Key Learning of the Hub– please open and share in team meetings or supervision and print out and display on noticeboards.

Recent Learning

  • The ACCT (Assessment, Care in Custody and Teamwork) is a prison led care planning process for individuals at risk of self harm or suicide.
  • This process is just one part of multiagency risk management.
  • Sometimes decisions around whether someone is on the ACCT process can be complex and nuanced.
  • When making difficult decisions, always seek support and document your decision making clearly.
  • Also consider other possible risk management strategies and interventions such as engaging with the gym, families, peer support, Chaplaincy, Samaritans and substance misuse teams.
  • If you're in the healthcare team, always talk to and involve your prison colleagues and vice versa.
  • It can be easy to get caught up in the process, always keep the person at the centre of what you're doing.

  • If suspecting someone of using SPICE, stay curious, they may be drowsy because of other prescribed medication, check for recent changes.
  • See SPICE use as an opportunity to educate the patient in a non-judgemental way about risks, especially if also taking anti-psychotics.
  • If declining to administer medication because you suspect the person may be sedated or intoxicated, contact the prescriber and share your thoughts.
  • If you are a prescriber and your patient is regularly using SPICE consider taking ECG measures and alternative prescribed medications that may be safer.
  • When SPICE use is suspected, avoid quetiapine and other antipsychotics that prolong QTc; studies show that aripiprazole and olanzapine are the most cardiac safe in this scenario.