This is an official Northern Trust policy and should not be edited
in any way
Emergency Department When a child leaves without being
assessed/treated
Reference Number:
NHSCT/12/546
Target audience:
This guideline is directed to qualified medical and nursing staff within all of the
Trust’s Emergency Departments
Sources of advice in relation to this document:
Amber McCloughlin, Named Nurse for Safeguarding Children
Valerie Jackson, Director of Acute Hospital Services
Replaces (if appropriate):
NHSCT Emergency Department – When a child leaves without being
assessed/treated (NHSCT/10/318)
Type of Document:
Directorate Specific
Approved by:
Policy, Standards and Guidelines Committee
Date Approved:
14 March 2012
Date Issued by Policy Unit:
7 June 2012
NHSCT Mission Statement
To provide for all the quality of services we would expect for our families
and ourselves
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When a Child Leaves Without Being Assessed / Treated
- Guideline for Emergency Department Staff
December 2011
2
When a Child Leaves Without Being Assessed / Treated Guideline for Emergency Department Staff
1.0 Introduction
1.1 Safeguarding and promoting the welfare of children is everyone’s responsibility.
Children, who access emergency departments within the Northern Health and Social
Care Trust and, for whatever reason, do not remain in the department before being
assessed and / or treated, should be considered in this context.
1.2 In the majority of cases the person with parental responsibility makes an appropriate,
informed and child–focused decision to leave the department. However on occasions
this decision may not be in the child’s best interest as the child may be in need of
health intervention, support or protection.
1.3 It is the responsibility of Emergency Department staff to make a risk assessment
based on available information and to initiate appropriate actions to promote the
child’s welfare.
1.4 This guideline should be read in conjunction with:
•
•
•
Area Child Protection Committee Regional Child Protection Policy and
Procedures (ACPC 2005) and subsequent amendments (ACPC 2008)
Understanding the Needs of Children in Northern Ireland (UNOCINI)
Guidance, (DHSSPSNI 2008)
Admission, Care and Discharge (Acute Services) of Children / Young People
(0-18yrs) where there are safeguarding concerns (NHSCT, 2011)
Alternative Formats
1.5 This document can be made available, on request, on disk, larger font, Braille, audio
– cassette and in other minority languages to meet the needs of those not fluent in
English.
Sources of Advice in relation to this document
1.6 The guideline authors and responsible Directors as detailed on the policy title page
should be contacted with regard to any queries on the content of this guideline:
Equality, Human Rights and DDA
1.7 The policy is purely clinical/technical in nature and will have no bearing in terms of its
likely impact on equality of opportunity or good relations for people within the equality
and good relations categories.
2.0 Purpose Of The Guideline
2.1 The purpose of the guideline is to assist staff, in assessing and responding to
children who present in the Emergency Departments and who leave before being
assessed and or treated.
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3.0 Target Audience
3.1 This guideline is directed to qualified medical and nursing staff within all of the Trust’s
Emergency Departments.
4.0 Responsibilities
4.1 Directors and managers are responsible for ensuring that staff have working knowledge
of, and adhere to this policy.
4.2 Staff are responsible for adhering to this policy.
4.3 The policy authors are responsible for reviewing the guideline within the agreed
timescale.
5.0 Risk Assessment
5.1
A risk assessment must be carried out on each individual case based on information
available on Emergency Department flimsy and any other information available.
5.2 This must involve both the nurse in charge and the senior medical officer on duty and
take into account:
•
•
•
•
•
•
•
•
•
Any concerns identified
Reason for attendance
The age of the child*
Presentation of the child
Competence of the child
Person accompanying the child
Demeanour of person accompanying the child
Reason for leaving if known
If the child is known to Social Services or on Child Protection Register.
5.3 Every effort must be made by the nurse in charge to contact the parent to discuss
concern and encourage them to return to the department so that the child can be seen
and assessed.
5.4 In exceptional circumstances, e.g. when there is suspicion of a crime, staff should
consider contacting PSNI before contacting parents. (A referral to social services will
also be made in such instances).
5.5 It is the responsibility of senior medical officer to discuss safeguarding concerns with
the consultant in charge/associate specialist and the paediatric consultant where
necessary.
5.6
The flow chart in 7.0 must be adhered to. There are general actions in the flow chart
that could be undertaken by either the nurse or medical officer. However all
discussions, actions and persons responsible must be agreed and documented
immediately.
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5.7 If staff are unsure about, or cannot agree on the action required, the relevant line
manager, safeguarding children nurse specialist and named or designated doctor for
safeguarding children must be consulted.
5.8 NB. An additional arrangement exists in Causeway Hospital, where documentation
(flimsies) of all attendances, are reviewed by the consultant of Emergency Medicine at
the earliest opportunity, and appropriate action initiated.
6.0
Social Work Team Contacts
Antrim Area Hospital: Monday – Friday 9 am – 5 pm 028 9442 2339/2328
Causeway Hospital: Monday – Friday 9 am – 5 pm Northern Gateway Team
028 7032 5462
Out of Hours Social Work Team: 5 pm – 9 am public holidays and weekends
028 9446 8833
*By law a child is a young person under 18. However in many instances young
teenagers are capable of attending alone and must be afforded the same rights as an
adult in the absence of any concerns. In other cases if the young person is disabled or
vulnerable they may need to be accompanied so therefore would fall into the same
category as that of a younger child.
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7.0 GUIDELINE for EMERGENCY DEPARTMENT (ED) STAFF
WHEN A CHILD LEAVES
WITHOUT BEING ASSESSED/TREATED
THE FOLLOWING FLOWCHART IS TO BE USED IN CONJUNCTION WTH ACPC
REGIONAL POLICY & PROCEDURES (2005) AND MUST NOT BE USED IN ISOLATION.
WHERE THERE IS CONCERN FOR THE WELFARE OF A CHILD ALL STAFF HAVE A
DUTY TO REPORT TO SOCIAL SERVICES
A RISK ASSESSMENT MUST BE MADE BASED ON INFORMATION AVAILABLE FROM
REGISTRATION AT ED, PLUS ANY OTHER AVAILABLE INFORMATION
CONCERN IDENTIFIED
NO CONCERN IDENTIFIED
CHECK IF KNOWN TO SOCIAL
SERVICES/ON CHILD
PROTECTION REGISTER
DISCUSS WITH SENIOR
MEDICAL OFFICER/NURSE IN
D
CHARGE
•
•
ATTEMPT TO CONTACT
PARENT/CARER BY PHONE TO
CLARIFY CONCERNS/DISCUSS
TREATMENT OPTIONS.
ADVISE PARENT RE SHARING
INFORMATION
•
•
IF FOLLOWING
DISCUSSION/
ANALYSIS INVOLVING
PARENT/ ALL
RELEVANT
PROFESSIONALS, NO
INDICATORS OF RISK
ARE IDENTIFIED
FOLLOW NORMAL
PROCEDURE TO INFORM
HEALTH VISITOR/GP
IF CONCERNS PERSIST:
• CONTACT SOCIAL SERVICES
IMMEDIATELY BY PHONE *
• INFORM GP OR DALRIADA
URGENT CARE IF AFTER 6PM
• INFORM FAMILY OF REFERRAL
• INFORM SCNS as soon as possible
• INFORM HEALTH VISITOR BY
PHONE as soon as possible
•
COMPLETE UNOCINI
WITHIN 24 HOURS AND
COPY TO GP/HV/SCNS
UNOCINI: Understanding the Needs of
Children in Northern Ireland -Referral form
GP: General Practitioner
HV: Health Visitor
SCNS: Safeguarding Children Nurse Specialist
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