Post Bag September 2015
The much-used phrase “If it’s not written down it did not happen” is frequently bantered around in everyday life, and no place is it more commonly used than in our arena. There are times when it is used to drive home a salient point to clinicians, for example with regard to the assessment and treatment of patients; the rationale behind this being that the patient record must reflect all the actions and pertinent negatives which took place so that a full picture can be presented either for the patients GP, at the hospital or at a subsequent investigation.
Another reason why patient treatment records must be completed fully and accurately is that they may be audited and the content reviewed, inspected, or examined to check for compliance with best practice. Through the audit process it may become apparent that a particular piece of manual handling equipment is extensively being used across the Trust or that a piece of equipment is rarely being used, either because something else is better suited or it was not considered. If the carry chair was used to move the patient, but it is not recorded, then as far as the audit is concerned “it did not happen”.
Auditing can also be used with regard to the Datix system to establish if there are common features, localities or problems being encountered by our work force. For accurate results to be achieved it first requires employees to complete the Datix, either on a computer or via telephone to S.P.O.C. the single point of contact.
The difference between staff completing a patient treatment record and a Datix would appear to be that the PRF or ePRF is a mandatory action whichMUST be completed by clinicians whereas the Datix system appears to suffer from a lower level of priority which often means that when employees intend to raise a Datix report, they are not able to do so, either because they are over worked with their core role or the incident happens so late in their working period that they go home, intending to raise it later, but it is often forgotten. As a consequence, by not recording it “the event did not happen”. Perhaps we should elevate the importance of the Datix system to ensure that events are recorded and members of staff view it as an important procedure.
Over the past few years there has been considerable work carried out to improve the efficiency of our service and this has not always been a straight forward or simple task. Risk assessments needed to be carried out, vehicles needed upgrading, communication systems & staff required attention, Policies & Procedures needed reviewing and while all this was going on the service underwent radical changes and came under scrutiny as it tried to meet national response targets set by a Government that allowed no leeway for geographical locations or topographical difficulties encountered by employees in different counties.
The same principle would appear to being applied to issues being raised by employees with regard to issues surrounding their rest break or the end of their shift period. For mobile employees who work in cars or on the ambulances, the basic information is already there: Day, date, time, CAD number, Call sign. All that is needed is a brief statement of what actually happened. Unfortunately if the incident is only raised verbally, then anecdotally “because it was not written down, it did not happen”. A bit like Nelson turning a blind eye or burying one’s head in the sand, hoping the problem will disappear.
A considerable amount of time and effort by management and staffside working together was undertaken to resolve the issues surrounding the rest break issue which was causing friction between road staff and control centre staff. This resulted in the implementation of ESOP 25 which includes information and a step by step flow chart to guide control room staff in how they can or cannot assign calls to road crews. The document was well received and has been disseminated across the Trust so that all members of staff involved in the process are aware of what they are required to do in a specific situation.
One would be forgiven for thinking that the promulgation of ESOP 25 would resolve the issue of what became known as “Red 2 Red” passing the meal break; but it has not. The problem keeps arising.
Prior to joining the service I was selected to undergo Auditor training by my previous employer presumably they saw “potential” in me or recognised certain traits in my behaviour which indicated that I was suited to the role. However, it was an interesting and motivating course, presented by an enthusiastic and experienced auditor, who was able to capture our attention and encourage us to become a valuable asset to our employer. The key point which I will always remember from Day One of the Auditing course is that there are generally four outcomes which may be considered when finalising an audit of a company, its policies or processes and these are:
- The company has very robust Policies & Procedures and a workforce that are fully compliant.
- The company has very robust Policies & Procedures but the workforce are NOT fully compliant. The company should address the situation so that all of the employees are compliant.
- The company has Policies & Procedures but they do not reflect the way that the employees carry out their work. The employees are very efficient and safe in the way that they carry out their work. The company should review its Policies & Procedures to reflect the way that the employees carry out their work which is safe, efficient and productive.
- The company does not have robust Policies or Procedures and there does not appear to be any correlation with what the employees are doing. A comprehensive review of the Policies & Procedure should be carried out in conjunction with an appraisal of the workforce activities. Unsafe place.
So where do we go from here? We have a procedure which has been extensively researched, drafted and agreed by a joint management and staffside team that refers to the actions which MUST be carried out by control room staff when allocating a call to a resource. The HEOC / EOC management, dispatchers and mobile clinicians are aware of ESOP 25 so there should no longer be instances where complaints are being raised by employees that they are being deployed in a manner which is contrary to ESOP 25. Yet the complaints are still coming in. So I ask myself the question “which of the four outcomes listed above is the cause of the problem?”
Bearing in mind that we have an agreed Procedure, one has to consider how it must complied with:
- A 999 call comes into the call centre and after triage it is allocated to a resource.
- The resource responds to the call they are allocated to.
- The crew pass their allocated rest break time.
- A higher category call is received at the call centre (dispatcher refers to ESOP 25)
- Dispatcher contacts resource and asks if they are prepared to accept the higher category call.
- If crew accept call they are then stood down and allocated to the higher category call.
- If the crew decline they are left on the original call and are not to be challenged or pressure applied
- When the crew come clear from the original call they will then be out of service and sent for meal break.
The same principle applies when allocating a call to a resource that is near the end of their shift: If the resource is past its planned shift finish time, the dispatcher MUST still refer to ESOP 25 if considering allocating the call to that resource. If the resource declines the later call then they should remain on the original call without being challenged or pressure applied. The issue being raised is that at the point when a higher category call is received at the call centre, the crew are not being contacted and asked if they would be prepared to accept the higher category call, which could effectively mean that they may not get their rest break, or finish their shift for a further 2, 3 or more hours. Instead they are being stood down and reassigned regardless.
So who is failing to follow the Procedure? I believe and audit would show that ESOP 25 is not always being complied with by one or more members of staff in HEOC / EOC to the detriment of road staff welfare which can only serve to create a barrier to the teamwork necessary between HEOC/EOC and its “resources”.
This Post Bag may appear to be attacking EOC / HEOC, but it is not intended to be viewed that way; I am merely identifying an area where we do not appear to be following our own procedures , and suggesting possible reasons why. The media is constantly referring to the issues and stresses being experienced by our staff and that is why this edition is focusing on our clinicians and certain aspects of their working time which have a detrimental effect on their well-being. Later editions will be looking at other groups of staff.
Clinicians are practical people. They look at problems, unravel them, come up with a solution, and then move on to the next problem. Take for instance the inter-hospital transfer of patients. Looking backwards, many may recall with a shudder, how patients were packed, parcelled and loaded onto our bulk standard stretchers and conveyed with medical equipment dangling by bandages, tie-wrapped to stretcher sides and fingers crossed that there was enough diesel fuel and oxygen on board to reach the other end.
Jump forward to 2015 and it is a totally different picture; we now have ambulances that are designed in-house by the Vehicle Working Group, supported by the input received from road staff that looked at the problems and came up with the solutions. Don’t get me wrong, there will always be areas that we can improve upon. But it relies upon input from our staff to identify the areas needing improvement.
The “Trauma” trolley that is frequently utilised for the conveyance of patients from one hospital to another is one such improvement. In essence it is like taking a standard stretcher trolley, slicing it in half horizontally and inserting a tea trolley. (Laugh, but it does remind me of that). The advantages are clear: the patient can be prepared safely and securely by the hospital staff, the medications and medical equipment is all neatly stowed in fixed locations and even has its own oxygen supply which can support the patient when not inside the ambulance. Transferring a patient from a hospital treatment bed onto the “Trauma” trolley can be conducted carefully, without dislodging lines or interrupting monitors, whereas in the past we had to “scoop” all the odds and bods as the patient was slid across to the stretcher.
In the past, when a patient was transferred to another hospital, if a transfer team were going with the patient, the crew would advise the team that once the patient had been safely delivered and the ambulance made ready to depart, if a call came in during the return journey, the team may be required to make their own way back to hospital. This was not always well-received and many transfer teams viewed it with trepidation.
However; the Trauma trolley does NOT go up or down, it is of a fixed height and therefore crews cannot use it to convey any patients they are sent to on their way back to the originating hospital, due to the height they would have to lift a patient to get them onto it. Additionally, because ambulances have the fittings for just the one stretcher trolley, the crew are required to off load their stretcher at the pick-up hospital; this means that after completing the outward journey, the crew are required to drive back to the originating point to collect it. On the upside this means that the transfer team are more likely to get a return trip.
On the down side it means that if the crew that are allocated to the inter-hospital transfer are not locally based, they will be returning to a locality outside of their normal operating area in order to retrieve their stretcher. My view is that when an inter-hospital transfer comes into EOC, along with the ever-increasing high call volume and pressures on EOC staff, the dispatchers may be so pre-occupied that they may not have time to consider which base station the assigned crew are from, their start and finish times, mileage already driven or the calculated return mileage of the inter-hospital transfer. Don’t rant and rave. Call them and explain the circumstances… it may present a different perspective of the situation to them. Talking is a dying art form.
East of England Ambulance Unison 20106
Branch Health & Safety Officer