Most of us, on most occasions, can enjoy a bath or shower as a relaxing and pleasant experience, setting us up for the day or helping to bring on a good night’s sleep. It is easy to move from this sort of thinking, to see bathing as safe and not something needing careful preparation and planning. But in care services, this is not so. The clear risk from hot water, together with people’s vulnerabilities, presents hazards to be carefully considered and minimised.
A fatal accident inquiry
This was brought home very recently in Scotland, where the media and press reported the outcome of a fatal accident inquiry into the death of a person in care. Hot scalding water was found to be a “significant contributory factor” in the death of a person being supported at home who had a severe learning disability and was registered blind.
In his determination Sheriff Lindsay Wood said: “The scalding accident which contributed to the death might have been avoided if the hot water tap was not left running and if visual checks had been made whilst she was in the bath every three minutes or less.” Poor risk assessment, a faulty hot water tap, and lack of clear direction to staff were also discussed in the report.
Precautions to be taken
Sadly this incident is not without precedent. There have been previous reports of serious injuries or deaths of people in care while bathing or showering.
There are lessons which should be learned.
Firstly, individual risk assessments must be carried out, and bathing or showering seen as a danger for vulnerable people. These assessments and their measures to reduce risk must be known to care staff involved with the person. The assessments should be updated as part of the review of the person’s overall support plan, or more often where indicated.
Supervision of people using baths or showers should be at the appropriate and agreed frequency, while respecting people’s wishes and their need for privacy. Everything necessary during the bath-time should be easily available in the bathroom, without restricting free movement. Non-slip mats in the bath or cubicle may help, while other tripping hazards should be removed. Water should be run into the bath, cold first, then thoroughly mixed before ensuring the temperature does not exceed 43 degrees C. 41 degrees C is the safe limit for showering, and there should be closer monitoring for showering as there can be sudden variation in water flow and temperature
Staff guidance should be provided in written form, and regular training in safe bathing procedures must be given.
Water should be delivered through thermostatic control valves, set to supply water at the required temperature. These devices must be kept up to date, regularly serviced and checked for proper operation. Records of such maintenance and checks must be maintained, and recorded in the care plan for the person concerned.
Appropriate thermometers for measuring water temperatures at the point of bathing must be available and used, and the carer should record the temperature which is indicated. Each thermometer must be regularly calibrated, and again these tests of the thermometer should be recorded.
Overall, the organisation, managers, and care staff share responsibility for checking as far as possible that safe bathing procedures are in place.
Guidance on risk management for bathing and showering in care is available at http://www.hse.gov.uk/pubns/hsis6.pdf