each individual patient.

Always monitor changes in your patient’s health whilst at the pool. Patients should report any changes to the physiotherapist immediately for assessment.

5.5 Epilepsy

Patients who are epileptic should inform the physiotherapy team prior to entering the pool.

Patients should inform the physiotherapist of any changes to seizure pattern, frequency and prescribed medication.

Patients with poorly controlled epilepsy should not enter the pool

Patients with controlled epilepsy should be monitored at all times and bring all rescue medication to the pool session.

5.6.1 Procedure to Manage Seizures in the Pool

Note time of onset of seizure.

The lead physiotherapist should record the incident and any advice or treatment provided. They should also inform the patients GP.

If a seizure occurs:

Maintain head support at all times to avoid submersion.

Ensure patient is clear from injury.

Ensure patient is not at risk from or to others.

Raise the alarm (via the alarm system in situ).

Contact the emergency services as required via 999.

Commence emergency evacuation as required. (All staff to have completed training on pool evacuation ensuring they are able to demonstrate use of the spinal board and evacuation of a person both in and outside of the pool. This should be done on an annual basis and recorded in the Hydrotherapy File in the Physiotherapy Department) 5.7 Fatigue/Dehydration


Patients should follow physiotherapy staff advice on time spent in the pool.

Patient should spend no longer than 30 minutes in the pool in one session.

Staff should supervise and monitor patients and themselves and report any signs of fatigue/dehydration to the lead physiotherapist.

Regularly drink water during session to keep hydrated.

Rest in the department for 10 minutes after the session and advise patients keep hydrated that day and have a small snack.

5.8 Rest after the Session

Use towels after leaving the pool to keep warm and dry.

Shower after the session but do not use shampoo or shower gel (this may affect the balance of the pool systems and cause the shower floors to be slippery).

Take a short rest for at least 10 minutes in the building after the session and continue to keep hydrated.

Monitor patients whilst they are still in the department to ensure they are well. 5.9 Skin Rash/Irritation

Shower after the session to wash of any chlorine.

Report any skin rashes/irritation to the lead physiotherapist immediately. 5.10 Faulty Equipment

Staff to check all equipment prior to use.

Report any faults to the lead physiotherapist and Bradbury Day Centre reception.

Do not use faulty equipment. 5.11 Building Evacuation

Follow Bradbury Day Centre fire procedure.

Follow instructions from physiotherapy staff in the event of emergency pool evacuation.

5.12 Infection Prevention and Control

Staff, students or patients should not enter pool if they are unwell or have any infections such as gastro-intestinal infection, ear infection, chest infections, urine infections or uncovered wounds.


Waterproof dressings should be used to cover minor cuts and abrasions.

Continence pads must not be worn in the pool.

All staff, students and patients to purchase and wear own and appropriate swimwear.

All pool users to shower prior to and after session.

Use plastic shoe covers, indoor only shoes or barefoot on pool side.

No wheelchairs/uncovered outdoor shoes on pool side.

Clean changing beds/stretcher/pool chair and all other equipment with detergent wipes between each patient use.

Water testing carried out by Bradbury Day Centre staff. (See Appendix 9) 5.13 Verruca

Please arrange for verruca to be appropriately treated prior to attending hydrotherapy.

Verruca socks must be privately purchased and worn at the sessions until the verruca has gone.

5.14 Water Fouling

Staff, students and patients should not enter the pool if you have diarrhoea or vomiting or have had any symptoms within the last 48 hours.

Staff, students and patients must not enter the pool if they are unable to use internal feminine sanitary protection during menstruation.

Follow instructions from the Bradbury Day Centre Hydrotherapy Policy in the event of water fouling.

If towels are soiled then they are to be placed in alginate bags then into a red terylene al bags and taken to the laundry at Whitchurch Hospital.

6. Consultation

Claire Strickland Team Lead Physiotherapist Andrew Thomas Community Service Manager

7. Dissemination and Implementation

All staff must ensure that they comply with the arrangements in place to implement and maintain this policy, within the areas they work.


The policy will be disseminated to all staff concerned within regular staff meetings, both on a local and Trust level. It will also be published on the Trust intranet policy section. Team leaders must ensure team members have access to policy guidelines. This would include education and supervision to ensure safe practice.

8. Monitoring Compliance The policy will be reviewed on a 3 yearly basis. The compliance will be monitored in accordance with new guidance from the Chartered Society of Physiotherapy Guidelines on Hydrotherapy.

9. Associated Documents Infection Control Policy Moving and Handling Policy Consent to Examination or Treatment Policy Risk Management Policy

10. References Bradbury Day Centre (2012) Hydrotherapy Pool: Emergency Action Plan Whitchurch; Bradbury Day Centre Bradbury Day Centre (2012) Hydrotherapy Pool: Normal Operating Procedures Whitchurch; Bradbury Day Centre Chartered Society of Physiotherapy (CSP) (2001) Hazards in Hydrotherapy Pools London; CSP CSP (2005) Service Standards of Physiotherapy Practice London; CSP (Specifically Standards 17-18 Management of the Hydrotherapy Pool) Hydrotherapy Association of Chartered Physiotherapists (HACP) (2006) Guidance on Good Practice in Hydrotherapy London; CSP Working Group of the Resuscitation Council UK (2009) Guidance for Safer Handling During Resuscitation in Healthcare Settings London; Resuscitation Council UK 10. Appendices Appendix 1 Patient consent form Appendix 2 Hydrotherapy referral form Appendix 3 Hydrotherapy pre-pool health screen


Appendix 4 Hydrotherapy discharge form Appendix 5 Hydrotherapy leaflet Appendix 6 Hydrotherapy outcome measures Appendix 7 Hydrotherapy risk assessment Appendix 8 Pool evacuation procedure & training log Appendix 9 Hydrotherapy Water Testing at Bradbury Day Centre Hydrotherapy Pool Appendix 1 Patient Consent Form

Consent Form 3

Patient / parental agreement to investigation or treatment (procedures where consciousness not impaired)

Name of procedure (include brief explanation if medical term not clear) …………………………………………………………………………………………………………………


Statement of health professional (to be filled in by health professional with appropriate knowledge of proposed procedure, as specified in consent policy). I have explained the procedure to the patient/parent. In particular, I have explained: The intended benefits are: ………………………………………………………….…………………………………………………….. …………………………………………………………………………………………………………………

Serious or frequently occurring risks: …………………………………………………………………………………………………………………………………………………………………………………………………………………………………… I have also discussed what the procedure is likely to involve, the benefits and risks of any available alternative treatments (including no treatment) and any particular concerns of those involved.

The following leaflet/tape has been provided: Signed: .…………………………………… Date ……... …………………………………….. Name (PRINT) ………………………. ………. Job title …………………………………………. Statement of interpreter (where appropriate) I have interpreted the information above to the patient/parent to the best of my ability and in a way in which I believe s/he/they can understand. Signed ……………….……….Date…….…………..Name (PRINT)…………….………………….. Statement of patient/person with parental responsibility for patient I agree to the procedure described above. I understand that you cannot give me a guarantee that a particular person will perform the procedure. The person will, however, have appropriate experience. I understand that the procedure will/will not involve local anaesthesia. Signature ………………………………………. Date ……………………………..……………… Name (PRINT) ………………………………… Relationship to patient ………………………… Confirmation of consent (to be completed by a health professional when the patient is admitted for the procedure, if the patient/parent has signed the form in advance) I have confirmed that the patient/parent has no further questions and wishes the procedure to go ahead. Signed: …………………………………… Date ……... ……………………………. Name (PRINT) ………………………..……….. Job title …………………………………

Photocopy accepted by patient: yes/no (please ring)


Guidance to health professionals (to be read in conjunction with consent policy) This form This form documents the patient’s agreement (or that of a person with parental responsibility for the patient) to go ahead with the investigation or treatment you have proposed. It is only designed for procedures where the patient is expected to remain alert throughout and where an anaesthetist is not involved in their care: for example for drug therapy where written consent is deemed appropriate. In other circumstances you should use either form 1 (for adults/competent children) or form 2 (parental consent for children/young people) as appropriate. Consent forms are not legal waivers – if patients, for example, do not receive enough information on which to base their decision, then the consent may not be valid, even though the form has been signed. Patients also have every right to change their mind after signing the form. Who can give consent Everyone aged 16 or more is presumed to be competent to give consent for themselves, unless the opposite is demonstrated. If a child under the age of 16 has “sufficient understanding and intelligence to enable him or her to understand fully what is proposed”, then he or she will be competent to give consent for himself or herself. Young people aged 16 and 17, and legally ‘competent’ younger children, may therefore sign this form for themselves, if they wish. If the child is not able to give consent for himself or herself, some-one with parental responsibility may do so on their behalf. Even where a child is able to give consent for himself or herself, you should always involve those with parental responsibility in the child’s care, unless the child specifically asks you not to do so. If a patient is mentally competent to give consent but is physically unable to sign a form, you should complete this form as usual, and ask an independent witness to confirm that the patient has given consent orally or non-verbally. When NOT to use this form (see also ‘This form’ above) If the patient is 18 or over and is not legally competent to give consent, you should use form 4 (form for adults who are unable to consent to investigation or treatment) instead of this form. A patient will not be legally competent to give consent if:

they are unable to comprehend and retain information material to the decision and/or

they are unable to weigh and use this information in coming to a decision. You should always take all reasonable steps (for example involving more specialist colleagues) to support a patient in making their own decision, before concluding that they are unable to do so. Relatives cannot be asked to sign this form on behalf of an adult who is not legally competent to consent for himself or herself. Information Information about what the treatment will involve, its benefits and risks (including side-effects and complications) and the alternatives to the particular procedure proposed, is crucial for patients when making up their minds about treatment. The courts have stated that patients should be told about ‘significant risks which would affect the judgement of a reasonable patient’. ‘Significant’ has not been legally defined, but the GMC requires doctors to tell patients about ‘serious or frequently occurring’ risks. In addition if patients make clear they have particular concerns about certain kinds of risk, you should make sure they are informed about these risks, even if they are very small or rare. You should always answer questions honestly. Sometimes, patients may make it clear that they do not want to have any information about the options, but want you to decide on their behalf. In such circumstances, you should do your best to ensure that the patient receives at least very basic information about what is proposed. Where information is refused, you should document this overleaf or in the patient’s notes. The law on consent See the Department of Health’s Reference guide to consent for examination or treatment for a comprehensive summary of the law on consent (also available at www.doh.gov.uk/consent).

Appendix 2 Hydrotherapy referral form

http://www.doh.gov.uk/consent


HYDROTHERAPY Referral information Pt Contact Number: _______________________

Reason for Referral

Aims of treatment

Limitations

Poolside Medication

Requires Carer

Patient’s verbal consent obtained: Contraindications sheet completed: Information sheet provided: Initial date & time given to patient: If so, when:______________________________

TO BE COMPLETED BY HYDROTHERAPY TEAM

Dates patient attended:

Discharge Information Discharged from physiotherapy Discharged back to referring physio Other: _______________________________________________________________________ Appendix 3 Hydrotherapy Pre-Pool Health Screen


HYDROTHERAPY CONTRAINDICATIONS CHECK LIST

CONTRAINDICATIONS

YES

NO

COMMENTS

ABSOLUTE

Acute diarrhoea or vomiting

Recent acute CVA/DVT/PE

Resting angina

Resting shortness of breath

Uncontrolled cardiac failure

Weight in excess of evacuation equipment

Proven chlorine allergy

PRECAUTIONS

Acute systemic illness

Irritated skin as a result of radiotherapy

Infected wounds

Epilepsy

Unstable diabetes

Known aneurysm

Fear of water/non swimmer

Behavioural problems

Incontinence of urine/faeces

Haemophilia

Widespread MRSA

Hypotension

Renal failure

Open surgical wounds

Pregnancy

Cardiac conditions/pacemaker

Tracheotomy

Contagious viral/fungal infection

Poor integrity of skin

Hearing or visual deficiency

Walking aids

Additional information Method of entry into pool: Hoist chair Hoist Bed Independent Assistance required: Yes No Patient’s weight: ____________________ Walking aids: Yes No Type: ______________________________

Appendix 4 Hydrotherapy Discharge Form

HYDROTHERAPY


Discharge Information

Reason for Referral

Aims of treatment

Summary of Treatment

Aims Achieved

Future Treatment Plan

Dates patient attended:

Discharge Information Discharged from physiotherapy Discharged back to referring physio Other: _____________________________ Outcome Measures EQ-5D-5L used: Yes No Pre Score _______/25 Post Score _______/25

Appendix 5 Hydrotherapy Leaflet


HYDROTHERAPY INFORMATION You have been referred by your physiotherapist to attend a course of hydrotherapy at Whitchurch Community Hospital. The sessions take place in the hydrotherapy pool in the Bradbury Day Centre located next to Whitchurch Community Hospital. What you need to know: There will always be 2 members of staff in the hydrotherapy department (1 in the pool and 1 on dry land). There are changing facilities and showers available for you to use. The pool is warm and often humid so it’s important to have plenty of water before, during and after the session and ensure you have eaten a light breakfast or lunch so you don’t feel lightheaded. Exercises in water often feel more comfortable than those on dry land so it’s easy to do too much, please make sure you listen to your physiotherapist and don’t overdo it. If you would like to bring a family member or friend with you for support that is not a problem but please call to let us know beforehand. What to bring with you:

Appropriate swimwear Towels Filled water bottle

What to do on the day:

Please report to the Bradbury Day Centre reception and you will be directed to the pool (there is a lift should you require it).


If you need emergency medication please have it with you.

Please notify staff if you have a skin rash/lesion.

Please do not enter the pool until you have been asked.

Shower immediately before and after entering the pool.

If you use walking aids take care as floors can be slippery.

After your session we advise you to rest for 15mins with us and drink some fluids.

If you are unwell, e.g. infection/raised temperature 48 hrs before your

session please call the department and let us know.

Please do not bring shampoo or shower gel as this interferes with the cleaning and hygiene systems used in the pool.

You will be allocated 6 sessions in total and we encourage you to attend as many sessions as you can. Unfortunately, due to the high demand for the service if you have to cancel an appointment at short notice or do not attend on the day then this may be counted as one of your sessions. A new session may be booked for you at the discretion of the physiotherapist. You will be assessed at the end of treatment and may be referred back to your original physiotherapist if required. If you have any questions or are unable to attend your session please let us know.

Thank you!

Hydrotherapy Team

Appendix 6 Hydrotherapy Outcome Measure

Musculoskeletal Patient Reported Outcome Measures EQ - 5D - 5L


Date: _______________ Treatment: Pre Post

Body Region: Upper limb Lower limb Spine Other

Under headings, tick ONE box that best describes your health TODAY

MOBILITY I have no problems in walking about 1 I have slight problems in walking about 2 I have moderate problems in walking about 3 I have severe problems in walking about 4 I am unable to walk about 5

SELF-CARE I have no problems washing or dressing myself 1 I have slight problems washing or dressing myself 2 I have moderate problems washing/dressing myself 3 I have severe problems washing or dressing myself 4 I am unable to wash or dress myself 5

USUAL ACTIVITIES (e.g. work, study, housework or leisure activities) I have no problems doing my usual activities 1 I have slight problems doing my usual activities 2 I have moderate problems doing my usual activities 3 I have severe problems doing my usual activities 4 I am unable to do my usual activities 5

PAIN / DISCOMFORT I have no pain or discomfort 1 I have slight pain or discomfort 2 I have moderate pain or discomfort 3 I have severe pain or discomfort 4 I have extreme pain or discomfort 5

ANXIETY / DEPRESSION I am not anxious or depressed 1 I am slightly anxious or depressed 2 I am moderately anxious or depressed 3 I am severely anxious or depressed 4 I am extremely anxious or depressed 5

Appendix 7 Hydrotherapy Risk Assessment What are the hazards?

Who might be harmed and how?

What are you already doing?

Do you need to do anything else to manage this risk?

Action by whom?

Action by when?

Done

Patient requiring emergency evacuation .

Staff.

Regular training (every 6 months) and updates to staff as required. Ensure that there are always 2 members of

Ensure that all staff are aware of risk and have the ability to evacuate a patient as required.

All staff.

26/06/2014

Y


What are the hazards?

Who might be harmed and how?

What are you already doing?

Do you need to do anything else to manage this risk?

Action by whom?

Action by when?

Done

staff in the pool area at all times.

Wet floors surrounding the pool and shower areas may be slippery.

Patients, carers and staff.

Informing all visitors and staff to be aware of the risk and to walk slowly are carefully when in hydrotherapy. Use towels as required to aid grip when walking. Ensure that patients are assisted as necessary and dry feet before walking around.

Signs for the hydrotherapy area would alert to this risk. Staff ensuring that floors are regularly mopped so as minimising risk.

All staff and visitors.

26/06/2014

Y

Signed By: ________________________________


Appendix 8 Pool Evacuation Procedure & Training Log

Whitchurch Physiotherapy Department Hydrotherapy Emergency Evacuation Training

Staff Member

In Pool

Outside

Pool

Spinal Board

Date

Signed

Appendix 9 Hydrotherapy Water Testing at Bradbury Day Centre Hydrotherapy

Pool


Bradbury Day Centre

Hydrotherapy Pool Water Testing

1. How is the pool tested? The pool is tested 3 times a day (am, mid-day and 4pm). 2. What are the PH and Chlorine levels? They run between 7.2 and 7.6 PH and Chlorine range from 1.5 to 5 with an average of 2. 3. How often is the pool biologically tested? Twice a week by Staffordshire Scientific Services and we are sent a written report. 4. How often is the pool maintained? It is maintained by Ocean Pools and serviced every month and we are sent a written report. Maggie Allan Manager, Bradbury Day Centre