what are the advantages of using reporting systems for incidents, events and conditions?
- prevent misinterpretation of info
- timely reporting of info by a witness
- provides easy access to info for tracking and monitoring patients
when is it appropriate to share information?
- risk of harm
- crime committed
- safeguarding issues
- ensure effective diagnosis, treatment & care (e.g. handover)
- share improvements to/ good practice
- legislation requirements (e.g. GDPR or Care Act 2014)
what should be considered before sharing data?
- protecting identification
- using NHS no. instead of name
- informing and gaining consent (unless required by law)
- informing appropriate adult or advocate if age or mental capacity is of concern
- who intended audience is
- why info is ring shared
what are the Calicott principles?
8 principles to ensure info is kept confidential and used appropriately
- e.g. use minimum necessary and justify the purpose
what are the 7 different formats for the sharing of information?
- oral reports
- written reports
- forms and documents
- presentations
- graphs and tables
- leaflets or posters
- web pages and social media
what is an example of using ORAL REPORTS for sharing information and why is it good?
useful when info needs to be summarised and passed on quickly
- giving immediate verbal information
- answering questions to support an individuals care
what is an example of using WRITTEN REPORTS for sharing information and why is it good?
can be brief of very detailed and provides a permanent record of info
- completing change-of-shift reports
- other reports where a permanent record is required
what is an example of using FORMS AND DOCUMENTS for sharing information?
what is an example of using FORMS AND DOCUMENTS for sharing information and why are they good?
contains mandatory fields to gather specific info
- completing a report-of-injury form
- a referral form from GP to social care services
what is an example of using PRESENTATIONS for sharing information and why are they good?
useful for delivering training or info to group of people
- sharing good practice in a team meeting
- reporting findings of a research project
what is an example of using GRAPHS AND TABLES for sharing information and why are they good?
provides a visual display of numerical and statistical data gathered overtime
- summarising individual’s info
- findings of a research project
what is an example of using LEAFLETS OR POSTERS for sharing information and why are they good?
useful for providing “chunks” of info
- providing info about treatment options
what is an example of using WEB PAGES AND SOCIAL MEDIA for sharing information and why is it good?
provides access to vast amount of info and reaches large amount of people quickly. ensure trustworthy sites
- providing info about health promotion initiatives
what does record keeping provide?
- overview of medical history
- overview of care needs
- access to info for multidisciplinary teams
- record of all services accessed
what does record keeping support?
- continuity of care
- protection of individual (e.g. avoiding drug errors)
- protection of professionals (demonstrates they provided safe, effective care)
how does record keeping contributes to the overall care of an individual?
- ensures uniform care is provided as it should be
- ensures record of discussion, interactions and agreed next steps
what are the 5 responsibilities of employees and employers in relation to record keeping?
- legal requirements and inspections
- duty of care
- duty of candour
- investigating and tracking incidents and accidents
- accountability
in terms of responsibilities of record keeping, what are legal requirements and inspections?
care quality commission (CQC) inspect healthcare settings and use records to make decisions about standard of care provided
in terms of responsibilities of record keeping, what is duty of care?
record keeping is a way of demonstrating duty of care is being fulfilled
in terms of responsibilities of record keeping, what is duty of candour?
responsibility to be open and honest
- includes making individuals aware if something goes wrong
- if records not accurate, honesty with individuals required and updating records
in terms of responsibilities of record keeping, what is investigating and tracking incidents and accidents?
- accurate and legally complying record keeping required demonstrating actions carried out
- enables causes of incidents and accidents to be found
in terms of responsibilities of record keeping, what is accountability?
- responsibility for actions
- record keeping provides audit trail and is a way of demonstrating accountability
what does escalation mean?
to take an issue very seriously and to take further action, usually with senior member of staff/ management
when should you escalate an issue?
- safeguarding concerns
- radicalisation concerns
