Welcome to Care UK. Dr Ehsan Ahmadi Education and Training 2015

Transcription

1 Welcome to Care UK Dr Ehsan Ahmadi Education and Training 2015

2 Setting today s agenda Introduction OOH sessions, Triage, HV, PCC, NQRs, Record keeping questions from MyCareUK website ADASTRA Training A brief group introduction Hands-on with the training modules Rotamaster to instruct on bookings Admin Team to instruct on Trainee paperwork Closure - Question/Answer session

3 Workshops Tina to instruct on bookings Admin team to instruct on Trainee paperwork Clinical Lead on Adastra training

4 There are Six Key Competences for OOH Care 1. Ability to manage common medical, surgical and psychiatric emergencies in the out-of-hours setting. 2. Understanding of the organisational aspects of NHS out of hours care. 3. Ability to make appropriate referrals to hospitals and other professionals in the out-of-hours setting. 4. Demonstration of communication skills required for out-of-hours care. 5. Individual personal time and stress management. 6. Maintenance of personal security and awareness and management of the security risks to others

5 Sessions in Out of Hours 36 hours for 6 month GP attachment, on average one 6 hours shift/session per month. Sessions are graded as suggested by the COGPED paper: Direct supervision (red) - Sessions 2 &3 Supervised directly by the clinical supervisor and takes no clinical responsibility Close Supervision (amber) - Sessions 4 to 10 Consults independently but with the clinical supervisor close at hand Remote supervision (green) - Sessions 11 to 18 consults independently and remotely from the clinical supervisor who is available by telephone Pag

6 Sessions in Out of Hours Base/Triage 4-5 hours, primarily Base patients, but if quiet then triage. Mobile/Base 4-6 hours, primarily visiting, but if quiet then base or triage. GP Triage 4-5 hours mainly triage, but if needed for other resources, may be asked to see base patients or visit. Do not book sessions and then cancel them. This will be noted.

7 The Patient Journey Patient telephones the surgery Phone should be diverted to NHS 111 Patient speaks to a clinical advisor, who is non-clinical Clinical advisor records demographic details and entered the information to the specific clinical complaint pathway.

8 Patient Pathway

9 Patient pathway 111 dispositions include: Speak to GP previously called triage Contact GP face-to-face contact in either a primary care centre (PCC) or home visit Contact other healthcare professional seeing another professional e.g. a district nurse, pharmacist etc. Home management advice Calls are recorded for medico-legal safety

10 Speak to GP shifts / Triage The call centre for the service is based in Ipswich Provides the hub of the service Clinical triage (Speak to Doctor) Base for the local management team Training and meeting facilities Call centre designed to allow us to scale the service as required Each desk equipped for call handlers and triage clinicians

11 Telephone Advice & Triage Management Telephone Advice & Triage Management Child with fever: If no redflag symptoms-advice, but otherwise can be seen at PCC PV Bleed in early pregnancy: Refer to local EPAC/EPU by calling on call Gynae Pathology results! E.g. K+=6 with no tel no: Phone Lab, find out previous results, clinical indication. Use BT. Com to track phone no. if all else fails organise visit. Elderly Person vomiting: Get them seen,?mi Elderly Person with back pain: Get them seen?pleurisy/lrti

12 Telephone Advice & Triage Management Telephone Advice & Triage Management Methadone patient who has run out of methadone: See local policy, advise we do not get involved. DO NOT send to A&E. Nursing Home reports patient is attacking staff: Get patient assessed?refer to on call Social Worker. Patient who fell down stairs, can t get up/head bleeding: This is a typical A&E case (we don t carry bandages/stitches). 60 year old man chest pain, sweating: Get him an ambulance Suicidal patient: Get them assessed by GP if safe and then get crisis team

13 PCC- Primary Care Clinic The room is fully equipped including medicine cassettes. We do not carry speculums, sonic aids, ECG machines. Patients given an appointment slot and are usually seen quickly. 15 minute appointments.

14 Suffolk Primary Care Centres operating information Suffolk Central Weekdays Saturday Sunday Bank Holidays Eye HartismereHospital, 26 Castleton Way, IP23 7BH Tel: Fax: :30-08:00 08:00-08:00 08:00-08:00 08:00-08:00 From B1077 Victoria Hill/LambsethStreet, please turn into Castleton Way. HartismereHospital will be visible from Castleton Way. Please head to the Main Reception and the OOH receptionist will be located on the right side. OOH signs are visible. Stowmarket Violet Hill House, Violet Hill Road, IP14 1NL Tel: Fax: :00-23:00 08:00-23:00 08:00-23:00 08:00-23:00 From A1308 Bury Road turn into Violet Hill Road. Violet Hill House will be visible from Violet Hill Road. Please head to the Main Reception Entrance. OOH Signs are visible Sudbury Walnut Tree Hospital, Walnut Tree Lane, Sudbury, CO10 1BE Tel: Fax: :30-00:00 08:00-00:00 08:00-00:00 08:00-00:00 From A131 Gregory Street, turn into Walnut Tree Lane. Walnut Tree Hospital is visible from Walnut Tree Lane. Please head to the Outpatients 1, through the right door and the OOH reception is located on the left. OOH Signs are visible.

15 Suffolk Primary Care Centres operating information Suffolk North Weekdays Saturday Sunday Bank Holidays Bury St Edmunds Tel: :30-08:00 08:00-08:00 08:00-08:00 08:00-08:00 West Suffolk Hospital, Hardwicke Lane, Bury St Edmunds, IP33 2QZ Fax: From A1302 CullumRoad turn into Hardwicke Lane OR from A143 HorringerRoad turn into Vinery Road and continue down onto Hardwicke Lane. West Suffolk Hospital will be visible off Hardwicke Lane. Head to A+E Reception and take the door on the left hand side. Continue down andooh Receptionist will be there to greet. OOH signs are visible Haverhill Tel: :00-23:00 20:00-23:00 20:00-23:00 20:00-23:00 Haverhill Health Clinic, Camps Road, Haverhill, CB9 8HF Fax: From A1017 Lord's Croft Lane, please turn into Swan Lane and continue down onto Camps Road. Haverhill Health Clinic will be visible from Camps Road. OOH Entrance is on the left side of the surgery. Head to the Main Reception. OOH Signs are visible. Milldenhall Tel: :00-22:00 09:00-22:00 09:00-22:00 09:00-22:00 Milldenhall Health Centre, Chestunut Close, Mildenhall, IP28 7NL Fax: From A1101 Kingsway, turn into College Heath Road and take the first right. MildenhallHealth Centre will be visible. Please had to the Main Reception upon arrival. OOH Signs are visible.

16 Suffolk Primary Care Centres operating information Suffolk South Weekdays Saturday Sunday Bank Holidays Ipswich 18:30-08:30 08:00-08:30 08:00-08:30 08:00-08:30 Ipswich Hospital, Entrance 5- Rheumatology, Heath Road, Ipswich, IP4 5PD Reception Fax Follow signs to Ipswich Hospital A&E. On arrival, please head to Entrance 5- Rheumatology SAXMUNDHAM Lambsdale Meadow Saxmundham Ipswich IP17 1AS (Interim number) Fax 18:30-23:00 08:00-23:00 08:00-23:00 08:00-23:00

17 Home Visit Visits are reserved for the Elderly, Infirm, Disabled, Terminal Care e.g. Nursing Homes, Residential Homes, Prisons, Special Needs Institutions. Nursing Home Patient with breathing difficulty. Housebound elderly patient vomiting. M/S patient with recurrent UTI. Cancer patient requiring analgesia/antiemtic. Psychiatric patient who is suicidal. Special Needs patients who become aggressive. Confirming Death.

18 Home Visit - Equipment Doctors Bag. Drug cases (not CDs). Nebuliser. Referral Paperwork, No reply Paperwork. Defib/AED

19 Drug Cassettes Drug Cassette containing tablets and syrups Injection Cassette including palliative meds No CDs Ensure you are aware of what we carry and how to use them E.g. IM anti-emetics Complete paperwork correctly Care UK_EMERGENCY_CASE.xls Suffolk_Areas_Case_A_B_VC_I_Oct10.xls

20 National Quality Standards for OOH 1. Providers must report regularly to CCG s on their compliance with KPI s 2 Providers must send details of all OOH consultations to the practice where the patient is registered by 8.00 a.m. the next working day. 3 4 Providers must have systems in place to support and encourage the regular exchange of up-to-date and comprehensive information for patients with predefined needs (including, for example, patients with terminal illness or special patient notes). Providers must regularly audit a random sample of patient contacts 5 Providers must regularly audit a random sample of patients experiences of the service (for example 1% per quarter) 6 Providers must operate a complaints procedure that is consistent with the principles of the NHS complaints procedure. 7 Providers must demonstrate their ability to match their capacity to meet predictable fluctuations in demand for their contracted service, especially at periods of peak demand, such as a Bank Holiday weekend.

21 National Quality Requirements KPI s 9a 9b 9c 9d Urgent cases advised within 20 minutes Urgent cases advised with 60 minutes Routine cases advised within Routine cases advised within 6hours 11 GP cons available at all times & all places 12b Contact GP bases visit urgent cases completed within 2 hours 12b.2 Contact GP bases visit routine cases completed within 6 hours 12b.3 Contact GP bases visit - Routine cases completed within 12 hours 12b.4 Contact GP bases visit - Routine cases completed within 24 hours 12v Contact GP home visit urgent cases completed within 2 hours 12v.2 Contact GP home visit routine cases completed within 6 hours 12v.3 Contact GP home visit - Routine cases completed within 12 hours 12v.4 Contact GP home visit - Routine cases completed within 24 hours 13 Patients unable to communicate effectively in English will be provided with an interpretation service within 15 minutes of initial contact. Providers must also make appropriate provision for patients with impaired hearing or impaired sight.

22 NQR National Quality Requirements Sum of % Column Labe NQR09 NQR12 Base NQR12v Urgent Urgent Routine Routine Urgent Routine Routine Routine Urgent cases cases cases cases Cases cases cases cases Cases advised advised advised advised completed completed completed completed completed within 20 within 60 within 2 within 6 within 2 within 6 within 12 within 24 within 2 minutes minutes Hours Hours Hours Hours Hours Hours Hours Routine cases completed within 6 Hours Routine cases completed within 12 Hours Routine cases completed within 24 Hours Date 01/01/ % % % % 97.14% % % % 97.50% % % % 02/01/ % 90.91% % % % % % % 83.33% % % 03/01/ % % 90.48% % 93.33% % % % 90.00% 87.50% % 04/01/ % 90.14% 93.85% % 95.58% % % % 82.14% 93.02% % % 05/01/ % 98.85% 95.83% % 92.65% % % % 95.35% 97.78% % % 06/01/ % % % % % % % % % % % 07/01/ % % % % % % % % % % % 08/01/ % 92.86% % % % % % % % % 09/01/ % % % % % % % % % % 10/01/ % 73.91% 94.12% % % % % % 83.33% 72.73% 11/01/ % % % % 97.50% 98.64% % % 95.92% 93.18% % % 12/01/ % 98.68% % % 96.77% % % % % % % % 13/01/ % % % % % % % % % % 14/01/ % % % % % % % % % % % 15/01/ % 96.55% % % % % % % % % 16/01/ % % % % 90.91% % % % 90.00% % 17/01/ % 89.47% 87.50% % % % % % 90.91% % % 18/01/ % 96.92% 91.43% % 92.19% 99.38% % % 96.30% % % % 19/01/ % % 94.29% % 90.41% % % % 94.74% % % % 20/01/ % % % % 95.83% % % % 50.00% % 21/01/ % % % % % % % % 66.67% % % % 22/01/ % 92.31% % % 91.67% % % % 70.00% % % 23/01/ % % % % 92.31% % % % 61.54% % % 24/01/ % % % % 89.29% % % % % % % 25/01/ % 80.72% 90.70% % 97.50% % % % 93.44% % % % 26/01/ % % % % 95.00% % % % 82.22% 97.44% % % 27/01/ % % % % % % % % % % 28/01/ % % % % % % % % % % % 29/01/ % 96.00% % % % % % % % % % 30/01/ % 95.83% 83.33% % % % % % % % % 31/01/ % % % % % % % % % 92.86% % %

23 NQRs: Routine Vs Urgent

24 Record-Keeping and Medical Notation To ensure patients are treated efficiently and effectively by clinical teams As an indispensable element in responding to complaints Ensures high quality care for individual patients (ie via audit) Notes must be: Clear Objective Contemporary First-hand Original Do not use any abbreviations Patients, relatives or legal representatives may read your notes

25 Record-Keeping and Medical Notation Content of Medical Records - Notes should include: History relevant to the condition including answers to direct questions and important negatives Examination of the patient any important findings, both positive and negative, and details of objective measurements such as pulse, blood pressure, respiratory rate, temperature, capillary refill time and peak flow as relevant Diagnosis in clear, readily understood terms. It should be clear from your notes how you arrived at this conclusion. Include any uncertainties about diagnosis, and steps taken to rule these out. Detail any further investigations or referral arranged

26 Record-Keeping and Medical Notation Information what you have told the patient, including details of the risks and benefits of particular treatments where relevant Consent details of any consent the patient has given e.g. for specific examination, including whether a chaperone was offered and accepted and the name of the chaperone Treatment detail the type and dosage of drugs, the total amount prescribed and any further treatment organised Follow up include the arrangements for follow up and safety netting advice given, being as specific as possible and not relying simply on a function key entry for GP follow up when using electronic record Recommended Reading: MPS: Guide to Medical Records and RCGP OOH audit toolkit.

27 Care UK Policies All available online on at MyCareUK website Here are some of the most frequently used: Prescription Policy: OOH Formulary, FPS, 7days, no substances of misuse, coding, avoid faxing. Methadone e.g. this is not prescribed. Prescribing over the Telephone e.g. this is not allowed. No Reply Policy. CD policy: how to access. Palliative Care: Drugs held, Pink forms, Local prescribing guidance. Microbiology Samples: how to send them off. Local Antibiotic Guide. How to deal with abnormal blood results. Urinary Catheters: When to intervene. Prison patients: How to manage them. Public Health: Who to contact. EPU/PVB pregnancy: Strict plan (Updated). Confirmation of Death: Unexpected vs Expected.

28 Your local Team

29 Contacts Details Dr Ehsan Ahmadi Clinical Lead, Care UK Suffolk Dr Chris Browning Clinical Lead, Care UK Suffolk Emma Doughty Service Manager Theresa Kelly Nurse Lead Zoe Pursglove GP Relationship manager, point of contact for GPs and GP registrars Sally White Rota Manager addresses: Telephone:

30 Operational Staff Useful Numbers Co-ordinator Line: Operational Fax: Administration: (office hours only) Rota Team: / 2213 (office hours only)

31 Questions Question?