How to write a warning letter

Warning letters written to patients when their behaviour has been unacceptable should be detailed, complete, and clear, and include the following:

the name and role of person sending letter (normally someone not involved in the events)
a description of the incident
any measures taken previously to address unacceptable behaviour
an explanation of why the behaviour is inappropriate, including a description of the impact of the behaviour on staff, other patients and services
an explanation of the consequences of repetition of the behaviour (which might include, for example, restricting the patient's entry or providing care at a different location, notification to the police or civil legal action if appropriate)
a description of anyone else who will be informed of the behaviour or copied in to the warning letter
·notification as to whether the patient's clinical record will be marked and the events documented in the clinical record or those of other patients as appropriate (eg, partner or relatives)
a date when the warning will be reviewed and/or any marking removed
information as to how the decision can be challenged or a complaint made.

Records of unacceptable behaviour should be detailed and accurate, in case the decision to issue a warning letter or take further appropriate action is challenged. Incidents involving such behaviour should be documented in statements compiled as contemporaneously as possible by any staff members who were witnesses to the events.

For instance, phone calls in which the patient uses offensive or abusive language should be documented by staff members involved in the call, documenting if possible the exact words used by the patient. For letters or packages, envelopes should be retained and handled as little as possible in case a further forensic review is required. Abusive or threatening e-mails should be printed and inappropriate text messages transcribed and stored in the practice adverse events and/or complaints folder.

Issuing a letter

In some instances, where the information about the patient's behaviour is not completely clear cut, it might help to seek the input of the person accused of inappropriate behaviour. The organisation can consider the seriousness and potential risk of the alleged behaviour, and determine whether interim measures would be appropriate until further information and a response from the patient are received. Any letter to this effect should emphasise that these measures are temporary and explain that they may be upheld or removed when the extra information comes through.

When deciding whether to issue a warning letter, take into account the possibility that the behaviour may have resulted from or been exacerbated by a medical or mental health condition or a medication or treatment. Think about if the action being considered may adversely affect the patient's mental health.

Warning letters to patients: a practical guide

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Warning letters to patients: a practical guide