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Example of a De-Identified Protocol

Protocol for locking food cupboards/fridge

Name of Contact and Agency:	Acme Support Services
Protocol Description:	Locking of food cupboards/fridge
Name of Person Protocol relates to:	John Smith
Date of Birth	16/8/1998
Protocol Date:	24/03/2019
List of Related Documentation:	Personal Profile, Communication assessment, Meal Management Plan
Background/Context (ie Why is this Restrictive Practice in place?)	John has a meal management plan which recommends that staff supervise his eating as he tends to over fill his mouth and eat too quickly which becomes a choking risk even with small qualities of food.  He also cannot discriminate between safe and unsafe food. (e.g. he will eat raw meat stored in the fridge). To keep John safe, cupboards where food is stored must be locked at all times.
Protocol/Procedure described:	John can be relied upon to request food and drink when he needs it. He will come and grab a worker’s hand and point them towards the cupboard if he wants something to eat. John will also choose sometimes to use his communication cards to indicate he wants something to eat Staff will respond immediately if John indicates he wants to have a drink or some food at any time. If staff can’t respond straight away, then negotiate with John about when they can respond. Other residents’ requests for food or drinks should also be responded to as above.
Review Date:	24/03/2020
Protocol Training Schedule for Staff:	Buddy new staff as part of induction so they are aware of and can implement the protocol. Use of this protocol will be reviewed and discussed at monthly staff meetings. Consistency check (verbal) will be carried out at every staff meeting and the data recorded. Staff to support John with skill development re eating slowly
Signature (Team Leader):

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