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Computer records and clinical systems are of great importance in your clinical work whatever your role but this blog aims to highlight the particular importance of using clinical systems effectively when working as a locum.
Use a personal login for clinical systems
We should all be using a personal login for clinical systems so that all actions are personally attributable, and this is now accepted practice - though I can still remember the days when I was logged in as “Dr Locum”. Smartcards make this process easier now, providing the practice has your smartcard details in advance to add you as an authorised user for the practice.
Working in a practice with an IT system you are not familiar with is an added level of risk which should be avoided if possible, unless you arrange separate training on the system.
Records may need to speak for you
As a locum you want to be confident that in your absence all your actions are objectively recorded and nothing is left to word of mouth. It’s always difficult to defend yourself against criticism when you are not there so records need to speak for you. This is relevant not just to the clinical consultation but any actions take outside of this such as handovers, referrals or delegation of tasks e.g. asking district nurses to take bloods from housebound patients. It’s sensible to record that these actions have been taken or are planned in the consultation record, and also to use the practice’s own clinical “task” or “messaging” system to follow these through so that a clear audit trail is available and attached to the medical record.
The embedding of communication within standard clinical systems reduces practice to practice variation and should mean that sending a message to a secretary in one practice can be done using the same process as in a second practice where the same system is used. However, there of course can still be issues like knowing which secretaries are in on which days and whether they share an inbox to ensure cross cover.
Many practices pass work to doctors via different parts of the I.T. system- like telephone triage requests, visits, electronic prescription requests, and so on. As a locum you need to make sure you know where these sit if you are being expected to deal with them. It’s also a responsibility of the practice to inform you of this via the induction.
Useful practice and locality information is often found on the practice’s intranet system and showing you how to access this, with password information where necessary, should be part of the locum induction.
You should be shown how to use self-populating referral forms which are generated from the record and use the latest consultation. Often these referral forms also include inclusion and exclusion criteria for certain services/pathways to help ensure you use services appropriately.
Digital dictation systems also often require a login and it should be part of the induction to provide this. Locums who are worried whether this system works well may wish to ensure their consultation is sufficiently detailed to be used as the referral letter or may wish to send their referral letter within a “task”/ message to the secretary. It may be advisable to send a task for every referral dictated anyway, to ensure that the secretary is aware a referral is intended.
Be clear about Electronic prescribing (EPS) before you start
Electronic prescribing has been a recent change and many practices are just getting to grips with this. The box of unsigned scripts is no longer the visible cue of unfinished work as EPS requests can still be sitting in your EPS inbox well after you have left the building, with you and the staff being unaware if there is not clear agreement as to whether this a routine part of a locum’s work.
Locums need to exercise caution in authorising scripts for patients they have not seen but as indemnity providers advise, it’s also important for you and the practice to explicitly agree whether you will handle EPS requests or not.
Request lab & radiology requests via ICE and managing lab results
It’s important that you are given access to ICE for requesting tests including radiology tests. This is also of value for reviewing lab results, especially ones done in hospital which may not have been filtered down to the GP record. I recently heard of an incident where a locum who didn’t have an ICE login asked the secretary to ensure a neck ultrasound was requested and the secretary instead requested a neck x-ray, an avoidable error had the locum been registered by the practice into ICE.
Practices need to ensure lab results are not placed in a locum lab “inbox” if the locum is not there, has not agreed to process results for other doctors or has not been given access to the labs inbox. All members of the team need to be aware of whether results can be reassigned to a locum in box, taking the above issues into account.
Explain to patients why you are looking at the computer and not at them
There is a well-recognised tension in the consultation between engaging with patient or with the computer. As locums we rely particularly heavily on the patient record for background context and history and so need to find a way to “sell” to our patients why looking at the computer is actually part of doing a good job. Having some standard phrases for our patient may help here:
“Now that I have heard your story, I want to make sure I know all the important facts about your medical history, the tests you have had and the treatments tried so I just need a few minutes while I have a look through your record if you don’t mind…”
“now that we have agreed what we need to do I would just like to take a minute to write all this down on your record so that the next doctor knows everything we discussed and you don’t have to start all over again next time you come, is that ok ?”
Who is around for advice?
Computer systems also have the added benefit of allowing us to see easily who is else is consulting in the building and who might be available for advice. If you really need advice urgently a then screen pop up messages provide an urgent way to contact colleagues without necessarily having to interrupt with a phone call.
Really useful practical advice from Paula. I will be using your standard phrases. Thanks again for your wisdom, Connie