Top tips for conflict resolution
6 points
- open communication (active listening)
- empathy (underlying views)
- clarify and educate (root cause)
- mediate (seek help)
- seek compromise
- professionlism (sincere apology)
What is the LEARN model of conflict resolution?
L - Listen to pt perspective
E - Explain your perspective
A - Acknowledge the differences
R - Reccommend a plan of action
N - Negotiate a solution
5 tips for breaking bad news
- try and find something positive
- don’t shy away but fully explain
- demonstrate empathy
- give them time to reflect
How to tackle consultations for children?
- Address the perceived problem of parent and child (these may not be the same)
- Treat everyone in the consultation as equals
- Attend to any emotional concerns the family has because of the condition/symptom
What are the strategies for consultations with children?
Build rapport
Be non-judgemental
Be responsive
Show empathy and understanding
Be consistent, reliable and trustworthy
Be open and honest
Be kind and respectful
Use clear terms and language
Be friendly and smiley
What is covert administration?
Covert administration is when medicines are administered in a disguised format.
The medicines could be hidden in food, drink or through a feeding tube without the knowledge or consent of the person receiving them.
Every person has the right to refuse their medicine, even if that refusal appears ill-judged to staff who are caring for them.
Is only legal when appropriately used (lack of capacity)
3 key principles of the mental health act for covert administration
- Every adult has the right to make his or her own decisions. You must always assume they have capacity to do so unless it is proved otherwise.
- A person is not to be treated as unable to make a decision unless all practicable steps to help them do so have been taken without success. If you establish lack of capacity, it is important to involve the person as far as possible in making decisions.
- A person must not be treated as unable to make a decision merely because he or she makes an unwise decision.
- Anything you do or decide for or on behalf of a person who lacks mental capacity must be in their best interests.
When must you be aware of liability-use for covert administration?
Crushing a tablet or opening a capsule before administration may make its use ‘off-licence’ and change liability for any harms caused from the manufacturer to the prescriber.
How do you record covert admin?
- Clear record of which medicines are administered covertly and when should be maintained. This is particularly important for people with fluctuating capacity.
Actions taken to give medicines in the normal manner must be recorded. Include consideration of:
- whether the medicine is unpalatable
- adverse effects (actual or perceived)
- swallowing difficulties
- lack of understanding about what the medicine is for
- lack of understanding of the consequences of refusal
- ethical, religious or personal beliefs about treatment
What are the pharmaceutical issues concerning covert admin?
- Stability in food/drink - might not be information available, consider the risks of the medicine degradingversus the risks of not giving
- Acceptability to the patient - e.g. meds could have bitter taste or anaesthetic effect on the tongue
- Film coated tablets/capsules: often in this form to mask the taste
- Absorbtion - certain meds, must be taken on empty stomach
- Crushing/opening caps - not always possible and can harm patient
When is covert administration legal?
Only when:
- patient deemed to not have capacity
- best interests meeting with care team, health team and family advocate
- planned with a pharmacist how to do so
How common is polypharmacy in the UK?
- More than 1 in 10 people aged over 65 take at least 8 different prescribed medications each week.
- Almost 1 in 4 aged over 85 do the same.
- More than 60% of prescriptions prescribed in the community are for people over 60.
- Around 1 in 5 prescriptions for older people living at home may be inappropriate
What are the main reasons for over prescribing?
- Failure to recognise an adverse effect
- Patients’ or relatives demand or refusal of a drug
- Failure to individualise treatment
- Inadequate review
How to prescribe well in the elderly?
- Regular medication reviews and agreeing changes with the patient
- Stopping any current drugs that are not indicated
- Prescribing new drugs only if there is a clear indication, aim of treatment and point of review
- Where possible, avoiding drugs that have a known harmful effect in elderly
- Consideration of deprescribing
What are the main barriers to deprescribing?
- Clinician anxieties
- Easier to leave status quo
- Drugs started by specialists
- Patient anxieties – faith in their medicines and fear of what might happen if medication discontinued
- Trust in the prescriber
- Incentives to prescribe
What are the 5 stages of deprescribing?
- Comprehensive review of medicines - encourage patients to give opinions;
- Identify potentially inappropriate medicines - adherence, outcomes, risk of ADRs
- Determine whether a medicine can be stopped - withdrawal?
- Plan and initiate withdrawal
- Monitor and provide support - lifestyle measures, coping strategies, counselling services.
What should be included in S of SWAN?
Safety
- Bleeding risks?
- Falls risk?
- Renal function
- Electrolyte disturbances
- Hypoglycaemia?
What should be included in W of SWAN?
Working well
- No further symptoms/controlled condition
- BP within range? (for age, frailty etc)
- Weight changes?
What should be included in A of SWAN?
Appropriate
- Active indication for disease
What should be included in N of SWAN?
National guidance
- Where would you look for advice
- NICE guidelines etc
How should you make reccomendations for a SWAN review?
- weigh risks and benefits
- preventative medicines if shorter life expectancy
- can increase or reduce doses
- can stop or continue
