Moral Story – The Patients


I recently post a link to you tube called Empathy. I had some lovely feedback from this link and if you have not seen it I would recommend having a look. A simple reminder that behind every person there is a story.

You Tube Link:  Patient Care – Empathy http://wp.me/p1zPRQ-ql

This is another story that I came across that I would like to share – again it shows behind the “patient” there is a person.

Moral Story – The Patients

 Two men, both seriously ill, occupied the same hospital room. One man was allowed to sit up in his bed for an hour each afternoon to help drain the fluid from his lungs. His bed was next to the room’s only window. The other man had to spend all his time flat on his back. The men talked for hours on end. They spoke of their wives and families, their homes, their jobs, their involvement in the military service, where they had been on vacation.
Every afternoon when the man in the bed by the window could sit up, he would pass the time by describing to his roommate all the things he could see outside the window.
The man in the other bed began to live for those one hour periods where his world would be broadened and enlivened by all the activity and colour of the world outside.
The window overlooked a park with a lovely lake. Ducks and swans played on the water while children sailed their model boats. Young lovers walked arm in arm amidst flowers of every colour and a fine view of the city skyline could be seen in the distance.
As the man by the window described all this in exquisite detail, the man on the other side of the room would close his eyes and imagine the picturesque scene.
One warm afternoon the man by the window described a parade passing by.
Although the other man couldn’t hear the band – he could see it. In his mind’s eye as the gentleman by the window portrayed it with descriptive words.
Days and weeks passed.
One morning, the day nurse arrived to bring water for their baths only to find the lifeless body of the man by the window, who had died peacefully in his sleep. She was saddened and called the hospital attendants to take the body away.
As soon as it seemed appropriate, the other man asked if he could be moved next to the window. The nurse was happy to make the switch, and after making sure he was comfortable, she left him alone.
Slowly, painfully, he propped himself up on one elbow to take his first look at the real world outside.
He strained to slowly turn to look out the window beside the bed.
It faced a blank wall.

The man asked the nurse what could have compelled his deceased roommate who had described such wonderful things outside this window.
The Nurse responded that the man was blind and could not even see the wall.
 The Nurse said , “Perhaps he just wanted to encourage you.”

Epilogue:

There is tremendous happiness in making others happy, despite our own situations. Shared grief is half the sorrow, but happiness when shared, is doubled.

If you want to feel rich, just count all the things you have that money cannot buy.

Today is a gift that is why it is called the Present.

The origin of this story is unknown but has touched so many people.

 

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.

 

 

When a Patient Dies


Does your Surgery have a policy when a patient dies?

You might ask why you might need a policy on this – but it is extremely important in various areas. Let me share these with you.

When one of your patients dies you will probably be notified by one of the following

  • A member of family or a friend
  • A Carer
  • The local hospital (usually comes in the form of a letter or fax)
  • The Out Of Hours Service
  • A Nursing Home (this will normally come via a telephone call)
  • The Health Visitor from your own Surgery (if they were caring for the patient at home)
  • Local Health Authority (the patient might had died in another area/country)
  • You might see it in the local paper under the births deaths column.

COMPUTERS RECORDS

The next step is to record the death on your computer records. If your system does not do all of these automatically you will need to ensure that they are taken off.  Ensure that the patient is taken off any clinics that might generate recall letters such as

  • Flu Clinic
  • Diabetic Clinic
  • Asthma Clinic
  • Blood Pressure Clinics and so on.

If your surgery is mostly computer run it is still very important to make sure that an entry is made in the paper notes.

How does your Surgery record patient deaths?

TRUE STORY

I worked in a surgery before we have our death protocol in place where a very upset wife phoned to say that a letter had been sent out to her husband to have his flu vaccination done – he had died 3 months before. Although someone had entered that he was deceased on his records he had not been taken off the flu recall.

Link up any close member of their family and add to their records that they have been recently bereaved – this will help the Doctor if a member of the family comes in to see them. There is nothing worse than the Doctor asking after the deceased patient. And believe me this has happened on several occasions.

Ensure than any future surgery appointments are cancelled.

Remove patient details for any routine repeat prescriptions.

TRUE STORY

It is important that you put a stop to any further prescriptions – I am happy to say that it didn’t happen at my Surgery but there have been surgeries that have had people coming in to request repeat prescriptions for deceased patients and because they had not got a policy in place the prescriptions were issued – several times

Who you should informed of the deceased patients death will depend on where the patient died.

If The deceased Patient dies at home / or other place please check to see if they have any future hospital appointments booked.

The  most important thing you should check with your local hospital to see if they had any outstanding hospital appointments.

Ask the hospital to check if the deceased patient had any hospital transport booked. Why?

TRUE STORY

Again before our Surgery policy was put in place we had a deceased patient who’s funeral was taking place one Thursday morning – the wife of the deceased heard a knock at the door and thinking it was the undertakers she opened the door to find that hospital transport was there to take the deceased patient for his hospital appointment. Now can you see the importance of ensuring that all future appointments are cancelled?

WHO YOU SHOULD INFORM WITHIN THE SURGERY?

It is important for all staff to be made aware of the death of any patient. How do you record the death of a patient in your surgery?

  • Inform the Doctor
  • Inform the Health Visitor (in the event of a child or pregnant mother)
  • Inform the Health Visitor (in the event that they were due to start visiting the patient)
  • Inform any other healthcare professional that might have a reason to be in contact with the deceased patient.

The best way for this is to send an internal email – and if necessary put it in the message book.

When we reviewed our policy on deceased patients I designed a form that had to be completed. We had a member of staff that had the responsibility of ensuring that everyone was informed of the death. Each section had to be completed or ticked and at the end of the form a surgery supervisor had to sign it too – and this copy was then scanned onto the patient’s records and the paper copy placed in their medical records.

You can design your own form but an idea on what we had on our form:

  • Patients Name and Address
  • DOB (date of birth)
  • Place of Death (ie home/hospital/other)
  • Computer code entered (RIP code)
  • Deduction Requested (deduction from surgery list)
  • Next of Kin (entry made on their notes)
  • Hospital Notified – if applicable (I recommend that this should be done in a fax/email and not verbal.)
  • Hospital Transport Cancelled
  • Surgery Appointments cancelled
  • Doctor informed
  • Health Visitor Informed
  • District Nurse Informed
  • Other staff informed
  • Prescriptions Stopped
  • RIP Message on Notes
  • Records returned to the Health Authority
  • Any other areas that might be applicable to your Surgery

 I hope you have found this helpful. The important thing is to ensure that family / friends are not subjected to any more upset because their loved ones are still on your surgery system as still living.

REMEMBER:  This will be the last thing you will do for the deceased patient – show them the dignity they deserve.

I did go on to have an “alert” board where we also put this information. You can read this on  my blog :

Patients With Special Needs (Special Needs Board) http://t.co/wnWKmxHV

 

Privacy Curtains – the Protocol


 

I speak a lot in my blogs of Team Work. As a manager you can only be as successful as your team will allow you to be.

It is vital to have support from your team. Communication is a two-way thing. Your team not only learn from you but you can learn from them too. After all they are the ones facing the many obstacles that come up on a day-to-day basis. Learn to listen to your team and let them know that you are on their side.  Often staff can see Management as the “enemy” it does not have to be like that. Make your team feel that they are part of YOUR team.

A thank you at the end of the day can mean so much. When asking a team member to do a task always ask in a polite way – and always thank them and tell them that you appreciate their help.

The best way to share good ideas is at staff meetings – always use staff meetings to your advantage – include the staff in these meetings – make them a two-way thing – staff will feel that they are part of it that way and will be more inclined to attend.

Let me share with you an example of how a new protocol/procedure was written for the Surgery from one of these meeting.

It was the normal monthly Receptionists Meeting – the agenda had gone out and as always everyone had the opportunity of adding an item to the agenda.

One of the Receptionists had added “Privacy Curtains” to the agenda.

The meeting started and came to the part of the agenda that she had added.

She suggested that the girls at the Reception desk have access to privacy curtains as she had recently had an experience whereby her own father had collapsed  and died in his own Doctors waiting room with a heart attack and was left lying on the floor until the Doctor came out to him and took the necessary action. During this time patients were all watching what was going on – and the receptionists at the Surgery found this quite stressful.  Our Receptionist felt that her dad was on “show” and found this quite upsetting.

So, from a personal experience we wrote a Surgery policy on what would happen in the event of someone collapsing in Reception.

Some of the points that were taken into consideration were:

  • Who to notify in the event of a patient collapsing – first the Doctor – but as you know there is not always a Doctor on the premises. So your receptionists need to know what to do in that event – I would suggest calling the nurse, or if she is not on the premises call an ambulance.
  • A Receptionist would they get the privacy curtains and put these around the patient giving them a bit of privacy.
  • If in the rare event that a patient has died you might need to evacuate the waiting room as the patient might be there some time until the appropriate people have been notified. Maybe direct the patients into another area or another room.
  • It is important that your Receptionists will need to know what to do in the event of an evacuation.

It is rare that this happens – but it is how you or your team deal with it that can make all the difference.

Has your Surgery got such a protocol in place?

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.

Weekends in A&E – the Referee


Being a single mum to two girls and having no support from my ex it was down to me to support the three of us. I worked Monday to Friday in a Doctors Surgery and Weekends for the GP Out Of Hours Service. This is the emergency cover that your Doctors Surgery gives evenings and weekends when they are closed.

 

I worked a couple of shifts over the weekend and usually one evening in the week  – and on occasions more if there were other receptionists away sick or on holiday.

 

I worked alongside the duty Doctor on Call. Although we worked for the Out of Hours service we were based in the local A&E Department.

 

I enjoyed this role so much – I worked with some lovely Doctors – who were more laid back doing these shifts than they would be working in their normal surgeries.

 

I also worked with some lovely people who worked extremely hard in the A&E department. I have and always will respect these people for the work that they do. I worked very closely with the A&E Receptionists and was accepted as part of their team. I was honoured to be included in all their social events.

 

In the earlier days the Out Of Hours service was quiet – so I would often help the girls out on the A&E reception desk. I would help file, make the tea and help patients if they needed anything.

 

The “emergencies” came through another section of the department so we actually only dealt with the “walking” wounded. I cannot tell you what I seen and learnt during those years I was there. It certainly opened my eyes to how some people live their lives.

 

I will bring you different stories from my days in A&E from time to time – some funny and some sad, but I will respect the patients that came in – I will not identify anyone or use any names. These stories are true but unidentifiable.

 

Working with the Doctor we really only seen minor illnesses – some we did refer on to the hospital but mainly they were just routine coughs and colds. But working in the reception area I witnessed some of the more critical cases that came in. One that comes to mind…………………

 

It was a Sunday morning. The waiting room was full of the usual sporting injuries. Footballers, rugby, even golfers!!!

 

The ambulance brought in by blue light a referee from a local Sunday League football match. He was taken straight into Resuscitation – but sadly he didn’t make it.

 

It was awful – your thoughts go out to his family – who are yet to find out and also his colleagues that were with him when it happened. But what was really sad was that no one at the match knew anything about CPR – or if they did no one tried it on him.  Had they have done – perhaps…………………. well we would never know.

 

The referee came in with just his kit on with his coat over the top of him – he had a member of the football team with him but was not a relative. The nursing staff had the awful job of phoning his wife. The staff member took his phone out of his jacket and went into a private room to phone. A job that everyone admits is the worse part of their job.

 

About 30 minutes later a distraught woman comes in – she comes to the desk and says that she is the wife of the referee that had been brought in. Everyone’s heart went out to her.  Little did she know this morning what this day was going to bring.

 

The Nursing staff came out and brought her through. Minutes later another member of the Nursing Staff came out – she wasn’t the wife of the dead man. This poor woman had gone in to see “her husband” only to find it was a complete stranger.  She must have been filled with horror and relief at the same time. I can’t begin to think what she must have gone through.

 

We finally got to find out what had happened………………..the referee had collapsed on the pitch and while they were waiting on the ambulance to arrive someone from the sideline had taken his coat off and placed it over the referee to keep in warm. In the panic to get him to hospital quickly the jacket was taken with him in the ambulance.

 

What an awful error – this poor man was lying there – and no identity – but it only took minutes for them to find out his true identity and the Nursing Staff then had to make a second call – this time to the right person.  It was a lesson to us all – never take anything for granted.

 

And please remember just how important CPR can be. A life saver!