Task Messages for bloods, investigations, medications etc

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ASHCROFT LEADS

  • Doctor:   Dr Ramesh Mehay 
  • Nurse: 
  • Admin:  

DATE REVIEWED:

19th July 2019

DATE OF NEXT REVIEW:

July 2020

The Policy/Protocol

It’s really important to communicate to non-clinical staff carefully.  For example, with blood results, they will often pass on a message to the patient on our behalf.   The quality of the message they send depends on the quality of the message you send them.   Please do not leave it to staff to second guess what you are trying to say clinically.   Also, make sure that you are specific.  Don’t say things like “a routine review” or “needs to see doctor” – be more specific – review with doctor in 2 weeks.   ANd don’t use a range like 2-4 weeks – make your mind up, should the patient come back in 2 weeks or 4 weeks?  And finally, think of the patient who may get really anxious if you do not phrase things considerately.     So, rather than saying “needs to see the doctor” – which may get the patient worked up, consider “Tell the patient – not to worry too much.  Come and see the doctor within 4 weeks and we will talk about it”.

When sending task messages to your admin staff, a good rule of thumb is to write messages in the way you want the admin person to speak to the patient. Write as if you are writing to the patient.

Why's it so important? Well, imagine this scenario...

  • Receptionist phones patient.
  • Receptionist: ‘Hi, Mrs. XXX, Dr GGGG would like you to book in for a repeat blood test and then review with a doctor.’
  • Patient: ‘Why, what’s wrong?  I only had one done two weeks ago.  Why does he want another?’
  • Receptionist: ‘I can’t really say to be honest because he hasn’t said.  All I can say is that he wants you to have a blood test and then see him again?’
  • Patient: ‘Well can I have one for this week please, and then I want to see Dr GGG straight away after.  Oh my goodness, I hope nothing serious is going on.’.
  • Receptionist: ‘Unfortunately, it’s difficult for me to say.  Look, I’ve got an  appointment with nurse YYY in 3 days time and I can squeeze you in with Dr GGG next week?  I haven’t got anything sooner I’m afraid’
  • Patient: ‘Okay, I’ll book that nurse one please, and I’ll see if you have any cancellations when I come in, otherwise I might just have to see the emergency doctor.  I’m so worried now’.
  • Receptionist: ‘Okay, I’m sorry I could offer more detail’.
Let’s see what we achieved.   We created a worried patient.  We made the receptionist feel uncomfortable and incompetent.   And we clogged up the system – because the patient now plans to unnecessarily come to emergency surgery.  All of this could have been avoided if you had phrased things differently.  And what was the scenario?  LFTs with a very mildly abnormal AST.    

If the doctor had written in the following in his message task to the staff member, may be the patient wouldn’t have got so worried or booked unnecessary emergency appointments…. ‘One of your liver tests was slightly high.  It’s nothing to worry about at this stage as it can be common.  Let’s repeat it in 2 weeks’ time and come and see me 2 weeks after that.’ 
 

Learning points…

  1. When tasking admin staff to make contact with a patient, it is easier to write in a way that tells them exactly what to say.
  2. If a patient has to do something (book a blood test, see you again etc), always state the time frame eg in 2 weeks’ time.
  3. If a patient doesn’t need to worry, say so at the end of your message.  It’s unfair to keep patients in unnecessary anxiety.
  4. If a test is important to get done – says so.   “nothing to worry at this stage but it is important to get the test repeated again in 2 weeks’ time” 

We've created a database of messages (below) that you can 'cut and paste' into your task to save you time...

Cut and paste any message from below into your SystmOne task message – be it for prescriptions, health advice or anything else.   These task messages are worded in a way that tells admin staff exactly what to say.  In that way, no one is confused, the message is clear, and the staff can feel confident in what they say.  

Here is an easy peasey way of “cutting and pasting”

  • Triple click on one of the lines below (with your mouse) – it will select all that message.
  • Use CTRL-C (press CTRL then C) to copy that message.
  • Then place your mouse where you want to paste the copied message
  • Use CTRL-V (press CTRL then V) to paste that message into your systmone text box.

BLOOD TESTS

  • ALT:
    One of your liver tests is slightly high. The others are normal. This is nothing to worrying about at this stage. However, it is important to get it repeated in 6 weeks’ time and to see the doctor afterwards. Please arrange to have this done.
  • BLOOD TESTS ARE BACK
    Your blood tests are back.   Have  you arranged a review appointment with the doctor within the next 2 weeks?
  • CHOLESTEROL HIGH (new)
    Your cholesterol is high. Don’t worry too much but please speak to the nurse about a low-cholesterol diet if you have not already done so. Hopefully, we can get it down if you start a low-cholesterol food regime.
  • CHOLESTEROL STILL HIGH
    Your cholesterol level is still high. Please can you come and see the doctor for advice and to discuss within next 6 weeks,
  • DIABETES/PREDIABETES
    Nurses – please can you put on register, recall and counsel about diet +/-treatment.
  • eGFR slightly down
    The blood test for your kidneys is not as good before. However, it can go up and down, and therefore, we need to double check it in 2 weeks. Please can you arrange to have it repeated. Nothing too much to worry about at this stage, but it is important to get it repeated.
  • eGFR markedly down
    (Red flag the message)  The blood test for your kidneys is not as good before. It’s very important to get this repeated as soon as possible – in fact, within the next 1-2 days.  Please make sure you do not eat a heavy meat based meal 6 hours before the test.  If you feel unwell in anyway, please come and see the emergency doctor.
  • FATTY LIVER
    The scan shows you have a fatty liver. Normally, not much fat is seen within the liver. This might suggest you have quite a bit of fat inside your body which is quite dangerous for your health. Losing weight & getting more fitter will help you.  Please come and see the doctor about it. 
  • GLUCOSE:
    Your sugar test is a little high. We need to do another more reliable test to check for diabetes. Sometimes, sugars can go up and then down. So, at this stage, not to worry too much.
  • HBA1C 42-47
    Your sugar test was a little high. This does not mean you are diabetic, but you are at risk of becoming diabetic in the future. Speak to nurse to have a yearly blood test (HBA1C) and a diet to control your blood sugars better.
  • HBA1C>47 (one reading)
    HBA1C: Your sugar test was high which could mean you are diabetic.  We need to double check the result.  So, please book in with the nurse to repeat the blood test.   Also make an appointment with them afterwards to discuss the second set of results.  This is important.
  • HBA1C>47 (two readings)
    HBA1C: Your sugar test was high on two occasions now so it is likely that you have diabetes.  It is important that you book an appointment with the nurse who will explain more about diabetes and why we get so worried about it.  You will need to be regularly monitored from now on.
  • HBA1C>59 in KNOWN DIABETIC
    Your HIBA1C diabetes blood test is too high for a known diabetic.   It is important that you make an appointment to be seen at the diabetic clinic within the next 2 weeks.
  • REPEAT TEST
    Unfortunately, the last test you provided was unusable and sometimes this just happens.   Please can you arrange to get another one sent off. We are sorry about the inconvenience.
  • SCREENING – NO RESPONSE
    We’ve noticed that you have not attended for your invitation to the bowel cancer screening programme. It’s a really important programme that could potentially save your life one day.   You only have to do it once a year.  If you want to be part of it, please ring us to get you back on the list.
  • TSH LOW on Thyroxine
    Your thyroid test suggests your dose of thyroxine tablets needs to be lowered. Before we do this, please can you speak with the GP – either book a telephone or physical appointment within the next 2 weeks.
  • TSH NORMAL on Thyroxine
    Your thyroid test is normal, please stay on the same current dose of thyroxine.
  • TSH HIGH on Thyroxine
    Your thyroid test suggests your dose of thyroxine tablets need to be increased. Before we do this, please can you speak with the GP – either book a telephone or physical appointment within the next 2 weeks.
  • U&E
    The blood test for your kidneys is not as good before. But it can go up and down and therefore we need to double check it in XXX WEEKS. Please can you arrange to have it repeated. Nothing too much to worry about at this stage but it is important to get it repeated.
  • VIT D <20:
    Your vitamin D level is very low. Don’t worry, it isn’t serious but it can generally make you feel tired, low in mood, with a few general aches and pains in your muscles and bones. Therefore, please come to see the doctor within the next 4 weeks to talk more about this.
  • VIT D 21-75 :
    Your bloods show a slightly low vitamin D level – this isn’t something to worry too much about. It can cause tiredness, low moods and aches in the body. So, please ask your local pharmacy for some vitamin D tablets. They are cheap.

INVESTIGATIONS

  • BONE DENSITY
  • We have your bone density scan report back and it looks like you have weak bones. Don’t worry about this too much for now. But it is important that you come and see the doctor within the next 6 weeks to talk about it and what can be done.
  • BP READINGS (HOME)
    Please can you ring this patient and let them have a BP machine for a week and tell her how and what to record.  
  • CXR – LRTI
    Your chest x-ray showed an infection. The antibiotics you have been given should clear it up. If you have not got antibiotics, please come and see the emergency GP. However, the x-ray department will x-ray you again in 6 weeks. It’s very important to get that done and then see the GP 2 weeks after.
  • H PYLORI TEST +VE
    Dear patient, please can you come in and see the dr about your stomach test results within the next 4 weeks.  You have  a little bug which isn’t serious but does need treating.  
  • X-RAY JOINTS OA
    The joints that were x-ray’d show signs of wear that is common with age. If you’ve pain that is difficult to cope with, please make a doctor’s appointment.

URINE RESULTS

  • URINE TEST – UTI – no symptoms
    Your urine test suggests you may have water infection. However, if you do not have any urinary symptoms (like pain or burning), we suggest we repeat the urine test in a week’s time, before we consider treatment.  The body can clear most urine infections within a week if you drink plenty.  
  • URINE TEST – UTI  – unsure if any symptoms
    Your urine test suggests you may have urine infection. Don’t worry too much but please discuss this with your GP as you may need treatment for this. You can book a telephone consultation which may be easier for you.  In the meantime, drink plenty of water.
  • URINE WCC++
    Your urine needs repeating. It shows a few cells that shouldn’t be there but can often be a result of a recent water infection. We just need to repeat it to make sure it is gone. Please can you bring another sample in two weeks’ time.

MEDICATION TASKS

  • ANALGESICS/OTC:
    Dear patient, You may also find it helpful to know that you can buy many medicines over the counter (like Gaviscon, Paracetamol, Ibuprofen etc) without the need for a prescription from your GP. Please talk to your pharmacist about it.  It is now advised that these should no longer be prescribed on an NHS prescription.
  • BACK UP MEDICATION eg FOR HOLIDAY
    Dear Patient, It is practice policy NOT to provide a backup supply of medication for ‘just in case’ scenarios (e.g. calpol for children on holiday). If you need these, you can buy them from local chemists abroad.   Alternatively, if you do become ill, see a doctor abroad.  Otherwise it is a waste of NHS resources. 
  • COUGH MIXTURES
    Dear patient, in line with of GP practices, we no longer prescribe cough mixtures on the NHS anymore because the research shows they do not provide much benefit.  If you still want a cough mixture, we suggest you buy it from the chemist. Your local pharmacist will be able to help you.
  • GTN OVERUSE
    Dear patient, it seems that you are using this medication frequently.  Please make sure you see  you GP for a review as soon as possible.    Come to see the emergency doctor or go to A&E if your chest pains have become so frequent.  If three is any chest pain not relieved by the GTN, remember, call 999.
  • Rx NOT ON REPEAT
    Dear Pt, You have requested medication not on your repeat prescription list.   Unless a doctor has told you to continue taking it repeatedly, you should not be taking it again and again.  Speak to a Dr if you still require it.
  • Rx NOT ON REPEAT:
    Dear Pt, You have requested medication not on your repeat prescription list.  Just because you might have had it in the past doesn’t mean you can have it again without further discussion.  Speak a doctor if you still require it.
  • PARACETAMOL
    Dear patient, You may also find it helpful to know that you can buy many medicines over the counter (like Gaviscon, Paracetamol, Ibuprofen etc) without the need for a prescription from your GP. Please talk to your pharmacist about it.  It is now advised that these should no longer be prescribed on an NHS prescription.

MISCELLANEOUS

  • DNA 
    Dear patient, it is our practice policy to remove patients who fail to turn up to a total of 3 appointments in a year.   We do this because appointments are so precious and we have other patients complaining they cannot get in!   Your missed appointments could have been given to someone else in medical need if you had cancelled in time.   So, please consider this your final notification that we will remove you if there is anymore non-attendances where you do not cancel in advance.  It is a shame we have to write in this manner, but please do think about those who are desperate to see a doctor and cannot get in.

PLEASE LEAVE A COMMENT BELOW IF YOU THINK ANY OF THE ABOVE COULD DO WITH A WORDING TWEAK. EVEN BETTER - PLEASE RE-WRITE WITH YOUR VERSION. THANKS

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