Help!
I'd be much obliged if people signed this petition It's a campaign about the proper use of the 999 system. Cheers!
As my gift to you I will guide you through NHS Direct, what it's for, how it works, and when to use it. I'm doing this because people often seem confused about what we do. They think we can make home visits, that we have GPs on staff, or that we're a finite resource. None of the above are true.
What is NHS Direct?
NHSD is a telephone advice service staffed by qualified nurses. They often have a background in midwifery or general nursing, but we also have former district nurses and practice nurses. They're very experienced, and there are a lot of nurses who are unable to carry on more 'traditional' nursing roles due to injury or ill-health, and have been able to return to nursing through NHSD.
The nurses are there to give health advice about common symptoms, medicine interactions, and home care advice. They cannot diagnose or prescribe, as they never see the patients. They are assisted by CAS - the Clinical Assessment System. This is a series of computerised algorithms specific to particular symptoms. It prompts the nurses to ask questions about the patient's symptoms until a final disposition is reached. The dispositions include 'Home Care', 'Routine GP Appointment', 'Pharmacy Advice', 'A&E immediately', '999 Ambulance' etc. There are too many to list! The nurses can also fall back on their years of experience, as well as advice from colleagues or the Clinical Supervisor. The CS is a senior nurse who manages the other nurses, and can give advice to other staff who may be unsure about a call.
I'm a Health Advisor. We are usually the first person you speak to when you call NHSD. It's my job to prioritise/triage calls so that they can be dealt with in order of urgency, just like at an A&E dept. We can also give interim care advice to help you deal with your symptoms while you wait to speak to a nurse. Depending on the urgency of your symptoms we can sometimes refer you straight to your GP, A&E, or Dentist/EDS without your ever speaking to a nurse. Sometimes it might even be necessary for us to call an ambulance for you. As well as all of this we can also find you a GP, Dentist/EDS or Pharmacist in your area, or arrange for one of our Health Information Advisors to call you back if you have a more complex query.
Health Information Advisors perform an important role in NHSD, one which the public are often unaware of. If you've been diagnosed with an illness, or there's a public health alert, or you need to know who to contact for information about any part of the NHS then the HI Team can help. They can send literature to you in the post, direct you to approved websites, and give you details of helplines and support groups in your area.
How does it all work then?
OK, explanations and 'When to use NHSD' in my next post, I'm exhausted from all the typing, I feel like I'm at work!
Stay tuned.
As my gift to you I will guide you through NHS Direct, what it's for, how it works, and when to use it. I'm doing this because people often seem confused about what we do. They think we can make home visits, that we have GPs on staff, or that we're a finite resource. None of the above are true.
What is NHS Direct?
NHSD is a telephone advice service staffed by qualified nurses. They often have a background in midwifery or general nursing, but we also have former district nurses and practice nurses. They're very experienced, and there are a lot of nurses who are unable to carry on more 'traditional' nursing roles due to injury or ill-health, and have been able to return to nursing through NHSD.
The nurses are there to give health advice about common symptoms, medicine interactions, and home care advice. They cannot diagnose or prescribe, as they never see the patients. They are assisted by CAS - the Clinical Assessment System. This is a series of computerised algorithms specific to particular symptoms. It prompts the nurses to ask questions about the patient's symptoms until a final disposition is reached. The dispositions include 'Home Care', 'Routine GP Appointment', 'Pharmacy Advice', 'A&E immediately', '999 Ambulance' etc. There are too many to list! The nurses can also fall back on their years of experience, as well as advice from colleagues or the Clinical Supervisor. The CS is a senior nurse who manages the other nurses, and can give advice to other staff who may be unsure about a call.
I'm a Health Advisor. We are usually the first person you speak to when you call NHSD. It's my job to prioritise/triage calls so that they can be dealt with in order of urgency, just like at an A&E dept. We can also give interim care advice to help you deal with your symptoms while you wait to speak to a nurse. Depending on the urgency of your symptoms we can sometimes refer you straight to your GP, A&E, or Dentist/EDS without your ever speaking to a nurse. Sometimes it might even be necessary for us to call an ambulance for you. As well as all of this we can also find you a GP, Dentist/EDS or Pharmacist in your area, or arrange for one of our Health Information Advisors to call you back if you have a more complex query.
Health Information Advisors perform an important role in NHSD, one which the public are often unaware of. If you've been diagnosed with an illness, or there's a public health alert, or you need to know who to contact for information about any part of the NHS then the HI Team can help. They can send literature to you in the post, direct you to approved websites, and give you details of helplines and support groups in your area.
How does it all work then?
- You call 08454647 (0845 606 4647 from a textphone). When you get through I'll say "Good Evening, you're through to NHS Direct. My name's SSM and I'm a Health Advisor" The first thing I need to do is take your telephone number, and the address you're calling from. This is important in case we get cut off, or I need to send an ambulance. It seems impersonal, but it's necessary.
- I'll ask for a brief summary of your problem, ensure the patient is visible to you, then take their name and date of birth.
- I then have to ask five routine questions. This is necessary for every symptomatic call, so please do not bitch at me. These questions ensure the patient is conscious, that their airway, breathing and circulation are not compromised, and that the patient does not have a petechial rash that could indicate meningococcal septicaemia.
- I will then ask questions more specific to the patient's symptoms.
- These questions will enable the call to be given a priority (more on that soon). After I've accepted the priority (or upgraded/downgraded on the advice of a CS) I can complete the patient's chart
- If there's an existing chart for that patient I can link them up, if not I'll create a new one. I'll confirm the address and phone number, ptient's ethnicity and gender, and GP details.
- On the final screen I'll put in a call reason, the caller's name and relation to the patient, and a few notes.
- I'll give an estimated callback time, but always advise that the caller should call back if the patient's condition changes or worsens.
- P1 - caller in immediate danger, with severe breathing difficulties, heavy bleeding, chest pain, threatening suicide, in labour, meningitis symptoms, ingested toxic substance and vomiting/in pain etc. - these calls are dealt with immediately/by the next available nurse
- P2 - minor injuries, abdo. pain with diarrhoea and vomiting, fever, calf pain, mild chest/upper back pain, over 20wks pregnant with pain or bleeding, urinary problems, severe sore throat, heavy flu symptoms, swallowed toxic substance/foreign body but asymptomatic etc. - estimated callback within an hour, but in reality between 10 and 90 mins depending on how busy the service is.
- P3 - cold symptoms, stubbed toe, mild headache, vomiting, complex meds query, 'man flu', pregnancy symptoms under 20 weeks, teething, nappy rash, hives, heat rash etc. - callback time is anything up to 4 hours, but can range between 30 minutes-6 hours if it's horrendously busy.
- D1 - sudden facial swelling, heavy bleeding, unable to breathe, severe facial injury (next available nurse)
- D2 - Severe dental pain, pain relief tried and not working (within an hour)
- D3 - pain for more than 2 weeks, pain relief not tried or giving relief of symptoms, loose fillings or crowns (the possibilities are infinite)
OK, explanations and 'When to use NHSD' in my next post, I'm exhausted from all the typing, I feel like I'm at work!
Stay tuned.
Got to say it sounds like AMPDS in the ambulance srevice, which is the most rediculous thing ever thought up by someone whoh obviously has no medical knowledge.
You cant do seriously ill like this. Doctors need to be on-call. Therse things can not AND SHOULD NOT BE COMPUTER LED. It makesme mad to know the government is killing of the NHS in such an underhand way.
No disrespect to anyone working an NHS redirect but the whole system sucks.
Posted by
Iain MacBain - or maybe not!!?? |
3:16 am
CSPT is similar to AMPDS. We can override it, and obviously if we were only relying on CSPT then tghe country would be in chaos! A lot of it is down to critical thinknig, and discussion with CS/shift leads.
The main problem is that we were never meant to deal with serious injuries. The Govt. assumed that people would realise when to dial 999, when to see a GP, and when to go to A&E, sadly they don't.
Public education targeting misuse of A&E/999 always reaches the wrong people. The idiots who abuse the services always will do, and the sick, scared old people and young parents will call *us* because they're afraid they're 'wasting time' calling an ambulance when Little Billy has stopped breathing.
So, we're trying to be the umbrella that covers all eventualities, and unfortunately some people will get rained on, the umbrella's full of holes.
Luckily it isn't quite 'computer led' yet. There are still people there to make sure it all works correctly, but humans make mistakes too. If some GP practices weren't so underhand then the service would be a lot better. I'll post more about that later. It might only be a small percentage of GP practices, but that small amount can drastically weaken the system.
(sorry for length!)
Posted by
Sick Sad Minion |
3:27 am
Oh I meant 'serious illness *and* injuries', not just injuries.
Been a long day!
Posted by
Sick Sad Minion |
3:28 am
This is a really informative post SSM.
If you search for NHS Direct in Blogger, 95% of blogs slate NHSD; mainly because the writers are not aware of what NHSD actually is/does...
Posted by
Dory |
7:07 pm
Surely P3 should be told to go to their local pharmacy, especially as they'll have to go there anyway to purchase whatever you recommend.
And complex meds query should definitely be dealt with by pharmacists.
Posted by
UK Community Pharmacist |
9:52 pm
Dory - exactly. That's why I started the blog, because people seem very confused about our shadowy little organisation!
UCP - some discussion of that in my new post. 'Complex' in our case really only means a symptomatic "Can I give him Calpol and Calprofen together" or "I missed my Pill, what should I do?" scenario, or if a patient is on more than 2 medications and has a query. In hours we'll usualy refer them to a pharmacist, OOH there may not be one. (I particularly love sunday nights for that, yikes!)
Posted by
Sick Sad Minion |
1:04 am
Just a quick aside - Health Information Advisors now do most medication enquiries, such as interactions, and contraception enquiries, such as missed pill and EC, after extensive training with UKMi.
Just to clarify for UKCP - NHSD Nurses and HIAs have access to support from a pharmacist through a contract with UKMi in office hours, and if we are urgently concerned about a call in the OOH period we can contact an on-call community pharmacist.
Posted by
Dory |
2:33 pm
Yep, contracts with UKMi as well as Toxbase for any poisons/toxicity enquiries.
I keep forgetting that HI have been 'upgraded'. Ours are like ghosts, they're hard to pin down and oviously work different hours. As most of my work is at night I rarely see any HIAs!
Posted by
Sick Sad Minion |
7:00 pm
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