By Steve Turner, nurse prescriber and Managing Director of Care Right Now CIC
It is now common for clinicians to carry out consultations with patients over the ‘phone or online. Here are some simple suggestions to help staff in care homes prepare for an effective consultation. Our patient led clinical education work is show- ing that this can greatly improve the effectiveness and outcomes, even to the extent that an online or ‘phone consultation may be preferable in cases where a hands-on clinical examination is not required.
Whether you are assisting the resident to have the consultation or carrying it out on their behalf I recommend that you write some notes beforehand. Here is a brief guide to producing a simple checklist that will help you prepare for the consultation and lead to an agreed plan for what to do next.
In preparation, you may need to take some observations, e.g., temperature, blood pressure, heart rate, weight, and other measurements, including the resident’s feelings, behaviour changes, mood, cognition, mobility, and areas such as sleep & appetite. If the problem is something visible (like a rash for example) send pictures & monitor changes over time. Use early warning scoring systems where appropriate. Think particularly about what the resident would like to have happen. This is a question you may well be asked.
If you are speaking to clinician who does not have the person’s records to hand, be sure to have a list of their previous illnesses, long term conditions and treatments, plus a list of all clinicians and therapists they are currently seeing. The person’s preferences and beliefs about treatments, including on resuscitation & end of life care (often called advanced decisions or advance care plans), and whether anyone has Power of Attorney is a ‘Deputy’ in relation to their health and care need to be included.
You also need details of the person’s (current and past) medicines. This must include details of any allergies, sensitivities of previous adverse reactions. This may be critical. This list should include prescribed medicines; over the counter medicines; as required (prn) medicines, including the effect these have; herbal medicines; complementary medicines; vitamins and supplements and any other therapies they are receiving. In addition, diet, smoking and alcohol intake can affect medicines. You also need to have information on the person’s beliefs and ideas about medicines, and anything they do not want to take.
At the end of the consultation, you should confirm that all concerns have been listened to and have an agreed action plan , to be document- ed in the resident’s notes. This plan may be ‘watch and wait’ or may involve a change. You should also be clear on what to look for if the situation deteriorates, including who to call, and have access to related support and information for the resident.
I believe taking time to prepare for consultations and insistence on having a clear agreed plan as the product of the consultation will help improve outcomes & may even save someone’s life. There is emerging evidence that good remote consultations, where applicable, save time and can sometimes be preferable to face to face consultations when all factors are considered.
About the author: Steve Turner is a nurse prescriber, Managing Director of Care Right Now CIC, Head of Medicines and Prescribing for MedicineGov.org, Information Governance Lead for CareMeds Ltd and Associate Lecturer at Plymouth University.
You can find more on this, & related topics, at Steve’s blog site: https://medicinegovorgmedlearn-innovation-event-nhs.blog/
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