Sometimes Rules Need To Be Broken


We have just seen in the new year here in the UK. As I type this its 00.15 on the 1.1.19 everyone is celebrating all over the country wishing everyone Wealth, Health and Happiness.

My mum being Scottish New Years Eve was always the most important night in the year. She loved it. A as child I had lovely memories of her partying on NYE. New Years Day would be like another Christmas Day with another big dinner on the table.

Sadly this isn’t the case for some. People in ill health, people in hospital or hospices, others going through abuse in the home. Spare a thought for those that are not celebrating tonight.

NYE always bring me back to my mum being very poorly in hospital after having major surgery. I had to travel a 100 miles to see her and did this a couple of times a week.

We went to visit her during the day on NYE and I asked a nurse if my dad and I could come back that evening around 11.50 to sit with her to see the New Year in together. I explained the importance of what it meant to my mum. The nurse refused without given it a second thought. I know it was the rules, but would it have really hurt if we had come back. Mum was in a little bay to herself so we knew we wouldn’t disturb anyone else. All we wanted was 15 minutes sitting with mum. But she wasn’t going to allow it to happen. How I regret that I didn’t push it any further.

So, my mum was on her own for her first NYE. No one with her.

She died the following day.

I still feel angry with myself for not pushing it further, maybe asking someone else and hoping for a different answer. And I still feel angry with that nurse. Could she not have broken the rules just that once. I know if I were in her shoes I would have tried in someway of allowing this to happen. I felt that the nurse lacked empathy.

Seeing with the eyes of another

Listening with the ears of another

And feeling with the heart of another.

If you are ever in doubt and you inner self tells you its the right thing they try your hardest to get it done. Rules sometimes can be broken to make people happy.

The Intensive Care Bed #Hospital


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Here in the UK last night the BBC aired a programmed called “Hospital”. It was a very moving programme showing how stretched the NHS is. It certainly opened my eyes to the daily nightmares that consultants, managers and nursing staff find themselves in on a daily basis. The shortage of Intensive Care beds the result in operations having to be cancelled and patients being turned away for life saving operations. The look of frustration and helplessness etched on the faces of many.

How I felt for the patient that had his operation cancelled for the second time, being sent home after waiting in the ward anxiously waiting to hear that an Intensive Care bed was available – it didn’t happen the bed was needed for another patient.

It brought be back to when my mum was “that patient”. Extremely poorly with bowel cancel, awaiting a life saving operation. She was prepared for the op by having nil by mouth for 24 hours the day before the scheduled operation. By 4.00 that afternoon she was still waiting, we her family were waiting with her trying to keep her spirits up. Finally, I went along to the nurse’s station to find out what was happening to be told that her operation was cancelled due to there being no Intensive Care bed that she needed after her operation. Her operation was delayed to the following week.

The following week arrives, my mum another week on, getting weaker by the day but we were all optimistic she was having her op that day. It got to lunchtime and we got the dreaded news her operation was cancelled again for the 2nd time. The Intensive Care bed was needed for a man who was involved in a road traffic accident. I remember feeling anger at this person who I didn’t know – because of him my mum was not able to have her operation again – and then the instant guilt of feeling like that. This faceless unknown person fighting for their life as my mum was doing got the bed first – WHY!! I often wonder how their family felt – they probably just took it for granted that the Intensive Bed was there – as I thought before this nightmare began. Her operation was delayed for yet another week.

The 3rd week arrived – just a few days before Christmas. We were told previously that mum would be first on the operating list. I sat with her – her fight all gone. All 4 and half stone of my beautiful mum wasting away in the bed before my eyes. They came around to get her prepped for the operation. Excitement building like this was something that we didn’t believe was ever going to happen. Somthing that before this we had just taken from granted. Patients starting going down to the theatre – the consultant came up and asked if he could have a word with the family. His dreaded words “I’m sorry but we are going to have to cancel mum’s operation again” Our grief at that moment was unbearable. My heat was torn in two – how on earth could she survive another week. Amongst all of the shouting and swearing the panic and the disbelieve I still remember the look of despair on the consultants face. He just didn’t know what to say. He apologised and said that he would have felt exactly the same if it had been his family. It was the same story – they didn’t have an Intensive Care bed for mum after the operation.

I would never in my wildest thoughts that it would have been a bed that would have prevented my mum from having a life saving operation. It just didn’t make sense. I actually believed at this stage that this was just a lie – that they didn’t feel that mum at the age of 70 years was worthy of this operation. I felt they were just waiting on her dying.

The consultant went and spoke to mum. She had lost the will and just nodded – perhaps like me she thought that she was never going to have this op.

I remember mum saying she was hungry – I sent my Dad to get her a sandwich from the canteen. This has been her 3rd week of starving for 24 hours before being told she wasn’t having the op. She then asked the nurse for the commode. The nurse went off to get one. The nurse took longer than mum could wait and she attempted to get out of bed to get to the toilet – as ill as she was she still had her pride. As she stood upright the tumour burst – all over the floor. Within 10 minutes she was being rushed to the operating theatre where she had the operation.

She finally had the Intensive Care bed that she was promised 3 weeks ago, albeit only for 2 nights instead of the 5-7 she was told she would be in there for. She was  then transferred to the high dependency unit. I often wonder if someone had to be moved out of intensive Care to make way for mum, or if someone who was waiting for it had been cancelled like my mum had.

Watching the programme last night brought it all back. It made me see the nightmares that the staff have on a daily basis trying to access Intensive Care beds for patients. As the programme showed last night we in the UK have the most wonderful consultants with the most amazing powers to carry out life changing operations, the dedicated staff who work around the clock to look after the patients before and after their operations and the most marvellous well equipped hospitals that we should be so proud of. But how shocking it is to think that it sometimes comes down to the “luck of the draw” when it comes to needing that much-needed Intensive Care bed.

 

© 2011-2018 Reception Training all rights reserved

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. 

 

Patient Access – Appointments


imagesCAUP3U1D“Improving patient access” is all something that we hear about on a daily basis. It constantly being discussed at all levels, Partner meetings, Reception Team Meetings and Multidisciplinary Meetings. There is no one working within the NHS who is not aware of this.

As Managers we all strive to make patient access the best we possibly can. Often systems are changed to try to accommodate patients, yet still we hear people complaining that they are unable to access appointments for days at a time.

Not having appointments can often cause frustration not only from the patients, but from the Receptionist Team too, they often feel that are unable to do their jobs and often having to deal with difficult situations because some patients can become aggressive.

I decided to be proactive and look at the amount of DNA’s we had at the surgeries I managed. We had over 30,000 patients and I was shocked when I realised just how many hours were being wasted on a daily / weekly / monthly basis by patients for whatever reason not attending their appointments.

Patients are often the cause of the lack of appointments. It is not acceptable to just “not turn up”.

But what can we do to improve DNA’s? What does your surgery do to try and keep on top the wasted appointments?

Some surgeries (and hospitals) display in the waiting room the number of DNA’s each month, and this can be pretty horrifying when you see just how many appointments are wasted in this way. But of course the people who did not turn up for their appointment do not see these statistics.

Some hospitals will send out a text message a few days before an appointment, thus giving the opportunity to cancel if the appointment is no longer needed (also a good reminder if the patient has forgotten) This system will only be helpful for those with mobile phones, perhaps not so good for some of the elderly that may not use mobiles.

Some hospitals are now sending out reminder letters a week before the appointment, again helpful when the initial appointment might have been made some months before.

Adding something to a Surgery website is another way to encourage patients to cancel unwanted appointments, you could also display the DNA’s for the previous month.

Practice Newsletters is also another way of encouraging people to cancel rather than just not turning up.

We did a trail at one of our surgeries. When a patient DNA their appointment a letter was sent to them pointing out that they missed their last appointment, and the practice would appreciate if they could not attend a future appointment could they please phoned and cancel the appointment. The letter would go on to explain the amount of DNA’s the surgery was experiencing and that patients were having problems booking appointments.

Another surgery I know of has a system in place, that they feel works extremely well and have been getting positive feedback from patients and the Receptionists. They have over 25,000 patients, and have their fair share of DNA’s. They found the amount of DNA’s they were experiencing each day was getting increasingly frustrating for the staff. The Reception Team Leader started getting the Reception Team on the late shift to phone the patients who had DNA that day to ask the reason why they had not attended their appointment. They make the call as friendly as possible; the call is not made with “all guns blazing” or “pointing a finger” at the patient for not attending. The Receptionist simply asks the patient did they realise they missed an appointment today, and would they require another appointment. They found that most patients were extremely sorry for missing their appointments, and some genuinely did forget, but more important it made the patients aware that the Surgery was monitoring the appointments. Since starting this system they have found that their DNA has fallen.

The most important thing when doing this is when a patient cancels an appointment that IT IS CANCELLED. Often for whatever reason if appointment stays on the screen, despite the patient cancelling the appointment it could result in a letter or a phones call going to the patient.

This unfortunately happened at our surgery, a patient was sent a letter when she had in fact cancelled her appointment, and understandably was quite upset when she received a letter. If this system was to work it is essential that every single Receptionist understand the importance of cancelling appointments on the screen – in not doing so could result in the surgery receiving a complaint.

By highlighting the amount of DNA’s in these ways it lets your patients know that you are monitoring your appointments system – especially for those patients that just have not “bothered” to cancel their appointment.

It could also flag up that patients are perhaps cancelling, but for whatever reason they are not being cancelled on the system – which could indicate a training need.

Are appointments being booked too far in advance (i.e 6 monthly BP checks, diabetics checks etc) if so how can you best deal with this? Could you use the texting system to remind patients a few days before their appointment?

I am always in favour of giving out appointment cards especially to the elderly. Always remember to put the day as well as the date on the card along with the time.

Monitoring DNA’s will flag up those that repeatedly fail to attend.

Always approach patients about DNA’s in a positive way. Explain that the Surgery is trying to look as the amount of DNA’s and at ways of decreasing these and feedback on why they DNA would help with the exercise.

Explain if patients cancel their unwanted appointments then this will free up more for other patients – which could be them.

And when a patient does take the time to call the surgery to cancel an appointment, the Receptionist should always thank them for taking the time to do so.

Patients have to be made aware that by not cancelling their appointments it just adds more pressure to the already busy system.

© 2011-2017 Reception Training all rights reserved

 

There is nothing more weird than folk


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I had to go into hospital for the day last week. I was sent a letter with instructions on what I needed to do and what I needed to bring, pyjamas, slippers and a book etc. All simply written out, easy to follow and to understand.

I arrived in plenty of time and was shown up to the ward. The ward was very quiet; there was just one other lady in the bed next to mine. I was shown my bed and asked to get into my pyjamas and told the nurse would be round shortly to take some details.

Then another lady came in. She took herself off to a bed opposite and sat there waiting on the nurse. She greeted the two of us and remarked on the weather, we all passed small talk that you have with complete strangers. Both ladies seemed really nice.

The nurse came in; she went to the lady opposite and drew the curtains.

There was no confidentiality whatsoever, we could hear the whole conversation, the nurse was taking her whole medial history.

When you are sitting there, nothing to do and everywhere is so quiet it is so hard not to hear what is being said.

I know I shouldn’t have but the lady did make me chuckle to myself at the same time feeling sorry for the nurse taking the details as I imagined there was a lot of crossing out on her notes.

Some of the conversation went

Nurse : Where is your bag?

Patient : What bag?

Nurse : A bag with your pyjamas and slippers

Patient : Oh was I supposed to bring something in to change into

Nurse : Yes it was in your information did you receive it?

Patient : Yes I did (and said no more)

The nurse went off to get the patient a gown 

The Nurse returned and continued asking the patient some more questions

Nurse : Do you smoke?

Patient : No

After a pause

Patient : well I do have 3 or 4

Nurse : is that a day or a week?

Patient : errrr well I probably have about 5 or 6 a week.

I imagined the nurse having to cross out what she has already written.

Nurse : Do you drink?

Patient : No

After another pause

Patient : Well………… I might have a couple now and then

Nurse : How much is now and again

Patient : A couple of time a week.

Another pause whilst the nurse crosses out what she has previously written.

Nurse : when did you last eat

Patient : Yesterday at 4.00 pm

Nurse : Did your leaflet not tell you to refrain from eating after 1.00

Patient : Oh I didn’t see that

Nurse : What medication are you taking?

Patient : ohhhh let me think? (this took a bit of time after several changes)

That entry also had a few crossed out too I should imagine!

And so the conversation went on with similar discrepancies to what was originally said.

I must say the nurse was brilliant; she never once got short tempered with the patient, took everything in her stride and was even able to have a laugh with the patient. She really was so professional.

The nurse then came to me.

We whipped through the questions, and when she came to medical history and medication I handed her a typed sheet with all the information on – she smiled and whispered, “if only everyone was as well organised as you.”

© 2011-2017 Reception Training all rights reserved

 

Eye Contact and a Smile


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A friend of mine had to go for an X-Ray yesterday at his local hospital. The hospital is in the process of going through some building work and many of the departments have been moved around – so finding the X-Ray department was somewhat of a challenge.

He followed the temporary signs to the X-Ray department and upon arrival asked the Receptionist if he was in the right place.

He was quite surprised by her attitude, he was made to feel as if he was a nuisance, and an inconvenience for being there. She replied quite abruptly that he was, took his referral letter and told him to take a seat.

At no time did the Receptionist give him eye contact, smile or show any signs of any customer care.

He sat and waited. There were another 4 people in the waiting room.

A nurse came out and called his name, the receptionist rudely snapped at the nurse and asked what she was doing and asked if she had taken from the bottom of the pile. My friend said that you could feel the nurse’s embarrassment at being spoken to in such a way, her red face for all to see.

The nurse explained to the Receptionist that the other people in the waiting room in fact were waiting to be accessed by her colleague before being seen.

My friend got up and followed the nurse, who was absolutely lovely. She welcomed him with a smile. She asked him how he was, and spoke about the weather and held a general conversation. He found her extremely friendly and this put him at ease.

I asked my friend how he felt about the two completely different approaches when be dealt with and he said that going into a Department people can be often worried and concerned as they could be going for tests that could have such a big impact of their life. Many people that are having tests at a hospital are feeling anxious and do not need to be met with rude staff.

He found the Receptionist unhelpful, uncaring and actually felt uneasy when being dealt with by her. He also found it embarrassing when she spoke in such an abrupt way to the Nurse, and he felt that she should not have done that.

As for the nurse, he found her lovely, helpful and put him at ease within the first couple of minutes. He felt able to ask questions about his test something he wouldn’t felt he was able to do with the Receptionists.

Staff have such a big impact on patients in the way that they deal with them, from the moment they walk into your organisation whether it be a hospital, or a Surgery every single member of your staff should treat every single patient with respect.

Eye contact and a smile speaks volumes.