Does your Receptionist recognise signs of Sepsis. A Patients Story #Bournemouth Hospital


There has been a lot of publicity recently regarding Sepsis. This is aimed at raising awareness and those that work in the GP surgeries and Hospitals will know on too well that this will create fear amongst some patients and therefore will be more than likely phoning the Surgery/Hospital for advice.

We are being told Sepis should be treated urgently as we would a heart attack.

For all Receptionists, Secretaries and Administrators who could be faced with a query regarding this are you fully competent to deal with it? Would you be confident in dealing with a call that could be Sepsis? I must confess I am not sure I would be able to identify this emergency a few weeks ago, but I feel a lot more confident now that I have read up on it.

You probably have procedures and policies in place for dealing with a heart attack. Have you a procedure or policies in place to deal with sepsis? Perhaps at your next team meeting you could put this on your agenda or speak to your Reception Manager or Practice Manager about having one written up.

The most important thing is that you know the facts about Sepis and what is expected from you as a Receptionist if you take such a call. Don’t be one of those surgeries/hospitals that could be highlighted as missing something that might be so obvious to someone who knows what Sepsis is.

Many doctors view Sepsis as a three-stage syndrome, starting with Sepsis and progressing through severe Sepsis to septic shock. The goal is to treat Sepis during its early stage, before it becomes more dangerous.

Sepsis usually comes with a probable or confirmed infection and includes several symptoms. These perhaps can be discussed with a Doctor and the Receptionists and a guide of what questions to ask the patient.

Septis has to be treated quickly as the patient can go downhill very quickly

A chart that I found very useful to help identify some of the symptoms:sepsisqa-2015-big

A very interesting clip from the Royal Bournemouth Hospital highlighted a patients experience and how his Sepsis was nearly missed. They are keen to spread awareness. Well done Bournemouth Hospital for sharing this short film.

Published on July 13 2016. 

Sepsis is a medical emergency, here at RBCH we are keen to spread  awarness and listen to patients experiences to improve care. 

 

Phoning a Patient at Home


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Does your Practice have guidelines on phoning patients at home? We all know of the obvious one and that’s not to leave a message of any kind on a landline because of confidentiality.

But when is it a good time to phone when you need to speak to a patient? Perhaps it’s relaying on a message from the Doctor or Nurse, or just to let them know there is a prescription to collect due to recent tests coming in.

I will give you an example on how consideration should be made when phoning a patient at home.

Someone close to me has for the past 6 years been trying for a baby without any success. The couple have been through many hospital and doctors visits, pregnancy results and alternative treatment to try help them achieve a pregnancy. They finally went through IVF earlier in the year with the daily injections, hormone changes and finally the heart-breaking news that it hadn’t worked. They set their sights on more IVF in 3 months’ time. An eternity to them both. But to all our surprise and delight a month after the failed IVF they fell pregnant naturally.

Fast follow to her being 6 months pregnant. She hadn’t had an easy time, morning sickness and fatigue hit with a vengeance, she also has an over active thyroid that needs monitoring throughout the pregnancy and she also found out that she was rhesus negative blood type and tests would have to be done when the baby was born to see if she needed an anti D injection but the delight of finally being pregnancy got them through all of these hiccups.

Her symptoms were getting worse and she was feeling poorly with no energy she seen the doctor and bloods were sent off to check for her iron levels.

So last Wednesday morning she was in bed. It was 7.55 and the telephone rang downstairs. They have elderly relatives and she immediately worried something was up. No on every phones at that time unless its urgent she thought.

She rushed out of bed, rang down the stairs and as she picked up the phone it stopped. She waited for a message but then her mobile started ringing upstairs – she panicked as someone was trying to get hold of her.

As she ran upstairs to get to the phone she tripped on the stairs and fell. In the panic she got up and answered the telephone to find it was her Doctors Receptionist telephoning to say that there was a prescription in reception for her to pick up for iron tablets.

As you can imagine she was upset as the fall. As the day went on she couldn’t feel much movement from the baby and this caused her a lot of distress, until she finally telephoned her midwife to asked her to come straight into the maternity hospital to check the baby and to have an anti D injection.

So, did the Receptionist really need to phone at 7.55 in the morning? I don’t think so. This telephoned caused a lot of unnecessary worry and inconvenience not to say how awful it could have been – but we wont do there! And not to mention how bad the Receptionist would have felt had she had known about the fall.

There should always be a guideline for people being telephoned at home unless it is urgent of course. 7.55 is far too early, what if it had been an elderly or disabled person doing the same thing? A fall could have been a disaster for them.

When training staff I always told them unless urgent no patient should be telephoned at home before 9.00 and if possible leave it until around 10.00.

More and more surgeries are opening up earlier than every before, so perhaps guidelines should be set to what time Receptionists can start to phone patients.

Guest Blog: Make Someone Happy – Julie Bissett, Practice Managers Magazine


I would like to thank Julie Bissett who is a freelance journalist and editor of Practice Management Magazine for her guest post

 

Make someone happy

Julie Bissett asks what better way to improve your patients’ day than with a smile and some good humour

‘Smile if you’ve had it lately’ – these were the words on a bumper sticker my father slapped onto the back of our Ford Escort during the 1970s. I believe it was promotional merchandise for a local garage advertising their servicing provisions. Not a man given to crude innuendo, I was mortified at dad – and the sticker’s – suggestive tone. Dad, meanwhile, thought this even funnier than the cheeky message it conveyed to car drivers behind us.

We may have missed a trick here – what a fabulous tagline for a GP practice! Or maybe not…

But the real point is that, firstly, we all love a laugh and, secondly, we all welcome a smile, especially when stressed. On a bad day, the meeting of patient and GP receptionist can seem like the paradox of immovable object versus an unstoppable force – and, surely, something’s got to give?

Sassy

It may be tough to do – but a smile really does conquer the toughest of customers’ attitudes. We all need something to positively trigger our thoughts, senses and actions when we’re feeling fraught, ill or worried – and nowhere is this more relevant than at the reception desk of a GP practice.

In the increasingly competitive world of healthcare, a practice now needs to promote itself in the same sassy style as an advertising campaign might, for it cannot afford to get left behind, remain staid and prescriptive, or, indeed, come under fire in an increasingly ‘TripAdvisor’-esque world of online healthcare feedback forums.

A front desk team is a GP practice’s shop window that needs to welcome its audience – the patients – with a massive desire for them to be on side in an environment hugely pressurised. It’s you, the receptionist, often taking the brunt of the day-to-day demands on a practice. Many people demand your time – from GPs and practice nurses to pharmacists, specialists and hospital consultant PAs.

There are equipment suppliers to consider, recruitment agencies on your tail and protocols to adhere to and to remind everyone else about, also. You handle referral letters, prescription requests, and doctors’ letters. Patients –whether on the phone, in an email or face to face – should live up to their name while you juggle all this and more, shouldn’t they?

KISS principle

The KISS principle (keep it simple, stupid) – the acronym used by designers and engineers – translates well into the medical arena. Without meaning to offend, we should all strive to reach the lowest common denominator when communicating; not because we consider our patients incapable of understanding the science behind the mechanics of their care but because we all lead busy lives and bullet-point information is the perfect way to ensure we convey – and they retain – knowledge we expect to be squeezed into brains already jam-packed with ‘stuff’.

Look at life around us and consider what works and what we now instantly recognise – and why:
• Golden arches means ‘fast food here’
• A flashing SLOW DOWN sign means that: slow down in a built-up area
• And a beautifully shot retro TV ad of a truck ploughing through the snow with Coca Cola on its side can only mean that the Christmas ‘Holidays are coming’.

A smile could be YOUR practice’s very own marketing icon – it’s very difficult to remain angry when anyone smiles at you. It’s a reminder that we’re all human – even tricky patients and much-maligned doctors’ receptionists. It’s simple idea; it may also prove great marketing – but, most importantly, it’s a healthy option for us all.

 

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Dementia and the Carer #DementiaAwarenessWeek


 

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There are currently 800,000 people with dementia in the UK.

Over 17,000 are younger people with dementia and there will be over a million people with dementia in the UK by 2021.

I have witnessed dementia first hand. I had an uncle that suffered this awful illness it not only robbed him of his life but my Auntie lost the life she had shared with him for 60 years. She cared for him with love and dignity 24/7 until the day he died.

She was a proud woman whose pride wouldn’t let her ask for help. I feel the illness actually affected her more in so many ways than it did him.

Whist he lived in his own world, she would try to give him normality. He was extremely well looked after, always well fed, clothed and entertained – sadly he never remembered any of this, he struggled to remember most things. The days that he was like his old self sadly became fewer and fewer.

It was starting to take its toil on my Auntie. She had many sleepless nights when he would be up walking around the house looking for the cat that they didn’t have, shouting out the window at 2 am at the cows that were walking down the main road with the fireman behind them signing Twinkle Twinkle Little Star, the smell of burning when he put a plastic bowl filled with water onto the electric cooker. The flooded kitchen when he left the hot tap running all night and the lovely flowers that he had planted with such love and care some years before ripped from the ground and tossed in a pile in the middle of the garden.

He would go from being calm and almost like his “old self” to being rude and aggressive. He could be hurtful in things he would say to her. On a couple of occasions he would have an outburst of violence and because of that she actually starting being afraid of him. She never knew what was coming next.

With my help we managed to get him a place in a day centre 2 days a week. I could see the relief in her eyes when this was sorted. She planned to use those days to have her hair done, take a long hot bath without fear he might be getting up to no good and shopping with her friend, the simple things of life that most of us take for granted. This all came to a crushing end when he point blank refused to go, he wanted to be at home with his Maureen. She gave in and the hairdressers and the shops were put on hold.

When they went out she had to get taxi’s. Travelling on buses was not an option anymore, he had caused too many scene. She used a local taxi company who understood her needs, but this all came at a cost she could ill afford.

I could go on, anyone that has ever known someone with dementia will understand that what I have said is just a tip of the iceberg. Those that have never come across a family devastated by this awful illness count yourself lucky, and I hope you never do.

She told me she got up to another bleak day ahead to find he had a temperature and was generally unwell, he couldn’t tell her what was wrong but she just knew as well as the dementia there was something else going on, he was more aggressive and he was not in the best of form. She phoned the surgery and asked for a visit, the surgery asked if she could come down, not being one to cause a fuss she took the appointment offered to her for 09.30.

She had to get my Uncle up from bed, bath him, help him dress and try and get him to take some breakfast, and then get him to the surgery for his appointment. It was one of those days that he really didn’t want to oblige. She recalled as they got to the surgery the waiting room was full. She struggled to keep him in one place. His voice raised at times getting a lot of attention from others in the waiting room. A couple of mothers gathered their children closer. He started to get aggressive and started shouting, and then he stood up in front of everyone and wet himself. My poor Auntie was mortified. She felt sick, she wanted the ground to open up and swallow her. She told me she went to the Reception Desk and was so relieved to find the “nice Receptionist” there. The Receptionist showed them into a side room and went and got the nurse.

The nurse suspected that he might have had a urine infection. That was the easy part; they then had to try and get him to do a sample. He wasn’t having any of it and didn’t cooperate one bit. Finally after a lot persuasion they got the sample and with a script my Auntie started her journey home having to face getting my wet uncle bathed and dressed again for the 2nd time that day and it wasn’t even 11.00.

I tried to support my Auntie as much as I could. There were times she would let her barrier down and really tell me how she felt. She told me she often felt very isolated and confessed that at times she resented my Uncle, with a tear in her eye she admitted that sometimes she would snap at him through sheer exhaustion and as she looked at that betrayed look in his eyes and she would be eaten up with guilt. She was tired, lonely and most of all she felt that she had already lost him, this beautiful, caring most gentle husband who would always go out of his way to help others who had fallen a victim to this horrible disease.

I don’t know how she coped. It was the sheer love for him that got her through those bleak dark days.

I tried to get her help, but she refused. She saw it as her duty to look after him without a thought for herself.

The support for the carer is every bit as important as it is for the patient. They are unsung heroes.

There are 670,000 carers of people with dementia in the UK and these carers of people with dementia save the UK over £8 billion a year.

Carers can be family, friends or paid workers. They will often accompany the person they are caring for to a Doctors appointment, be it at the Surgery or Hospital. It is important that people with dementia have regular check-ups and equally as important for the carer to have regular check-ups.

My Auntie often found it difficult to get appointments to fit in caring for her husband. Early morning or late evening appointments were the worse for her. My uncle would not get up until late morning and for her that gave her the chance of getting things done in the house, and if she woke him early it would often result in him having a bad day.

It is important that anyone caring for someone is giving consideration and understanding as their life is difficult enough.

 

Sadly my uncle died. She was eaten up with grief, asking herself could she have done more. Lost in the endless time she now faced. Friends had moved away, neighbours she didn’t know anymore.

She was suffering another loss for a second time.

2. DNA – The Reception Team Member


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Referring back to my blog on DNA appointments I received a lovely reply from a Reception Team Member who works for a surgery that has approx 25,000 patients.

She too spoke of the frustration that DNA appointments can cause on a daily basis. She now had a system in place at the end of the day where she gets her team to first checks who made the appointment, and whether the patient has already booked. The team approach the patient in a positive manner (ie not guns blazing) as she agreed there could be an error on the surgery in not cancelling the appointment. People will also respond better when someone is approaching them in a positive manner.

The team asks the patients why they DNA their appointment, and in many cases they are extremely sorry for missing their appointments.

I think this is an excellent exercise as it can flag up several issues

  • It can let the patient know you are monitoring the appointments system – especially for those patients that just have not “bothered” to cancel their appointment.
  • It could flag up that patients perhaps are cancelling their appointments and they are not being cancelled on the system
  • Are appointments being booked too far in advance (ie 6 monthly BP checks, or diabetics checks – if so how could your surgery best deal with this.
  • Could highlight the importance of giving out appointment cards whenever possible.
  • Could highlight those few that are constantly not turning up for appointments.

When speaking to the patients regarding their DNA try to get the reasons why in a positive way and look at ways of improving the amount of DNA’s that your surgery has.

What would be helpful would be when you are talking to the patients if it is the first time you speak to them about their DNA you could explain that you are trying to look at the amount of DNA’s and at ways of decreasing these and their feedback on why they DNA would help with this exercise. Explain if patients cancel their unwanted appointments then this will free up appointments for other patients – which could be them. This was it will turn the telephone conversation into a positive one instead of a negative one.

But I am sure by getting a phone call regarding a DNA will certainly get a patient thinking more carefully next time if they simply do not want the appointment and hopefully they will phone to cancel the appointment.

Thank you for your feedback and hopefully this will help other surgeries in dealing with their DNA’s.

Dealing With The Bereaved


How does your staff  handle people when they come into the surgery that have recently been bereaved?

  • Do your staff have training on dealing with patients that have recently been bereaved? Remember good trained staff are confident staff.
  • Do you have a protocol on dealing with bereaved patients? Do you notify your Receptionists when a patient dies or do you just leave it for them to find out?
  • Are you confident in the way that your staff deals with patients that come into the surgery that had just recently lost a loved one?
  • Are your staff compassionate? Are they helpful to those patients suffering a loss?
  • Do you notify your Doctors / District Nurses / Health Visitors other appropriate healthcare professionals when you have notification when a patient dies?

It really does make a huge difference when dealing with someone who has recently been bereaved.

I can hear you saying that your staff are compassionate with all your patients – but they really need to have a “bit extra time” for those that have recently been bereaved.

True Story

I lost my dad 2 years ago. As you can imagine it was the most awful time and on top of our shock and sadness we had to get everything sorted out and we had to visit and telephone so many different organisations such as Hospitals, Funeral Directors, Banks, Solicitors, Florists, Utility companies, Pension agencies, Council,  ……..  the list went on and on.

I found that 99% of every  person that we dealt with to be compassionate, extremely helpful, and very understanding. They all had a policy in place to deal with a death. They had appropriate forms, they all knew exactly what they had to do. It really did help so much when we understandably upset confused and exhausted.

Every single one of them did as much as they could, and explained in full what would or had to be done. I cannot tell you how much stress this took off us as the family when dealing with so many agencies.

Unfortunately it was that 1% – that one person that was the most unhelpful,   and she was the only person that kept referring to my dad as the “deceased” unlike every other single person that referred to him by his name. I found my dad being called “the deceased” the most upsetting thing ever. I wanted to scream he is my dad and he has a name! But I just didn’t have it in me to speak up. I was exhausted. 

This particular person was really not very helpful – her attitude was uncaring and to to point of almost being rude in fact she made me feel very uncomfortable. She even sighed at one point when I asked a question that I was not sure about. 

It’s sad but when I think of all the people we dealt with over the weeks it is always the 1% – the one that was NOT helpful, NOT compassionate and NOT very understanding that comes to the front of my mind.

What a shame that had to happen. That 1% had to spoil it all.

I ask myself did she not have the right training; did she in fact have any training at all in dealing with such a delicate matter? Was she the right person to be dealing with such matters? She might be an excellent worker – but was she the right person to be dealing with customers?

So, when someone comes into your reception (especially the elderly) that has just lost a loved one, remember this, they will be extremely upset, confused, tired, and your surgery might be the umpteen place that they have been to visit that day or week.

So a little bit of compassion and a bit of time from your Receptionist will certainly help the patient in a big way.

Make sure you are never that 1% that sticks in someones mind – for all the wrong reasons.

See previous blogs:

1.    Special Needs Board http://t.co/wnWKmxHV

2.    When a Patient Dies http://t.co/qUBcbEsB

2. DNA – The Reception Team Member


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Referring back to my blog on DNA appointments I received a lovely reply from a Reception Team Member who works for a surgery that has approx 25,000 patients.

She too spoke of the frustration that DNA appointments can cause on a daily basis. She now had a system in place at the end of the day where she gets her team to first checks who made the appointment, and whether the patient has already booked. The team approach the patient in a positive manner (ie not guns blazing) as she agreed there could be an error on the surgery in not cancelling the appointment. People will also respond better when someone is approaching them in a positive manner.

The team asks the patients why they DNA their appointment, and in many cases they are extremely sorry for missing their appointments.

I think this is an excellent exercise as it can flag up several issues

  • It can let the patient know you are monitoring the appointments system – especially for those patients that just have not “bothered” to cancel their appointment.
  • It could flag up that patients perhaps are cancelling their appointments and they are not being cancelled on the system
  • Are appointments being booked too far in advance (ie 6 monthly BP checks, or diabetics checks – if so how could your surgery best deal with this.
  • Could highlight the importance of giving out appointment cards whenever possible.
  • Could highlight those few that are constantly not turning up for appointments.

When speaking to the patients regarding their DNA try to get the reasons why in a positive way and look at ways of improving the amount of DNA’s that your surgery has.

What would be helpful would be when you are talking to the patients if it is the first time you speak to them about their DNA you could explain that you are trying to look at the amount of DNA’s and at ways of decreasing these and their feedback on why they DNA would help with this exercise. Explain if patients cancel their unwanted appointments then this will free up appointments for other patients – which could be them. This was it will turn the telephone conversation into a positive one instead of a negative one.

But I am sure getting a phone call regarding a DNA will certainly get a patient thinking more carefully next time if they simply do not want the appointment and hopefully they will phone to cancel the appointment.

Thank you for your feedback and hopefully this will help other surgeries in dealing with their DNA’s.