document summary - extranet.whh.nhs.uk€¦ · ref: lor_100 – emergency care – majors /...

Ref: LOR_100 – Emergency Care – Majors / Walk-ins

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DOCUMENT SUMMARY

Title of SOP Emergency Care – Majors / Walk-ins

Context

This document is the Lorenzo Standard Operating Procedure (SOP) for the above processes. The WHH FT SOP and other Lorenzo SOPs are referenced where applicable. The processes as described in this SOP may have outstanding queries or actions for resolution, in which case these are highlighted and will be managed through the Lorenzo Programme governance and approvals process. The SOP is not exhaustive and describes variations to training collateral that require specific focus and additional training to avoid common data entry problems for Lorenzo operational staff.

Scope

This SOP describes the way that Lorenzo will be used to support the processes within the Emergency Department for majors and walk-in patients. The process is described as a narrative, with a supporting summary flow for a visual depiction of scope and an embedded detailed process flow illustrating the overall sequence of steps and activities. The roles associated with the process steps are depicted as swim lanes in the flow diagrams.

Approval Approver Role Approver Name Signature Date

Service Lead

Clinical Safety Officer

SRO (on behalf of Design Authority Steering Group)

SRO (on behalf of Lorenzo Programme Board)

Summary of Proposed Process Changes Summary of Predicted Benefits


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CONTRIBUTORS

Name Role Forum See Full Access Training Database for attendeees

Workshops x 6

Meetings 8

1-1’s


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Date

Created 12/05/2015

Standard Operations Document Creator Sandra Few

Standard Operating Procedures Version 0.4 draft

Review Date 06/07/2015

Title of SOP Emergency Care – Majors / Walk-ins

Purpose of SOP

This SOP describes the way that Lorenzo will be used to support the processes for Emergency Care following the deployment of Lorenzo Phase 1 in November 2015. The SOP highlights variations from the ‘standard’ use of Lorenzo as detailed in the end user training collateral and provides further guidance for operational staff in executing their administrative processes using Lorenzo.

Tools / Equipment Computer, Smartcard, appropriate access via RBAC Frequency of Use

For reference for operational staff at any time

Author Sandra Few, Business Change Team

Location Corporate or

Local

Copy maintained locally and also on the ‘Lorenzo’ community area on the WHH Hub.

Summary of Proposed Process Changes Summary of Predicted Benefits Search for patient on National Spine first Meds clerking to be undertaken with Lorenzo Integrated System with the Trust Use of ED Kiosks (when in situ) for registration Use of recording call no response in Lorenzo

Will assist in highlighting overseas visitors more easily Accurate list of Meds per patient Relevant Trust staff with access can monitor patient movement within ED Alleviate lengthy queue at reception enabling patients to register and triage themselves Enables ED staff to track patients who have left department without being treated – max call of 3 times


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Actions for Resolution1

No Description Step ID Owner Due Date Status Comments 1 Process for informing overseas officer - this will be

a DWARF report based on overseas information sourced from the

Overseas visitor status – value will be either…. Not applicable (not an overseas visitor) or

Charging rate not known (overseas visitor Patient registration message

1 Les McAdam/DWARF Team

During BPV Open Update 07/07/2015

2 Clinical assessment forms to be created and content to be confirmed

5 Les McAdam During BPV In Progress

Update 07/07/2015

3 Lorenzo extensions to be included in SOP process when design available in Lorenzo

Jan Lee/Les McAdam

Open

4 Savience integration to be included in SOP process when available

Jan Lee/Les McAdam

Open

5 Referral creation for accepted patients will be trialled at TTV/BPV to assess whether the process satisfies data reporting requirements

1 Jan Lee/Anthony Bailey

Open

1 The actions, if any, in this table are those with an impact potentially wider than the scope of this SOP. These will be managed through the Lorenzo Project action resolution route. The queries, if any,

noted in the SOP steps below will be resolved by the SOP owner as part of the sign-off process and do not have a wider impact.


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Note: Appendix 1 illustrates a summary process flow, to open the detailed process flow in pdf form please click the icon here: [to be added]

Dependent SOPs Description 1: LOR_080-Allergies 1: Detail of how and when to record allergy and health issues information is

described in the allergies and is referred to here

2: LOR_040-Bed Mgt 2: Detail of the Patient Flow Team responsibilities as part of the admissions process referred to in this SOP

3: LOR_060_Meds Clerking: v0.11 3: Detail of how to record Medication clerking

4: LOR_061_Meds Mgt: v0.10 4: Detail of how to record outpatient prescription

5: LOR_050_Ward Admin 5. Detail of managing an Inpatient

No Main Operating Steps Key Points Explanation / Examples / Diagrams2 For audit purposes to monitor process

Compliant Yes

Compliant No

1 Arrival: This process involves:

Registration of patients new to the Trust

Checking demographic details for patients known to the Trust

Recording attendance details for all patients

The process is undertaken as follows for different patient groups:

Adults who walk into the department may be registered through a kiosk to be tested once in situ) or at the reception desk

Children who walk into the department may be registered

Role: Bed Bureau Admin/ ED Reception staff Mandatory Information

a. Where patient arrival is communicated via the Bed Bureau team, they will create a record on the expected patient list [

b. If Patient is ‘transferred’ from RUCC, patient will be disposed from RUCC and a new attendance created at WED

c. Where patient demographic details are not

available record patient as;

Surname – Unknown Forename – Male/Female/Baby DOB – 01/01/1850

d. Mandatory Information

Only the following 4 fields are mandatory data items [in Lorenzo] for all patients:

2 Supporting information in flowchart form is illustrated in Appendix 1


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Compliant Yes

Compliant No

through a kiosk or at the reception desk

Adults who arrive by ambulance may be registered in a cubicle, at ambulance triage or by NOK at the reception desk

Children who arrive by ambulance may be registered in a cubicle or by NOK at the reception desk

Overseas Visitors Attendance Type

Ethnicity

Religion

Disability details

Overseas visitor status – value will be either…. Not applicable (not an overseas visitor) or

Charging rate not known (overseas visitor)

For children the following should be recorded or reviewed

Educational information for school aged children

Name and relationship of the accompanying adult

Next of Kin details should be recorded or reviewed for all patients in ‘relationships’

e. Overseas Visitors Overseas visitor information will be captured from the patient registration message where patient is admitted or booked for OP appointment and communicated via a DWARF report to the Overseas visitor officer. Where patient has an address overseas, postcode ZZ99% and Country of residence are used to record a “no fixed abode” address in the appropriate country.

f. Attendance Type Most patients will be “New Attendances”


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Compliant Yes

Compliant No

GP referrals in ED Assault Data [RTC Data will not be captured]

Patients reattending with the same clinical problem will be recorded as “Follow-up Unplanned” – this will be used to calculate the reattendance quality indicator Patient reattending the next day for an x-ray at RUCC will be recorded as “Follow-up Planned” – this group should be small and will not count towards the reattendance quality indicator

g. GP referrals in ED Referral source should be recorded as General medical practitioner and assigned to the appropriate care provider and specialty. The referral details will update with the care provider and specialty as selected but the associate referral remains as ‘Self-referral’

h. Selecting “Assault” for the Patient Group launches the “Assault Details” screen which captures the additional data items for patients presenting following an assault

2 Call No Response:

Role: ED receptionist/Triage Nurse/Clinician

Where a patient does not respond to a call from the waiting room a call response will be recorded; Call count and date/time are recorded, after 3 calls with no response the patient attendance will be closed.

- This process may occur at multiple points


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Compliant Yes

Compliant No

throughout the ED attendance as patient may leave the department, after registration, triage or being seen.

3 Triage and Stream: The process is undertaken as follows for different patient groups:

Adults who walk into the department may be triaged through a kiosk or by the triage nurse

Children who walk into the department may be triaged through a kiosk(once in site ED Kiosks – to be tested) or in the paediatric area

Adults who arrive by ambulance may be triaged in a cubicle or at ambulance triage

Children who arrive by ambulance may be triaged in a cubicle or at ambulance triage

Patients arriving by ambulance who require immediate resuscitation will be triaged as part of the assessment process in resus

Role: Triage Nurse Assumption: Ambulance triage will operate between the hours of 11am – 11pm, outside these hours patient will be assessed by the Nurse co-ordinator and directed to the appropriate area of the department Majors/Minors/Paeds The process of self-triage through a kiosk will mirror the Lorenzo process and appropriate fields in Lorenzo will be populated with data from the Kiosk The Triage Date/Time will be used for the initial assessment quality indicator [ambulance patients

Triage identifies patients requiring urgent clinical assessment based on a series of discriminators Streaming allocates patients to the correct care group/team based on:

Onset

Suitability for ENP

Suitability for ambulatory care

Requiring a trolley for assessment The “Triage Tool” CDC Form will provide decision support to assign the triage category, stream and in addition there will be the facility to record a set of observations with the NEWS and PEWS be calculated automatically as well as a prompt for patients who show signs of sepsis The following are data items will be recorded a. Triage Category b. Stream c. Pain Score d. Allergy/ADR Check e. Update Location At the end of the process the following items will be printed:


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Compliant Yes

Compliant No

only] ED Card Front Sheet [Adult]

ED Card Front Sheet [Paediatric]

UCC Card Front Sheet [Adult]

UCC Card Front Sheet [Paediatric] Wrist bands and labels will be printed as required

4 Seen By:

Role: Doctor/Nurse Clinician/Emergency Nurse Practitioner

a. The first “Seen By” time will be used to calculate the “Treatment Time” quality indicator

b. “Seen By” will be recorded every time a handover occurs as this will update the responsible clinician on the ED Peg Board

c. Senior Review can also be recorded using “Seen

By”

5 Clinical assessment : All notes will be recorded electronically using the appropriate Clinician Notes Clinician notes will have hyperlinks to:

Medication clerking

Allergies & ADR Checks

Health Issues [to record Previous Medical History]

Any supplementary paper will be scanned at the point of discharge or transfer

Role: Clinician / Nurse

The following Clinical Notes will be used: Clinician

Majors Clinician Notes

Minors Clinician Notes

Paediatric Clinician Notes

Nursing

Majors Nursing Notes

Minors Nursing Notes

Paediatric Nursing Notes In addition the following “print & scan” forms will be used:


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Compliant Yes

Compliant No

Investigations will be ordered via ICE Bloods results will viewed via ICE Imaging will be viewed via PACS

Initial Assessment Plans

Pathways

Forms

6 Decision to admit: Role: Doctor/Nurse Clinician/Emergency Nurse Practitioner/ Nurse Co-ordinator

All inpatient referrals will be recorded to admitting Team (default care provider is team leader and is not significant to the admission)

7 Create Booking Request: Role: For CDU ED Team Role: For All other Wards Patient Flow Team Refer to bed management SOP Ref:LOR_040

a. For CDU the booking request will be created by the ED Team [Coordinator or Admitting Clinician]

b. For all other wards the booking request will be created by the Patient Flow Team - this will in effect allocate the patient to specific ward

8 Close Attendance [admitted patients only] – Medical Discharge

Role: Doctor/Nurse Clinician/Emergency Nurse Practitioner

Free text discharge comments will be MANDATORY to feed the GP Letter [using Lorenzo Extensions] PBR and Diagnostic Coding will be recorded and it will be MANDATORY to record at least one of each

Diagnosis [UDDA coding scheme]

Investigations [AE_Investigation coding scheme]

Treatments [AE_Treatment coding scheme Lorenzo Extensions will allow the UDDA Qualifier and UCC Dashboard to be recorded into Core Lorenzo


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Compliant Yes

Compliant No

and to make recording of the DIT coding mandatory. Code sets will also be used for common diagnoses

9 Close Attendance [admitted patients only] – Actual Discharge

Role: Transferring Nurse

Complete the disposal fields and destination ward Disposal Date/Time will be used for calculating the quality indicator [4 hour target].

10 Create Admission Role TBC Progress Chaser : to be confirmed during testing

Admission will be created immediately following “Close Attendance”

11 Outpatient prescription Role: Doctor/Nurse Clinician/Emergency Nurse Practitioner Record TTO medication (as required) – Refer to the Meds management SOP Ref:LOR_060 FP10 prescriptions are not in scope for

If medication is supplied from department stock:

The prescription will be completed, printed out and signed by the discharging clinician

The medication will be checked with a second clinician or nurse who will also sign the prescription

The prescription will be scanned into Lorenzo

If the patients pays for their prescriptions the original will given to the patient for payment

If medication is to be dispensed by Pharmacy:


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Compliant Yes

Compliant No

Lorenzo phase 1 deployment

The prescription will be printed out, signed and given to the patient to take to the Pharmacy

12 Book Outpatient Appointment ED [Medical] Clinic ENP Clinic ED Paeds Burns Clinic UCC Review Clinic UCC ENP Clinic Only ED staff book patients for these clinics

Role: ED Receptionist +/- Clinical Staff Appointments may be booked before or after the attendance has been closed

Clinic appointments will be booked from the Outpatient Peg Board using the following process:

a. Find clinic b. Find patient c. Find appointment d. Book appointment e. Create [new] referral f. Print appointment letter Confirm during testing process of booking other appointments using waitlist team and method of notification

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Close Attendance [discharged patients only] – Medical & Actual Discharge

Role: Doctor/Nurse Clinician/Emergency Nurse Practitioner It will be critical to record disposal date/time accurately as this will be used for the 4 hour target

See 8 and 9 above The GP letter should be “finalised” which will trigger the process of electronic distribution to the GP. There is also the option to print a copy to give to the patient

14 Scanning Reference Ward Admin SOP_050 Ward Admin

Role: ED Receptionist

Admitted patients – all paperwork scanned before the patient is transferred; originals to accompany patient Discharged patients – all paperwork scanned after the


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Compliant Yes

Compliant No

patient has been discharged To be tested during BPV and TTV

END OF PROCESS


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Future State Process – Document Overview

Amendment RecordStatus Version Date Author Comments

0.1 Draft 07/05/15 Sandra Few First draft

0.2 Draft 20/05/15 Sandra Few Second draft

Warrington and Halton Hospitals

NHS Foundation Trust

Emergency Department Summary

Flow

V0.2 Draft

Notation standardThe notation standard followed is BPMN (http://www.bpmn.org/). Key symbols are explained

below.

Events – which signal the start or end of a process, (or an intermediate event that awaits another

trigger before continuing or is used to connect pages in a large map). The line styles indicate the

type of event. Icons within the events indicate what type of information triggers the event. The

exception is the Link icon which acts as a connector.

Intermediate events can occur in the normal sequence or when placed on the boundary of a Task

indicate an exception flow.

Activities and sub-processes – which describe what happens at that point in the process. The

activity is a contiguous or uninterrupted piece of work that is carried out by a person, sometimes

called an ‘actor’ after UML (Unified Modelling Language) convention. When one activity

completes a flow arrow directs the reader to the next activity. A sub-process is a compound

activity that is included within a process in the same way as an activity. It differs from the latter in

that it can be broken down into finer level of detail. Sub-process are expanded on separate

pages.

Gateways – which control the flow along different pathways. They branch, fork, merge or join

paths depending upon conditions/criteria. These are commonly referred to as decisions.

The symbols are connected by arrows which indicate the direction of flow. A conditional flow is

independent of other path decisions.

Artefacts which indicate objects such as documents, which do not affect the direction of flow, but

are utilised or produced by the process. They include data objects and annotations.

Message flows and associations which indicate the flow of information, or an association rather

than work. Message flows are used to show where work may await receipt of information or

provide information to someone outside of the workflow and associations may link a data object

to the activity that utilises it or produces it.

Scope:This document describes the process flow for the following business processes:

Emergency Department (ED) (SOP ref: LOR_100)

The SOP (Standard Operating Procedure) for the above processes provides the narrative to support the process flow and highlights those areas

where the Lorenzo User must observe specific rules when capturing information, over and above the generic guidance provided via the Lorenzo

training. Adopting the recommended ‘way of working’ illustrated here and detailed in the associated SOP(s) will ensure consistency of information

capture and optimum quality of data to support WHH Trust strategic aims, predicted benefits and reporting requirements.

Start

event

Intermediate

event

End

event

Task +

Collapsed sub-

process

Gateway

Sequence flow

Data ObjectAnnotation

Message flow

linkMessage RuleTimer

Process

error event

Association

Expanded sub-process

Cancel

event

Conditional flow

Directed association

System process Other process

Process Owner: Roy Bhati

Review Date:


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Clin

icia

nA

dm

in

Print wrist band

and CAS card

If the patient requires a senior review or

handover the patient may be seen more

than once, potentially by different

clinicians

Pa

tie

nt F

low

Te

am

Ambulance

Patient

Walk-in

(Ambulatory)

If the patient details are not

available the patient would be

registered using the ‘Unknown’

default details

Search for/

Register Patient

Start of Process:

Patient arrives

at ED

Create Attendance

Triage & Stream Seen by clinician Create e-note Admit?

Triage assessment form completed and

allergies and ADRs are checked

Record DTA

Create booking

request

Close attendanceRecord medical

discharge

Produce Discharge Summary

Process End:

Patient Disposed

Yes

No

No

CDU?Create booking

requestYes


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EQUALITY IMPACT ASSESSMENT To be completed and attached to any policy or procedural document when submitted to the appropriate committee for consideration and approval. Title:

What is being considered?

Policy [ ] Guideline [ ] Decision [ ] Other (please state)

Who may be affected?

Patients [ ] Staff [ ] Public [ ] Council / PCT/ Other agency [ ]

Is there potential for an adverse impact against the protected groups below?

Age

Disability

Gender Reassignment

Marriage and Civil Partnership

Pregnancy and Maternity

Race

Religion and Belief

Sex (Gender)

Sexual Orientation

Human Rights articles

Yes [ ] No [ ]

D If you are unsure, please contact the Equality & Diversity Specialist - 5229

On what basis was this decision made?

National Guidelines e.g. NICE / NSPA / HSE / DH (other) Committee / Other meeting Previous Equality screening

[ ]

[ ] [ ]

With regard to the general duty of the Equality Act 2010, the above function is deemed to have no equality relevance. Equality relevance decision by Title / Committee Date

The Equality Act 2010 has brought a new equality duty to all public authorities which replaced the race, disability and gender equality duties. This Equality Relevance Assessment provides assurance of the steps Warrington and Halton Hospitals NHS Foundation Trust is taking in meeting its statutory obligation to pay due regard to:

• Eliminate unlawful discrimination, harassment and victimisation and other conduct prohibited by the Act. • Advance equality of opportunity between people who share a protected characteristic and those who do not. • Foster good relations between people who share a protected characteristic and those who do not.


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For further information or guidance please contact - Joe O’Grady, Equality & Diversity Specialist x5229 [email protected]

DOCUMENT INFORMATION BOX (COMPLETED BY AUTHORISED

DIVISIONAL/CORPORATE SERVICE LIBRARIAN)

Item Value

Type of Document

Title

Published Version Number

Publication Date

Review Date

Author’s Name + Job Title

CQC Standard Measure

NHSLA General Standard

NHSLA Maternity Standard

Consultation Body/ Person

Consultation Date

Approval Body

Approval Date

Author Contact

Librarian

Division

Specialty (if local procedural document)

Ward/Department (if local procedural document)

Patient documentation included

Y/N

Date Approved at documentation group

Readership (Clinical Staff, all staff)

Information Governance Class (Restricted or unrestricted)

Key Words for Search Engine

Audit registered in the audit dept by:

High risk = 1 Annually

Medium = every 2 years

Low risk= every 3 years

mailto:[email protected]

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