Information sharing

Sharing information about clinically related challenging behaviour is vital to ensuring the quality, safety and continuity of care. Communication should be open and transparent and should involve the individual, their family and carers from the outset.

Confidentiality

Patient confidentiality is a core principle of healthcare. However, it shouldn’t hinder the sharing of patient information where this is necessary to ensure the public’s safety. Sharing patient-identifiable information within healthcare services to safeguard patients and protect staff is not an unlawful breach of confidentiality.

An organisation’s Caldicott Guardian can give advice on the sharing of confidential personal information about challenging behaviour with third parties. The NHS Code of Practice on Confidentiality also provides guidance.

Sharing information: when and with whom?

It may be appropriate to share information about clinically related challenging behaviour with any of the following:

    • All relevant staff, including those in other units or localities (to which the patient may be transferred)
    • Hospitals providing emergency or acute treatment
    • Community healthcare providers
    • Social care providers
    • Social services
    • Local authorities.

Some established channels for information sharing include:

Care plans

Ideally, care plans should be shared with the individual to discuss treatment goals. They should also be discussed with the multidisciplinary team (MDT), reviewed regularly and communicated to all relevant staff.  Care plans can include a description or analysis of the patient’s behaviour, risk assessments and any planned special observations. They can also record strategies to prevent challenging episodes and preferred interventions.

Shift handovers

Conducting handovers is best practice for continuity of care. Handovers allow staff to talk to each other and provide feedback based on observations to inform oncoming shifts.  Managers should ensure that there is sufficient time during handovers to discuss incidents of challenging behaviour or changes in a person’s behaviour, as well as any identified interventions or solutions.

Transfer

When an individual is transferred to a different ward, organisation or care setting (e.g. from an ambulance crew to A&E, from A&E to a ward, or from a ward to the community), staff have a legal duty to tell each other about any risks of challenging behaviour, causes of distress, and management strategies. This is important for the safety and well-being of staff taking over care of the individual, who may have little time to assess the risks. It is also important for the well-being of patients or service users, as it can help them settle into their new settings.

Patient passports

Individual profiles or ‘patient passports’ can be a useful way for staff to share information when the individual is transferred. The profile or passport should ideally be completed prior to admission by those who are responsible for the care of the individual, or following admission by the primary nurse, involving family and carers. Staff should then use these as a ‘running document’, adding any further information as the individual is moved between care settings. You can view a sample patient passport developed by the Alzheimer’s Society.

Post-incident reviews

Thorough post-incident reviews enable staff to learn lessons about patient and staff safety. Reviews can be used to update the care plan and share information with all those responsible for delivering care.  At a departmental and organisational level, a review of incidents may help to identify shortfalls in the allocation of resources or delivery of care. Reviews may highlight a need to update policies and training programmes or to promote best practice widely among staff.

Markers and alerts

A marker or alert can be added to patient records to highlight risks, triggers and behaviours and/or refer staff to the care plan for appropriate interventions. The decision to add a marker or alert should be based only on current information. Markers or alerts should not have the effect of prejudicing staff or preventing patients from receiving equal treatment and care. Organisations must have clear procedures for notifying the person, their family and carers when a marker is added, as well as for regularly reviewing and removing markers when they are no longer needed. NHS Protect has produced related guidance on placing markers on patient records.

For further information on information sharing, please refer to the full guidance document.