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.”

 

Its Not Always About The Patient #Dementia #Carer


There are currently approx 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.

Two thirds of people with dementia are women. One third of people over 96 have dementia.

60,000 deaths a year are directly attributable to dementia.

The final cost of dementia to the UK will be over £23 billion in 2012.

There are 670,000 carers of people with dementia in the UK

Carers of people with dementia save the UK over £8 billion a year.

Identify

Do you identify on the patient’s records that they have dementia; this will often help when the carer is making an appointment on their behalf.

If the carer is a patient at your Practice do you identify them as a carer? Often carers have medical conditions related to being a carer.

  • Back problems due to lifting the patient.
  • Depression. Often due to isolation.
  • Not sleeping due to caring for the patient.
  • Other medical conditions

If medical issues are not identified it can often lead to the carer becoming unwell and the patient having to go into hospital or a nursing home.

Carers save the NHS a lot of money caring for people in their own home. Carers need the support to help them continue caring for their loved ones at home.

Yearly flu vaccinations are vital, if the carer has a bad attack of the flu the cared for person will often have to go into respite care.

Appointments

If a carer telephones for an appointment always try and accommodate them in a time or day that is suitable for them.

Carers will often accompany the person with dementia to the GP. The carer can often describe the symptoms or problems to the GP or Nurse. The carer can often remember afterwards what was said and provide the appropriate support.

Confidentiality

Sometimes people with dementia prefers to see their GP alone, or it may not be possible for anyone to go with them. If this is the case a family member may wish to talk to the GP afterwards. When a carer or relative contacts a GP with concerns about a person, the GP may decline discussion on the ground of breaking patient confidentiality.

The General Medical Council (GMC) has issued guidance on this matter (confidentiality 2009) The guidance states that doctors should listen to the concerns of carers, relatives, friends or neighbours because they may have valuable information that can help the patient. The GP should make it clear they may tell the patient about the conversation.

Respecting Cultural Values

Some patients might have cultural or religious background. If so it is important if these are identified that everyone at the Practice acts accordingly. These may include:

  • Religious observances, such as prayer and festivals
  • Touch or gestures that are considered disrespectful
  • Ways of undressing
  • Ways of dressing the hair
  • How the patient washes or uses the toilet

The person with dementia might not be able to explain about their culture so it is important that the carer informs the Receptionist or the Doctor before the appointment.

Training for Receptionists

It is important that your Receptionists are not only aware of patient needs but the needs of carers too.

By understanding any illness or disability it can often help when dealing with patients and their carers over the phone or at the front desk.

There are lots of organisations dealing with dementia that would be more than willing to come and talk to your receptionists and give them some insight into the life of someone suffering with dementia and that of the carer too.

Here are so do’s and don’ts of communication that might be useful for Receptionists.

Do

 

Don’t

Talk to the person in a tone of voice that conveys respect and dignity.

Talk to the person in “baby talk” or as if you were talking to a child.

Smile – this will help relax the person.

Don’t argue – the demented brain tells the person they can’t be wrong

Maintain eye contact by positioning yourself at the person’s eye level. Look directly at the person and ensure you speak clearly.

Glare at the person you are talking to. Always use good body language.

Use visual cues whenever possible.

Begin a task without explaining who you are or what you area about to do.

Be realistic in expectations.

Talk to the person without eye contact, such as while typing on the computer.

Observe and attempt to interpret the person’s non verbal communication.

Try and compete with a distracting environment; Loud noises, other people talking at the same time.

Use positive body language and a reassuring tone of voice.

Provoke a reaction through unrealistic expectations or by asking the person to do more than one task at a time.

Speak slowly and clearly

Disregard talk that may seem to be “rambling”

Encourage talk about things that they are familiar with

Shout or talk too fast.

Be kind – treat them, as you would want your family to be treated.

Interrupt unless it cannot be helped.

Keep your explanations short. Use clear and flexible language.

Invade their personal space if they are showing signs of fear or aggression.

 

Invade their personal space if they are showing signs of fear or aggression.

 

Use complicated words or phrases and long sentences.

Carers

Does your practice have a Carers Group? Such groups have proved to work extremely well in many surgeries.

I formed a Carers Group at my Surgery and the group would meet every 3 months, at lunchtime. Carers that were caring for people with all disabilities would come along for 2 hours to sit and chat. We would have different organisations attending the meetings on subjects that would help the carers in many different ways. We would have someone in from Social Services to talk about their entitlements. Someone in from Help and Care would come and help out, the local Fire Officer would come in and talk about safety in the home, and we would often have local businesses coming in to show support in many different ways.

But the most important part of these Carers Meetings were that the Carers had someone to talk to, people who understood what they were going through. Friendships were formed and often problems halved.

And finally……….

Each person with dementia is an individual with their own experiences of life, their own needs and feelings, their own likes and dislikes.

Dementia affects each person in a different way.

We all needs to feel valued and respected and it is important for a person with dementia to feel that they are still valued.

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Managers Training: The Other Side of the Desk


When managing staff it is always good to give them feedback. Yearly appraisals are a good opportunity for this but why leave it once a year?

Here is a little exercise I used to carry out on my Reception staff.

Sit in your Reception area at the busiest time of day. Observe what is happening in your Reception area – see how the receptionist deal with patients how they cope with the busiest time of day and how they copes with the pressure that the busy time can bring.

Put yourself in the place of a patient – see it from their eyes and ask yourself how do they see our Surgery?

Have a note-book with you and take notes – but the most important part of the exercise is not only to pick up on any negative issues but also highlight the positive issues too.

What should you be looking for:

  1.  Is patient confidentiality being broken? Can people in the waiting room hear conversations from the Reception Desk? Patient confidentiality it vital in any Practice – and more so at the front desk.
    People in the waiting room can often hear conversations at the front desk. Make
    sure you staff use as little personal information as possible. Make sure that
    all your staff has the appropriate training on Patient Confidentiality. (see
    blog on A Quick Confidentiality Checklist. http://t.co/S3E94mU8)
  2.  How does the Receptionist interact with the patients? Do they have good eye contact? Are they polite and always helpful? It is easy to be short with patients when you have a queue of people at the front desk. Training in dealing with such times is vital – train your staff in dealing with such times –
    how to move patients on quickly without being rude or appearing that they are
    not caring. A smile and a thank you go a long way.
  3. How does the Receptionist answer the phone? Is it answered quickly enough? Does the Receptionist deal with the call efficiently? Always make sure that your staff answers the phone with good morning/good afternoon – the name of the surgery and their own name. Staff than give their name takes ownership of the call more than those that do not give their name. Again, if they are in ear shot of the waiting room it is important that they remember Patient Confidentiality.
  4. What are the other staff doing whilst the busy time is happening – are they helping out?  Often in Surgeries you have Receptionists at the front desk and others doing other things such as admin, typing, prescriptions – have you got a contingency plan for such busy times – if someone is busy on the front desk or on the phone do you have someone who can come and help out for short periods of time.
  5. Can you hear conversations between Receptionists behind the desk? When the quieter times come Receptionists often will have a little chat – but they should be made aware to be careful on what they are chatting about – I had an incident where 3 Receptionists were discussing a TV programme that was on the night before. They were discussing the programme about Breast Cancer and about a lady having terminal Cancer – they talked in-depth about the programme – talking about people who had lost relative/friends to the horrible illness. What there were not aware of was a patient was sitting listening to them in the waiting room that had just recently been diagnosed with Breast Cancer – she found the conversation very upsetting. Whilst I was doing
    this exercise I also heard Receptionists discussing an issue that could have
    upset a patient in the waiting room.
  6. Is the Reception area being kept clean and tidy? It is important to
    keep your reception area clean and tidy. Not just for a good impression but for
    Health and Safety reasons too – magazines, children’s toys left lying around on
    the floor is dangerous – someone could easily slip and fall.
  7. Are the patients kept waiting for long periods of time (often a problem in surgeries) This unfortunately happens in every surgery. Observe how your patients feel about it – and how your Receptionists deal with the patients if they come back to the desk to complain/enquire about their appointment running late. Do you have a policy on Doctors/Nurses running late?Do you have a surgery policy about Doctors/Nurses running late?

After you have done your observation bring them to your next staff meeting.

I always find the best way to approach this is to tell your staff that it was not an exercise to “catch them out” but an exercise to find if and where improvements can be made.

Always start with the positive notes you have:

  •  How well you thought the receptionist dealt with a certain patient/incident.
  • How good their telephone manner is.
  • How lovely and tidy the reception areas looks.
  • How pleased you were to see others helping each other at the
    busiest time.
  • How good they are with dealing with confidentiality.

Then

If there are any (and I am sure there will be) go onto the negative things that you found – discuss them and ask your team to give their opinion. Ask if there is a better way it can be dealt with. Include them in any decision-making. Include them in your findings.

Staff do not like change so I always used to say – we can change it, try it and if it does not work we can look at it again.  This always used to work.

Make minutes of the meeting – ensure that you record any changes that are going to be made and ensure that everyone has a copy – including those that were unable to attend the meeting.

Turn those negative into positives.

The Importance of Receptionists Training


imagesCAFXOIRQLast week I held a training course for new Receptionists.

I am very passionate about staff training. As a previous manager I felt that I owed it to staff to give them the appropriate training when starting as a new receptionist, secretary or administrator and to also provide longer service members of staff with more advanced training.

After all you would not hire a mechanic or a chief if they had not had the appropriate training – so why should a Receptionist be any different, after all they are the ambassadors of your surgery and therefore you want them to get it right.

It never ceases to amaze how new Receptionists (and fairly often a longer servicing member of staff) know so little about their role – especially the little things that could make their role so much better, and in turn run a more efficient Reception area and how it could be better for your surgery and therefore giving first class Customer Care to your patients and customers.

It always gives me enormous pleasure to be able to share with the group my experiences; how I gained my knowledge I was sharing with them and tips on how to make their role so much more. How they can become a Receptionist that any Practice would be proud of to have on their team.

What do I base my training on? Simply from experience – I too once sat in their seat, not knowing some of the things that I am now sharing with them. I embraced my role back then with enthusiasm and was hungry to learn more. By doing this I was always first to volunteer to go on another training course, taking on my NVQ and achieving so much more. This all came about from enjoying the courses, learning from the courses wanting to learn even more and putting all of these things into practice. I am forever grateful that my practice believed in me. I hope to pass on that enthusiasm  that on to others.

From a receptionists I worked my way up to a surgery supervisor, and then on to a Manager with another practice. Every single step on that ladder was built on the knowledge that I had learnt the qualifications that I got and the experience that I had gained. You too might have a Receptionist that has that hunger to learn and climb the ladder – can you think of one at your practice? Or are they there but not had the right training for them or you to see the potential they might have.

You might ask yourself why you should give them training. There will be costs involved. Staff will be away their posts to attend courses and perhaps extra costs to cover their hours while they are away.

Investing in staff training is vital. If you cannot afford to send all of your staff on training course why not bring the trainer into your surgery – or better still train one person up in your surgery to then train the others.

What are the benefits of staff training?

  • Staff will value you as an employer by supporting them in this way.
  • Staff will have more confidence in dealing with issues that might arise at Reception.
  • Their job will have more meaning; it will be more rewarding and satisfying.
  • Their job will become more interesting – the more they learn the more they understand
  • They will be valued by your patients and customers as they will be able to offer a first class service.
  • They will enjoy testing and improving on their skills – and hopefully want to learn more.

What are the training needs of Reception Staff?

  • Receptionist Training (aimed at new Receptionists)
  • Patient Confidentiality
  • Telephone Techniques
  • Dealing with difficult patients
  • Basic Health and Safety
  • Disability Awareness
  • Team Leader training (ideal for those that are being promoted within)

 

Invest in your staff – well trained staff are confident staff

Receptionist Training: Young Patients and Confidentiality


  •  HOW CAN WE HELP YOUNG PATIENTS

 It is important that a young patient feels confident to be able to
speak to a Health Care Professional in confidence.

 

Young patients also have the right to confidentiality! Often it is difficult when a young patient around the age of 15 years comes into the surgery alone. They often don’t want their parents to know that they have been to the Surgery. Often it is of a personal nature. So what happens when the Surgery need to get in touch with the young patient:

Do not phone the patient on their home phone (if possible)

This often leads to questions by parents as to why the surgery is phoning – especially if the patient has not told their parents they have been to the surgery.

Never leave a message on the home answer phone

Again, this will lead to questions by parents.

Use Mobile Telephones wherever possible.

It might be a policy of your Practice not to use mobile telephone numbers. But in the case of a young patient it is advisable to use a mobile number if you have one. This is one safe way of being able to speak direct to the patient – in confidence.

When is a good time to phone?

Ask the Young patient when would be the best time to phone. You don’t want to call when they might be in school or perhaps at home.

If a young patient comes in alone for an appointment

If a young patient wants to make an appointment and wants to be seen on their own please check with you Doctor/Supervisor/Practice Manager that they can be seen on their own. Your Practice should have guidelines on young patients.

At the time of the appointment check if they have a mobile telephone number – this will allow you direct access to the patient if you or a healthcare professional should need to contact them.

If Tests are being carried out

Make an appointment for them to receive the results. Normally we ask
patients to telephone for results – giving a young patient results can often lead to confusion and the correct procedures not taken. An appointment can give the Doctor/Nurse a chance to make sure they understand. It is amazing how many young patient do not understand medical terminology – I have had young patients believe that a “positive” pregnancy test means that they are NOT pregnant. Positive meaning it is good that they are not pregnant.  Do not assume that they understand – always clarify that they understand – explain exactly what the results mean. If as a Receptionist you are giving out a pregnancy result to a young patient and the test is “positive” follow-up by saying:

“Your pregnancy test is positive – that means you are pregnant – would you like me to make an appointment for you to see the Doctor”?    or

“Your pregnancy test is negative – this means that you are not pregnant”

When a Young Patient wants to book an appointment.

There are several things take into consideration when a young patient comes into the surgery to book an appointment:

  •  The young patient may not want their parents knowing that they are going to see the doctor.
  • Young patients are often nervous about seeing the Doctor.
  •  It might have taken a lot of guts for them to come in to book the appointment – maybe it might be of a sensitive nature – something that has taken them time to come in about. So don’t scare them off before they have a chance to see the Doctor/Nurse.
  •  Always try to fit them in when it is convenient with them – if they don’t want their parents knowing it won’t help giving them a tea time appointment – parents might ask questions to where they have been.
  •  Offer an appointment straight from school – or perhaps in their lunch break. Ask the young patient when it would be best for them to come to the surgery.
  • If you feel that the young patient is nervous see if you can fit them in there and then (if you have a surgery going on) – often they will book an appointment and not attend – their nerves get the better of them and they do not come back.
  •  If it is a male young patient try to book them in with a male doctor and a female doctor with a female patient. This will help if the appointment is of a sensitive nature.
  •  If the young patient comes to the desk with a friend – you can always mention that the young patient is welcome to bring their friend in with them to see the Doctor. They sometimes appreciate the support from a friend.

And most important – Young patient have the right to confidentiality – if they are old enough to come on their own then they should have the respect of confidentiality like any other patient. Sometimes Parents get to know that the young patient has been to the see the Doctor and will phone the surgery to ask what they have been in for – you do not have any right to give out any information. So be very careful. If young patients wanted their parents to know they were seeing the Doctor they would have told them.

Make sure you have the correct training in a situation where a parent calls the Surgery and asks why their child has been seen in the surgery. It may happen so be prepared.

Patient Confidentiality – When Someone Claims To Be The Patient


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We have all been shocked by the sad news of the nurse Jacintha Saldanha in London who sadly took her life after a hoax call.

Many Receptionists and Nurses have no doubt thought of the sad incident and run through their mind how they would have dealt with such a call. I know I have.

We all know the importance of patient confidentiality – it is vital that patient information is protected and only shared with those on a need to know basis.

But, many of you reading this will think back to an incident whereby it has been difficult to deal with such a call – but it is how you deal with it that is the most important – and more importantly is how you have the knowledge and ability to deal with such calls. This comes with experience, training and support from the organisation that you work with.

Did Jacintha have that support and training? I am not here to judge or comment on the incident but I can share with you how as a receptionist a call that I dealt with. When I become a manager I took this experience on with me and used it in the training of all new receptionists.

The story I am about to tell is similar in as much as the caller was pretending to be someone they were not and trying to obtain patient information from the surgery.

True Story:

One morning I was on took a call. The caller asked if her daughters’ pregnancy results had come back. I explained that due to patient confidentiality I was unable to give her the results as she was not the patient.  She was not very happy about this – she insisted that her daughter had asked her to call; she explained that her daughter was in college and couldn’t phone.

I suggested to the caller that she ask her daughter to call in her lunch break – or perhaps when she finished college as we were open until 7.00 pm. She was having none of it – she had every excuse to why her daughter couldnt phone the surgery herself. She then started getting aggressive  – I again said that I was unable to give her any information regarding her daughter.

She gave some more abuse and hung up.

Five minutes later I answered the telephone again – the same woman this time claiming she WAS the patient. (I suspect she thought she would have got another receptionist answering the phone the second time but she got me again)

I asked this caller if in fact it was the same person that I had spoken to only five minutes ago – she denied that she had phoned before  and insisted she was the patient and asked for her results again. 

So…………….as a receptionist what would you have done in this situation?

I had to think quickly – this caller was claiming she was the patient – I had my doubts that she was the patient.  Had another receptionist have taken the call she would have presumed that she was the patient and may have given out the results.

So I asked the caller her DOB which she was able to tell me (after all if I was correct she was the mother of the patient)

I asked the caller to confirm when she had brought the test in – this time she couldn’t answer my question – she tried to say that she wasn’t too sure but thought it was about 3/4 days previous. (Checking the patients’ records she in fact had brought the test in 2 days previous)

I kept the call going in a professional way and said I could not find a record of the results (although they were there in front of me) and asked if I could have her mobile telephone number and I would call her back once I had called the hospital for the results.

Guess what – she couldn’t give me “her” number. While we all usually know our own mobile telephone numbers we don’t usually know others off the top of our heads.

The caller again started to get aggressive and insisted that she would phone me back when I had spoken to the hospital. At this point I agreed that she would call me back in 20 minutes and gave her my name. I doubted that she was going to do this.

She never did call back.

I put an entry into the receptionists’ message book of the incident to warn them in case this woman called back again.

So, what if something similar were to happen a few questions that you could ask are:

  • Confirm date of birth
  • When did the patient last come into the surgery?
  • What Doctor/Nurse did they see?
  • What time was their appointment?
  • Tell them you will call them back – if they are not the patient they usually are unable to give you their number off the top of their head.

If you are speaking to the patient I am sure they would only be too pleased that you are taking patient confidentiality seriously and will not mind answering any of your questions.

And most important if you are in ANY doubts do not give out any information – ask the caller their telephone number and tell them you will get back to them. When you finish the call speak to your team leader or manager and seek advice.

As a manager I would always tell my team as long as they took every possible step towards maintaining patient confidentiality and in the event that patient confidentiality was broken I would support them 100%.

Patients Letters for Collection


As a Receptionist/Supervisor how would you deal with the scenario below:

A patient consulted her GP requesting a referral to a gynaecologist for a termination.  She stated in the consultation that she did not want her husband to find out. The GP wrote a referral letter, which was placed in the “for collection” box in reception. For some reason the letter was not collected.

The patient then visited the surgery 3 months later to ask for a letter for the clerk at the Magistrates court, explaining that she could not attend court due to a medical reason. The GP had the letter typed and this was also placed in the box for collection.

The patient’s husband came into the surgery 3 days later to collect the letter to take to the Magistrates court but the wrong letter was given to him. The letter he was given was the one typed 3 months previously for the Gynaecologist.

The husband took the letter to the Magistrates Court. When the Court clerk opened the letter and found it was not for them she handed the open letter back to the husband who then read the letter.

There are several issues here – can you identify what could have happened and what action could have been taken to ensure that it does not happen again.

  • All personal letters should be placed in a sealed envelope.
  • Each envelope should be dated on the back of the envelope and the “collection box” should be checked on a monthly basis.
  • Any letters that are over 4 weeks old should be opened and checked.
  1. Inform their GP that the letter has not been collected so they can follow this up. The GP might need to call the patient and ask if they still need the letter, and according to their reply the necessary action taken.
  2. If your practice asks you to follow the letter up ensure that you record the event. Enter on the patient’s records (or in a separate message log) that you have spoken to the patient about the letter and their response and the action that you have taken. Also remember to date and time the call.
  3. If the letter is not longer required remove the letter from the “collection box” and ensure that you have guidelines on what to do with it. Shred it, or other.
  4. If the letter is required and the patient is going to collect it cross off the first date and add the date you spoke to the patient on the back of the letter to avoid the same process happening again.
  • If you go to the “collection box” and identify two letters there look at the dates on the back of the envelopes, check the patient’s records and see which date corresponds with the envelope. If you are unsure open and check the letter and place it in a new envelope. remembering to add the dates on the back again.
  • In today’s society Patient Confidentiality is vital – we should be asking if we should have actually given such a letter over to her husband. But it was the patients choice to have her husband come in and collect the letter for the Court.
  •  Having it in a sealed envelope is definitely more secure than just handing over the letter without an envelope. So please ensure that all confidential letters are in sealed envelopes.
  • 99% of the time it would be safe to hand over such a letter  – but there is always that 1% that could backfire. But with everyone living such a busy life we always rely on family/friends helping out at such times. If you are in any doubt speak to your Supervisor/Manager or even phone the patient and ask if they are happy for you to give the letter to the person at the desk.
  • The 1% of this backfiring could be that when her husband read the letter which was meant for the Gynaecologist it could have caused a big problem, especially as she had already said she did not want her husband knowing about the termination. This could have led to the surgery being sued for breach of confidentiality.
  • Always think of the 1% and cover yourself as much as you can.

Does your practice have a policy on the collection of letters?