What is Caldicott and how does it affect me.


 Here is a list that you can have on your staff notice board – or inside your staff handbook. A quick reminder of Caldicott and what it means.

Does your staff have a good understanding of Caldicott and what it means?

                                                     

LINICAL GOVERNANCE

There is an important clinical Governance element to safeguarding confidentiality. The handling of information provided in confidence is an important aspect of the quality of care.

WARENESS

ALL staff should be aware of their responsibilities and have an obligation to respect patient confidentiality.

ITIGATION

Serious breaches of confidentiality could lead to criminal prosecution for the organisation and in some cases the individual. IT COULD BE YOU!

ISCIPLINARY

The organisation will take a serious view of breaches of confidentiality and could lead to dismissal.

NFORMATION TO PATIENTS

Patients must be informed of the Data Protection Act, Confidentiality and their rights as a patient.

 ONFIDENTIALLY

Everyone working for the NHS has the legal duty to keep information about patients and clients confidential at all times both in and outside of the workplace.

 WNERSHIP OF DATA

A designated individual should take responsibility for ownership of a particular set of information.

ELEPHONE AND FAX MACHINES

Be aware of telephone conversations, which provide patient identifiable information. Ensure your call cannot be heard by patients in the waiting room. When faxing patient identifiable information, ensure the fax machines are located in a safe area and in a locked room when not in use i.e. overnight.

RANSFER OF INFORMATION

Transfer of patient identifiable information should be carried out in strict accordance with the Caldicott principles. Where possible patient identifiable information should not be held on portable computers, where this is unavoidable, it should be password protected or encrypted. Any patient identifiable information should be secured in a locked unit.

*see previous blog on confidentiality: The 6 Key Principles http://wp.me/p1zPRQ-3S

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Helping Patients With Learning Disabilities


People with learning disabilities are a small proportion of the population; however evidence suggests they have greater health needs, in relation to hearing and visual disabilities, hypertension, chronic bronchitis, epilepsy, cerebral palsy, gross obesity, spinal deformities, skin disorders and mental health.

Patient can often feel intimidated and often feel confused and may be happy to let their carer speak for them.

They might often see the Doctor or Nurse but leave the room without having communicated what the reason was for attending the Surgery. In addition to these problems many people with learning disabilities may not be able to understand written instruction which can cause them some distress.

Areas to be Considered

Communication

  • Use clear short sentences
  • Check the patient’s comprehension of the conversation by asking questions that will clarify that they have understood.
  • Give clear information. It might be necessary to explain in more detail because of the patient’s level of understanding.
  • If it helps the patient write instructions down.
  • When asking the patient asks a question please give them time to reply.
  • Direct the question at the patient rather than just to their Carer.
  • Use good body language and eye contact at all times.
  • Make them feel at ease.
  • Do not rush them.
  • Give them your full attention.
  • Most of all give them time.

Appointments

  • Consider booking a longer appointment to give both the GP and the patient time to communicate.
  • People with learning disabilities may become anxious in a crowded and noisy waiting room, so appointments booked at quieter times of the day might ease anxiety.
  • Some people with learning disabilities may find it difficult while waiting for their appointment; this may be overcome by booking at the beginning of the appointment list.
  • Continuity is important to people with learning disabilities – if they gel well with a certain Doctor or Nurse wherever possible please try to book them with that Doctor/Nurse.
  • Always give an appointment card for their next appointment; please do not give it verbally.

Know Your Patients

A good receptionist will know her patients – and will understand the patients especially those with special needs. She will know exactly the needs of the patient and will endeavour to do her utmost to ensure that the patient has a good experience when coming to the Surgery and this begins at the front desk.

 

 

Appointments


When Making an Appointment

It is important when making an appointment for a patient that you are clear about the time, date and even the month.  Often hospital appointments can be months in
advance.

If the patient is booking their appointment in person at the reception desk always try and make an appointment convenient to the patient.

Often if you give an appointment and it’s not convenient that the patient will either not turn up or phone to cancel and re book. Try to get it right first time.

When you book an appointment at the reception desk always give the patient an appointment card – or put the appointment on a piece of paper.

Often patients will “insist” that they will remember their appointment but quite often they will end up phoning to check when it is – or worse still not turn up.

Always put on the appointment card

  • The day       (Monday)
  • The date     (16th)
  • The month  (September) and
  • The time      (11.00 am)
  • Who the appointment is with (Dr / Nurse / other)

If the patient is making the appointment over the telephone again please give clear instructions on when their appointment is. Again repeat as above.

If you don’t give the day  (Monday)  quite often people will get their date (16th) mixed up and often turn up the day before or after – this is quite a common thing especially some  elderly people.  People will remember a day rather than a date.

When giving an appointment over the telephone always speak slowly and clearly – the person on the other end of the phone might be writing it down.

At the end of the conversation ask if they are happy with the appointment – this will give them every opportunity if they are anyway unsure.

Every Doctors Surgery and Hospital have a high volume of DNA’s (Did not attend) each day and every day through the year. Therefore it is essential to try and avoid any unnecessary misunderstanding over appointments.

When making ANY appointment always make sure that you have the correct patient. You will often have patients have the same name or similar names. If unsure ask for DOB (date
of birth). But please remember confidentiality at all times.

When The Doctor/Nurse is running late.


When a patient books in at the reception desk and you identify that the Doctor/Nurse or other healthcare professional is running more than half an hour behind schedule PLEASE inform the patient before they sit down.

No one likes to be kept waiting, but everyone would rather be told and given the option to wait or re book another appointment.

Lack of communication can often lead to a complaint or even worse someone getting aggressive.

When a patient comes to the desk you could say:

“I apologise but Dr Smith is running about 35 minutes late this morning – he had an emergency / visit to do. Would you like to wait or would you like to re-book another appointment?”

By doing this you are giving the patient a choice. If they choose to wait then they can not come back to the reception desk after 25 minutes and complain – which they more than likely would have done if they had not been informed.

  1. It also gives the patient a chance to go to the paper shop/car to get something to keep them occupied while waiting.
  2. They might want to make a phone call to tell someone who they are running late.
  3. They simply might need to go to the toilet.

They would be reluctant to do any of the 3 above if they did not know they were in for a wait – they would sit there waiting to be called in at any minute.

If the patient cannot wait for various reasons, it gives them the opportunity to re-book at a time suitable to them. By patients booking another appointment it will lessen the already late and give the Doctor / Nurse a change to catch up.

Always try to defuse any potential complaint. It is always better to try and solved a situation sooner rather than later.

Always look ahead.

Managers/Supervisor Training: Registering A New Patient


Registering a New Patient

Every surgery will have new patients registering on a regular basis.

How do you register your new patients?

When I first started working at the Surgery we used to give patients a “new patients” form to complete.

The patient would fill in the form hand it back to the receptionist we would then process it and request their notes from their previous Doctors.

Sometimes we would not see that patient for a long time, other times they would be regular patients to the surgery.

I was made up to Surgery Supervisor – one of my roles was to look at ways of improving the services in the Surgery.

One of them was when registering new patients.

When a new patient came into register I would take them aside to one of the rooms. I would ask them to complete the form(s) once for each member of their family and I left them for a few minutes.

When I went back I quickly checked that the forms had all been filled out correctly – this saved time if they had not.

Something very important is that to remember than not everyone can read and write. It is amazing just how many people I came across that could not do that. (please read blog How to deal with people who have difficulty reading and writing)

When I had checked that the forms were all completed correctly I would have a look to see who/ how many were in the family

CHECK

  • Was it just a single person?
  • Was it a couple?
  • Was it a family – if so how many children did they have?
  • Or did they have an elderly parent living at home with them?
  • Were they a Carer for someone?

WHY?

  • Well by determining this it would give me some idea of who they might want to see if they needed to come to the surgery.

Doctors

Practice Nurses

Health Visitors

District Nurses

Midwife

Physo

Groups that the Surgery organised such as the Carers Group

WHY FIND OUT THIS INFORMATION?

By finding out this information I could tell the patient a bit more about the practice. Information that would be best suited to them.

I could explain about the Doctors, there was a Doctor that was extremely good with
backs.

There was a Doctor that was excellent in dermatology and a Doctor that dealt in paediatrics. I explained that we had a female doctor but she only worked part-time and told them the days she worked.  Often the new patient might be pregnant and I would tell them about the services we had and when our weekly anti natal clinics was held.  If they had an elderly person living with them or a disabled child/adult I told them about the Carers Group when held at the Surgery.

N.B. This was before Practices had Practice Booklets. So no other information was   available at this stage.

I would tell them our policy of requesting  a prescription. Told them what times were best to call for appointments and home visits and best times to avoid. I explained that we were closed at lunchtime but open until 7.00pm.

I would try to give the new patient as much information as I could that was best suited to them. After all a single man would not be interested much in our anti natal clinic would he?

But the biggest help would be when the new patient they had some sort of idea on what
they were asking for and when this perhaps was at our busiest time i.e first thing in the morning it certainly helped the receptionist as she could often deal with the request quickly and efficiently. Rather that the patient asking several questions over the phone – which I had been able to answer when the registered.

Therefore in my experience spending a bit of time with someone at the start saves so much
time further down the line.

Receptionists Training: How To Identify People that Have Difficulties Reading and Writing.


How would you identify and deal with a patient that might have problems with reading and writing – and not embarrass them?

I have seen many patients embarrassed by a receptionist insisting that the “complete” the form in front of them.

TAIL TALE SIGNS OF SOMEONE THAT MIGHT HAVE PROBLEMS READING OR WRITING

  • They will often become agitated or look uncomfortable when given a form to complete
  • They might go very red in the face with embarrassment
  • They will try to make an excuse ask if they can bring the form back at another time
  • They might say they can not wait and will fill it in next time (when they can bring
    someone back with them)

And the most often used excuse is:

They have left their glasses at home!

Many of the above could indicate that the person had problems completing the form. For
whatever reason do not embarrass the person by insisting they complete the form.

If the form can be taken away and completed and brought back all well and good, but as I
well know many of these forms never come back again. So I appreciate the importance of getting the forms completed there and then.

HOW DO YOU HANDLE IT?

If you have reason to believe that the person is having difficult completely the form you
should

  •  Be very discreet
  • Never ask the person if they have problems with reading and writing
  • Never snatch the form back and say “give it to me”
  • Offer to help complete the form
  • Try and put them at ease – if they say they do not have their glasses just tell them that it is ok and that lots of patients do the same and you are more than happy to
    help complete the form.
  • Put the patient at ease by saying that it might be quicker for you to do the form
    because you know what parts have to be filled in.

You will often find by showing kindness and not judging the person will in fact tell you
that they have problems in completing forms. If they do tell them its fine – and they we get many request for help with filling in forms.

Explain  to them that you would be more than happy to help again, and that they should ask for you or another member of staff to help complete the next necessary form.

Ask the person if you want them to make a note of it on their patient notes – so in future they are not asked to complete a form again at the desk. Many are happy for you to do this. It also helps other team members know of their disability in not being able to read or write.

Every patient should be treated with respect at all times.

Sarah – My First Experience of Death


Having never worked within the healthcare sector before certainly was an eye opener, the pace that everyone worked at, the different services that the Surgery offered and the sheer volume of people through the doors and the phones that never stopped ringing.

But I love it. Every day brought something new – I was constantly learning new skills together with getting to know the staff and the patients. For once I enjoyed going into work every day.

Don’t get me wrong there were ups and downs – Doctors getting grumpy with the Receptionists because they put extra’s into their clinics, Patients getting grumpy because they couldn’t get their way – and other receptionists getting grumpy because everyone else was grumpy with them.  But you got through those days and came out of them to face a similar one the next day.

One of my very first patient memory was a mum called Sarah. I had spoken to her several times on the phone and she always seemed to be very anxious. She always asked for an appointment. On speaking to other receptionists it soon became clear that she was a “regular” to the surgery.

Over the years working in Reception I got to know our “regulars” very well. Now regulars can again come in all shapes and sizes. We have the regulars that need to be seen by the doctors for one reason or another, and are pretty poorly and we have the regulars that perhaps don’t need to be seen quite so often. These patients do take up a lot of time and money from the NHS. They take up Doctors appointments; they request tests that require nurses, or hospital appointments. More often than not their tests all come back clear. But as a Receptionist it was not my place to judge – if a patient asked for an appointment they would get one. But you can’t help getting a bit frustrated by a patient demanding to see a Doctor in an emergency slot for a runny nose that they have just developed that day – and usually the regulars know the system and know that if they insist on being seen that day they we have to offer an appointment.

We used to get a lot of anxious mums – again we would never refuse for a baby or child to be seen. But a lot of times the child might just have a cold or teething. It did occur to me that a lot of these young mums did not have the support from older experienced family members – they were often single mums or a first time mum with no guidance from a mum or gran. Sad really as all they needed was reassurance from someone – so often they had no one else to turn to other than their Doctor.

I remember one of the Doctors saying once that he felt more like a social worker than a Doctor.

So, back to Sarah – she would phone on a regular basis – and it was always for the same thing – her back. She would come into see the doctors – they ordered tests on her back and blood tests and all came back clear. After a while the doctors and the reception staff began to wonder if there was actually anything wrong with her at all. But she insisted that her back was bad.

I liked Sarah – she wasn’t like one of the “regulars” that didn’t have anything wrong. She never caused a fuss she just wanted an appointment.

She also had 3 beautiful daughters – age 8, 5 and 3. They were always dressed beautifully and always very well-behaved when they came into the surgery. We rarely seen her husband but all in all a lovely family unit.

Then Sarah became ill. She was admitted into hospital. She had cancer in her back. The surgery was in shock – and more so the doctors as nothing had shown up in any tests.

Sarah sadly died some weeks later. I was completely devastated by this – it was the first patient that I had known died at the surgery. All I could think about was she was right – she knew that there was something wrong.

I couldn’t sleep at night for thinking about those 3 little girls – their mummy now gone.

But if I wanted to carry on working in the Surgery I knew that we would lose patients again and again. But what I never have ever forgotten from that day to this is NEVER judge and think someone is “putting on an act” I have no right to judge – and from that day to this if someone requested appointments time and time again they were treated with respect and given the appointment.

Sarah’s husband gave up work to look after the girls – he would come in from time to time with one of the girls. He seemed to be doing a great job of looking after them – he still kept them immaculate – they were a credit to him. Sarah would have been so proud of them all.

I used to chat to him when he came in – I asked how the girls were coping and how he was coping. He always seemed to enjoy our chats. He told me that he was getting on very well – he still missed Sarah but the girls were keeping him going, but one thing he did have problems with was their hair – every one of them had the most beautiful long hair – but he just couldn’t “do” long hair. The girls had to wear their hair back or up for school. Often, They often wanted it platted or put into pigtails – he tried and tried but just couldn’t do it. He said there had been more tears over hair in the house than anything else.

He said that it would be so much easier if they all had short hair –  but their long hair had always been Sarah’s pride and joy and for that reason he would battle on and try his very best to do that pigtails.

I cried that afternoon when I thought of that poor man – coping with the loss of his wife, being a dad and a mum to the girls and trying very hard to create that perfect hair style.

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