Introduction It has been NHS policy to actively share information between professionals for well over a decade. In England clinicians should send copies of their clinical letters to their patients. 1 This will give patients a written record of their consultation, the discussion, the decisions made and the reasons for making them. It will give patients the opportunity to read information that they might have misheard or may have forgotten, to reflect on the conclusions arrived at and to discuss them with important others such as friends and carers. It recommended including patients as a partner in their healthcare, encourage greater openness and transparency. There should be an assessment of the patient’s capacity to make decisions about …show more content…
An ‘Easy read’ is a presentation of information in a simple and easy to understand format involving short sentences and images. It is often useful for people with Intellectual disability and for people with conditions which affect the way they process information.3 Patients have a right to see or have copies of their records. The Code of Practice also states that it is important to recognise different communication needs of different patients such as with disability and difficulty in communication does not remove the obligation to help people understand.4 Aims 1) Ascertain the practice of copying clinical letters as per GMC guidelines, Royal college of Psychiatrist guidelines and code of practice from department of health. 2) To find if the implementation of the service improvement project ‘Easy read’ improved the team’s performance. Audit Standards 1)Department of Health (2003a) Confidentiality: NHS Code of Practice. pp. 212. London: Department of Health. 2)Department of Health (2003b) Copying letters to patients: good practice guidelines. 3)Royal College of Psychiatrists (2006) Good Psychiatric Practice: Confidentiality and information sharing (CR133). London: Royal College of Psychiatrists. 4)GMC: Good medical practice (2013) Methods The setting was Salford Intellectual disability team. All clinical letters for the month of
The Data Protection Act (1998) requires that personal details and information must be kept secure and confidential. Confidentiality is necessary in any Health and Care Social setting because it maintains between the individuals and the organisation. An environment of trust encourages people to be open and honest with those who care for them. They provide all the details necessary so that they receive the best care possible. The employers are accountable to the regulators for protecting confidentiality .Preserving privacy and confidentiality is essential so that they do not risk the discipline of being struck off a professional register. Each member of the staff has a responsibility to ensure that the care record are accurate recorded. A clear information will aid patients to participate fully in decision making about their
Throughout I will maintain all individuals who were involved confidentiality in accordance with Nursing And Midwifery Council; the code of conduct (NMC,2010) states that all practitioners must respect people’s right to confidentiality
The different reason people communicate is to show pain, anger, joy, love etc. It is important for people communicate so their views, wishes and information gets across. The communication could be formal or informal. Documentation and record keeping is important in the social care sector as this information may be used for legal reasons. All communications is confidential and are on a “need to know” basis. Communication between colleagues and other healthcare professionals is essential, as it ensures continuity of care. It also shows staff are aware of the current needs of the client.
I believe that patients have the right to decide what they intend to do for their future health care. Patients are not just people we give a bed to so they can die. They have plans that they intend to have laid out for themselves. As healthcare professionals, we must respect the patient’s
To begin the understanding of confidentiality, the author first provided readers with a formal concept analysis on confidentiality. He explained how confidentiality did not truly become a concept of interested until 1961, when the general nursing guides made a small mention related to the concept in regards to privileged
The need for older people to have their autonomy to make a decision and be an active partner in the decision making process must be recognised and is an essential component in person centred care. ‘’The older person and family have the right to make informed decisions about all aspects of their care and the nurse respects the level of participation desired’’ (An Bord Altranais, 2009). Nurses most realise the importance of patients participation in their care and strive to uphold it as a principle of person centred care, ‘’Lack of time and/or restrictions on patients choice and involvement, was listed as the number 1 factor to hinder quality nursing care’’ (An Bord Altranais, 2009). As nurses it is our responsibility to take the time to overcome communication barriers, for example, a hearing or speech deficit. The nurse can opt to use non-verbal communication to facilitate the decision making process for the patient. Patients are entitled to information about every aspect of their care and should be frequently updated. Information about management and prevention of conditions, procedures, assessments and investigations ,diagnosis, treatment, follow on care, referrals and services available to patients( i.e. health, social) should all be disclosed to patient (Department of Health,2001). If they
Within the health and social care setting there are numerous peices of legislation and codes of practice designed to protect individuals.These are there to protect from breaches of confidentiality were the information held on that individual is only viewed by staff directly involved in their care.
This act is vital to follow in a health and social care setting. The act controls how your persona information is used by organisations, businesses or the government. Information must be used fairy, lawfully and for limited, specifically stated purposes. It should be handled according to people’s data protection rights and be kept safe and secure. By protecting vulnerable adults, confidentiality is essential. If a service feels that they cannot express their feelings freely, without assurance or judgement that it will be in self-assurance, then patients may withhold necessary information that may be important to their recovery. Violating someone's confidence may also outcome in alternate conditions for the patient. For example, if the patient
All of the staff need to make sure that confidentiality is paramount. Staff have to read and understand the Data Protection Act of 1998. We have to make sure that we are clear about our standards of conduct, that we are expected to meet. We are encouraged to use the codes of conduct to maintain our own practice
People communicate for different reasons, to portray their feelings, emotions, pain, opinions, etc. The communication could be professional (formal), or personal (informal). It is important within a social work environment that information is recorded, as it may be called upon for legal reasons. All communications are confidential, and on a “need to know”, basis. Communication between colleagues is essential, so that it ensures a continuity of care for the client, and all staff are aware of the current needs of the client.
Therefore every care practitioner should endeavour to promote theses rights when dealing with services users and their relatives. Furthermore, it is crucial for service users to understand that any information they give will be with strict confidentiality. It is a legal requirement for health and social care services to keep personal data confidential.
Legislation and codes of practice that relate to handling information in social care settings e.g. Data Protection Act 1998, Freedom of Information Act 2000, The Health and Social Care Act 2001 (and subsequent amendments in 2006 and 2008), Human Rights Act 1998, Mental Capacity Act 2005, The Access to Medical Reports Act 1988 legal requirements and codes of practice for handling information e.g safe storage, need to know basis, recording must comply with policy and
Shared decision making should involve both health professionals and patients in discussions about their care. “While health professionals hold the expert clinical and technical knowledge, patients are experts about their own lives and treatment objectives, and also what is important to them when making decisions. (Lally, Macphail, Palmer, Blair and Thomsom, 2011).
(pg310 of ethics book). [Thie primary purpose of documentation is to provide patient information that might not otherwise be remembered between visits.](pg 2 journal of ethics]. [Records should be clear, concise, unbiased, free of abbreviation, legible, objective and accurate]. (Certificates pdf pg 6) Consultation – including those via telephone and outise operation hours – should include identification of who conducted the consulatation, date of consultation, name and contact details of the patient or proxy, relevant clinical findings and special instruction or advice (pg 6 of certificates pdf).
The three areas of the tutorial I notice that I am confident in, is Communication on the tutorial on the Conduct Written Communication 1 explains that written communications is better because it provides evidence, including letters, forms, taxes, emails, telephone messages, orders, and instructions for patients. Also, for a written document verifies that you are correcting the document by grammar check and that the spelling is correct. When making a mistake on a written document it can affect the facility, and a mistake can lead the patients from receiving the wrong dosage this can be life- changing; therefore, that is why written documents are important. The Conduct Written Communication 2 demonstrates how to label a letter, which includes