POLICY and guidelines
Post holder responsible for Policy: / Diversity Lead for Patient Care, DEAG Chair
Directorate/Department responsible for Policy: / PGLS
Contact details: /
01392 406571
Date written: / July 2010
Date revised:
Approval route (names of committees): / DEAG, IPSG
Level of Impact Assessment
(Screening or Full – attach to policy)
Date of final approval:
Date due for revision:
Date policy becomes live:
This document replaces: / N/A
Controlled document
This document has been created following the Royal Devon and Exeter NHS Foundation Trust Policies, Procedures, Protocols, Guidelines and Standards Policy.
It should not be altered in any way without the express permission of the
author or their representative.
Please specify standard/criterion numbers and tick other boxes
as appropriate / The Strategic Directions 2007-2012 were agreed by the Board of Directors in October 2007 to support the Trust’s vision “Respond, Deliver, Enable”. The Key Milestones below will ensure there is a shared understanding about what needs to be delivered.
Monitoring Information / Strategic Directions – Key Milestones
Patient Experience / / Waiting
Assurance Framework / Privacy and Dignity
Monitor/Finance/Performance / Efficiency and Effectiveness
Care Quality Commission
Outcomes: / Outcomes 1, 4, 5, / Delivery of Care Closer to Home
Infection Control
NHSLA Risk Management Standards for Acute Trusts
NHSLA CNST Maternity Clinical Risk Management Standards:
Other (please specify):
Note: This policy has been assessed for any equality, diversity or human rights implications
Care of Patients with Specific Requirement Policy and Guidelines
Approved by DEAG: date
Approved by IPSG: date
Review date: <next review datePage 1 of 6
CONTENTS
Section / Page1 / Introduction / 3
2 / Legal and Regulatory Framework / 3
3 / Policy Statement / 3
4 / Definitions / 3
5 / Procedures / 4, 5, 6
5.1 / Specific Requirement Assessment Form
5.2 / Flagging of Patient Records (Health Records and PAS) and Bedside Drip
5.3 / Theatre Scheduling
5.4 / Access Support Card
5.5 / Emergency Admissions
6 / Process for monitoring compliance with and effectiveness of the Policy / 6
7 / Useful Contacts / 6
8 / Associated Trust Policies / 7
Appendices
Appendix 1 / Specific Requirement Assessment Form
Appendix 2 / Specific Requirement Consent Guidelines
Appendix 3 / Specific Requirement Consent Form
Appendix 4 / Access Support Card Application Form
Appendix 5 / Rapid Impact Assessment Screening Form
Care of Patients with Specific Requirement Policy and Guidelines
Approved by DEAG: date
Approved by IPSG: date
Review date: <next review datePage 1 of 6
1.INTRODUCTION
This document introduces the Royal Devon and Exeter NHS Foundation Trust’s (hereafter referred to as ‘the Trust’) approach to addressing the needs of patients with specific requirements (defined below). It includes a policy statement on the importance of recognising and addressing these patients’ individual needs and guidelines for staff on the implementation of the systems developed in the Trust to support them.
2.THE LEGAL AND REGULATORY FRAMEWORK
[Equality Act 2010 – as of 1st October]The Disability Discrimination Act (DDA),1995 (revised 2005) outlines the legal requirements for service providers in the way in which services are delivered to users with disabilities. It is unlawful for service providers to treat service users less favourably because of a disability, and they must make ‘reasonable adjustments’, such as giving disabled service users extra help, or changing the way services are provided.
The Care Quality Commission’s (CQC) Regulatory Framework must be complied with by all registered health and adult social care providers in England and Wales. This framework includes a focus on recognising and respecting the diversity, values and human rights of all people who use services by assessing their needs and making reasonable adjustments to ensure service delivery takes these needs into account.
Care of Patients with Specific Requirement Policy and Guidelines
Approved by DEAG: date
Approved by IPSG: date
Review date: <next review datePage 1 of 6
3.POLICY STATEMENT
The Disability Equality Action Group (DEAG) has been commissioned by the Involving People Steering Group in order to work in a positive and proactive way with people with specific requirementsto improve services and to fulfil the Trust’s obligations under the DDA and CQC regulations (outlined above). This includesdeveloping admission and assessment processes for patients who have specific requirements and also providing training and highlighting issues with staff.
4.DEFINiTIONS
Under the DDA [Equality Act] a person is defined as having a disability if, “he has a physical or mental impairment which has a substantial and long-term adverse effect on his ability to carry out normal day-to-day activities”. The Trust has interpreted this definition as patients with “Specific Requirements”, and these include: learning disabilities, visual impairments, hearing impairments, physical impairments, acquired brain injuries, and other cognitive impairments. This has also been extended to include other factors that affect the quality of care for patients, for example, assistance with eating and drinking and nil by mouth.
Care of Patients with Specific Requirement Policy and Guidelines
Approved by DEAG: date
Approved by IPSG: date
Review date: <next review datePage 1 of 6
5. PROCEDURES
5.1Specific Requirement Assessment Form
This form should be completed at first contact which could be in the Emergency Department (ED), at a pre-assessment appointment, or a general admission (Appx 1). It should be completed with the patient, relative, or carer and is designed to ensure that patients with a specific requirement (as defined above) have their specific care needs met. This has been developed to guide staff to ask the appropriate questions to elicit clear information to support the appropriate care for the patient. For those patients who are unable to communicate their needs, please discuss with whom ever knows them best (i.e. family or carer).
Examples to some questions:
- How to best help me understand things and communicate with me:
“I use Makaton sign language to help me communicate with you. The use of symbols or pictures will also help me to understand.”
- How to best undertake medical procedures:
“I don’t like needles and I am frightened of medical procedures I don’t understand; please make sure it is explained clearly and I have someone with me who knows me well.”
- Eating and Drinking:
“I will only drink out of a particular cup; I only associate eating with sitting in a chair at a table. Someone will have to help me drink and eat.”
- How you know I am in pain
“I am unable to verbally tell you I am in pain but you will know if I become noisy and start hitting myself. Please check with someone who knows me well if they think I am in pain.”
5.2Flagging of Patient Records (Health Records and PAS) and Bedside Drip Poles
It was identified within DEAG that patients’ specific requirements are not always met effectively, causing anxiety and affecting their care.It was recognised for the need to develop a method of identifying patients who have a specific requirement and a number of standardised symbols have been agreed to flag patients’health records with yellow sticky labels and theirPAS records with the abbreviations below.
At Risk of Physical Hearing Visual OtherSpecific
Falls ImpairmentImpairment Impairment Requirement or
Learning Disability
FL PH HR VSSR or LD
The symbols and abbreviationsalert staff to patients with hearing impairment, those who have mobility problems or wheelchair users, patients who require support with communication, including patients with a learning disability, patients with a visual impairment, and those who are at risk of falling.
In addition to the notes flagging, yellow square clip-on signs are to be attached to the patient’s bedside drip pole;these include the additional symbols indicating ‘Nil by Mouth’, and ‘Requires Assistance with Eating and Drinking’.
Assistance with Nil by Mouth
Eating and Drinking
Prior to flagging a patient’srecordsand their bed space area it is essential that the patient’s consent is obtained (within the CID for Inpatients or on the separate consent form for Outpatients). Therefore, before using any of these visual triggers please follow recognition of specific requirement consent guidelines (see Appx 2).
The patient must be asked to consent to their records being flagged. The Consent Form should be completed and signed, the appropriate symbol placed on the outside of the notes and, if an Inpatient, a symbol placed above the patient’s bed.
Once the consent form has been signed, the Data Quality Office on ext 2627 must be contacted in order for PAS to be flagged with a specific requirement.
Should a patient withdraw their consent, the flags should be removed from the notes/bed, the consent form crossed through and dated and the Data Quality Office contacted on ext 2627 for the flag to be removed on PAS.
All specific requirement labels and bed signage should be kept in a Perspex container on a designated area on the ward or department.
5.3Theatre Scheduling for Patients with Specific Requirements.
All patients booked for routine surgery are pre-assessed in a clinic led by the nursing pre-assessment team. At this assessment a patient who has a specific requirement can be identified, and plans made to ensure their specific requirements are recordedand met effectively during their admission.
With the written consent of the patient, and/or their representative (within the CID for Inpatients or on the separate consent form for Outpatients see guidelines Appx 2) their hospital notes are flagged by attaching the relevant symbol. The pre-assessment nurse will then complete a specific requirement tracking form electronically, and forward this to all relevant personnel to alert them of the patient’s specific requirements.
Relevant personnel include:
- The matron responsible for the area the patient is booked to go to.
- The theatre sister responsible for the speciality/consultant that the patient is booked under.
- The Learning Disabilities Liaison Nurse (if the patient has a learning disability).
The assessment nurse or secretary will then enter comments on the waiting list comments page to ensure both the ward staff and site practitioners are made aware of the patient’s specific requirements. The matron will then take the appropriate actions to ensure the patient is expected and their specific needs are anticipated. The matron will also contact the patient or their representatives if they consider this is necessary. If the theatre schedule is likely to need to be changed the matron needs to ensure that the theatre sister is contacted and informed.
Appropriate Persons to Consider Initiating these Actions:
- Any patient with a specific requirement and who requires unique, specialist care.
5.4Access Support Card
The Access Support Card has been introduced to assist patients and visitors who have a specific requirement to communicate effectively with hospital staff when accessing services within the Trust. Any patient or visitor with a communication difficulty or disability can have access to the card by asking for an application form at the Health information Centre in the main entrance of the hospital, or by downloading a form from the RD&E website (Appx 4). The bright yellow card should be presented at reception on arrival for an appointment at the RD&E to indicate that extra support or assistance may be required. For patients with a visual impairment, the card can be adapted to ensure easy recognition.
Fig 1: Access Support Card (Front) Fig 2: Access Support Card (Back)
When presented with the card, staff should follow the procedure outlined on the back of the card (Fig 2).
5.5Emergency Admissions
If a patient is admitted via the emergency route the nurse who received the patient must either complete the appropriate specific requirement documentation or alternatively ensure that a request is made at hand over for the documentation to be completed.
6. MONITORING and EVALUATING DISABLED USERS’ EXPERIENCES
Evaluation of the views and experiences of users with specific requirements will be made against the standards set out above. The following ongoing methods are used to obtain feedback relating to users with specific requirements:
- Patient Advice and Liaison Services (PALS) / Complaints
- Annual Patient Survey
- Patient Feedback Cards
- Internal surveys
7.USEFUL CONTACTS
Name / Title / ContactNigel Lawrence / Diversity Lead for Patient Care, Chair of DEAG /
01392 406571
Liz Jennings / Learning Disability Liaison Nurse /
01392 402237
Natalie Stone / Patient & Public Involvement Facilitator /
01392 402187
Health Information Centre / - / 01392 402071
8.ASSOCIATED TRUST POLICES
- Environment and Accessibility Guideline and Tool
An environment and accessibility audit tool which has been developed in order to ensure that all hospital wards and departments are accessible to disabled staff and users.
- Single Equality Scheme
Trust statement on commitment to equality and diversity for patients and staff and our action plan for how this agenda will be delivered.
Care of Patients with Specific Requirement Policy and Guidelines
Approved by DEAG: date
Approved by IPSG: date
Review date: <next review datePage 1 of 6
APPENDIX 1
Specific Requirement Assessment Form
To be completed by a healthcare professional with the patient/carer/relative. Please provide information in the boxes below.
I like to be called: / What is the specific requirement:Person who knows me best (1st contact):
Carers & other healthcare professionals who know me well:
People who care for me and when they care for me e.g. paid carers and family
Staying safe e.g. * Bed rails * Risk assessments * Absconding * Who needs to be with me and when
How to best help me understand things and communicate with me e.g. * Speech * Gestures * Sign Language
Behaviours that others might find challenging
How to best undertake medical procedures e.g. * Taking blood
How you know I am in pain or distressed e.g. * Rocking * Banging head
Going to the toilet e.g. How I’ll let you know if I need the toilet
Problems with seeing and hearing e.g. Can only see things on right side
Moving around e.g.*Positioning in chair * Level of supervision * Aids
Eating and drinking (swallowing) e.g. *Choking * Food consistency * Help * Aids
Taking medicines e.g. *Crushing tablets * Injections * Syrup
Personal care e.g. * Putting clothes out in a specific order * Not liking water on face
Likes e.g. * Favourite objects *Watching TV * Routine / Dislikes e.g. * Physical contact * Change * Noise
Sleeping e.g. * Bedtime routine * Level of supervision at night * Positioning in bed * Bed rails
Who needs to be informed when I am due to leave hospital?
Other special requirements
Signature…………………………………..Date: …………………. Time: ……......
Print Name…………………..…………….
Author: DEAG Working Group Page 1 of 2
Approved: Information Governance Committee ???
Last reviewed July 2010, next review due July 2011
APPENDIX 2
SPECIFIC REQUIREMENTCONSENT GUIDELINES
Background
On occasions we will care for patients whose individual needs will require further arrangements to be made to ensure their needs can be addressed.
When patients are seen in an outpatient setting the Recognition of the Specific Requirement Consent form allows us to highlight these needs visually through a sticker on the medical record and a flag added to PAS. Consent must be sought prior to using any of these visual triggers.
Scope
The group of patients whose needs may be met in this way will include the following disabilities:
Hearing, Visual, Communication, Learning, Physical and acquired brain injuries i.e. cerebral palsy.
Responsibility
Consent must be sought from patients. It is the responsibility of the Practitionerwho is most directly involved with the patient (or their carer) to ensure that they are given the option of having their specific requirement flagged.
When patients with a specific requirement are seen in an Outpatient setting the procedure below must be followed:
- Specific Requirement discussed and Consent Form given
- Ensure Consent Form is signed
- Place the appropriate sticky label/s on the front of notes
- Contact the Data Quality Office on ext 2627 to flag the specific requirement on PAS
- Ensure Consent Form is filed in the notes in Charts & Special Sheets
If patients withdraw their consent the sticky label must be removed from the notes and the Data Quality Office contacted to remove the flag on PAS. A line must be drawn through the consent form.
The procedure will be audited during regular casenote audits, if the consent form is not contained within the casenotes displaying a sticker, the sticker will be removed.
Author: PPI Facilitator on behalf of the DEAG Working Group Page 1 of 1
Approved: Information Governance Committee Jan 07
Last reviewed July 2009, next review due July 2010
APPENDIX 3
RECOGNITION OF SPECIFIC REQUIREMENTS
CONSENT
I have a requirement as indicated below:
(please tick appropriate box)
Hearing Physical *Specific VisualFalls
(HR) (PH)Requirement OR (VS) (FL)
(SR)
Learning Disability
(LD)
* eg Communication Difficulties
I consent to a sticker with the symbol indicated above being placed on the outside of my hospital medical record and my electronic information being flagged to indicate my requirement: (please tick)