Administration revision notes

48 terms by Barbarosa 

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Stages involved in the procedure when a GP sends a patient to hospital as an Emergency Case

GP sees patient & decides needs to be admitted.
GP contacts admissions staff with patient details - name, sex, age, diagnosis & speciality.
Admissions staff look for a bed, agree with duty medical registrar/surgical registrar (whoever is responsible for admission on that day).
Patient is taken to hospital.
Patient details are entered onto PAS.
Medical records retrieved from MRD (Medical Records Department) or new records made up.

Elective Admission Process to hospital (ie from Waiting List)

Medical staff select patient from the waiting list,- this forms an 'admission list'.
Medical secretary/admissions department sends admission letter to patient, asking for confirmation.
Patient replies (or not).
Patient confirms or declines.
Details entered on PAS.
Medical staff informed.
Appointment for pre-assessment is sent or patient placed on suspended waiting list.
Confirmed admission list is printed and distributed (to all relevant staff/departments).
List of expected admissions are given to each ward daily.
Copies are also sent to the Records Dept. so case notes can be made available.

Emergency Admissions

Where the patient needs to be admitted immediately.
This may happen via, ED ( Emergency admission) (formerly A&E), An Outpatient Department - specialist decides patient needs immediate treatment, Through a GP - GP decides patient needs immediate treatment, From another hospital - eg if the local hospital did not have the right facilities to deal (specialist burns unit perhaps)

Ambulance driver passes on info to A&E receptionist.
Receptionist checks for any previous records for that patient.
Receptionist takes patient details - name, dob, GP, next of kin, details of injury.
Details entered onto PAS.
Triage nurse sees patient - assesses for urgency.
Doctor decides if patient needs to be admitted.
Doctor may refer to specialist for advice if necessary.
Special procedures followed if RTA victim - costs to be recovered from driver's insurance etc.
Special procedures for suspected non-accidental injury to child

Things an administrator may need to do when setting up a formal meeting

Agree date for the meeting .
Book a room/venue.
Book refreshments.
Organise/book any equipment required, -
Flip charts & pens?
Data projector, computer, screen for powerpoint presentation?
Videos?
Stationary?
Organise seating arrangements - sufficient chairs/required layout .
Send out Notice of meeting
Send out Agenda.
Organise/prepare any other 'papers' required, -
Handouts,
Reports,
Accounts.
Prepare attendance list, name badges, signs.
Prepare Chair's agenda.

On The Day of The Meeting

Arrive in good time.
Check all final details in place .
Check refreshments are organised.
Check spare copies of papers, badges etc available.
Check all required equipment present & working.
Check room layouts are as required.
Ensure all delegates/speakers have necessary papers.
Check water & enough glasses on tables.
Arrangements made to welcome any important quests.
Health and Safety checks - fire procedures, room exits clear etc.
Locate source of First Aider/kit.
Arrange for reception of late arrivals.
Sign in delegates & issue name badges

After a meeting has taken place

Ensure any remaining documents are removed & securely disposed of if necessary.
Tidy room - arrange for removal of refreshment debris etc.
Note date of next meeting.
Prepare draft minutes.
Give copy to Chair for checking.
Make any corrections required.
Send out final minutes to participants.
Note any actions to be taken & diary to check completed before next meeting.
File a copy of the final minutes in Minute Book

Suggestions to help deal with discord amongst a team

Develop an attitude of resolution.
Set the stage - plan your approach.
Arrange a time & place to talk.
Gain an understanding of the issues.
Listen actively and with empathy.
Generate solutions & shared win-win vision.
Test for satisfaction.

Features of an effective team

Have a common purpose or goal which all members are committed to achieving.
Take responsibility and accept credit for it's actions as a team, rather than individually, with each member taking responsibility for the achievement of the goals of the team.
Communicate effectively with each other.
Encourage new ideas & accept feedback from other team members.
Have shared power, recognise that they depend on each other an there is mutual support between members.
Learn to appreciate the diversity of knowledge that other team members to offer, so that everyone's input is valued & respected & members are not afraid to share opinions, ideas and suggestions.
Have a strong feeling of unity & commitment & high level of team spirit - each member working co-operatively with others.
Trust each other in order that members can openly and honestly express their opinions, feelings and disagreements.

Typical types of characteristics found in an effective team (Belbin)

PLANT - creative, imaginative & unorthodox - Generates ideas and solves difficult problems.
RESOURCE INVESTIGATOR - Outgoing, enthusiastic & communicative - explores opportunities, develops contacts.
CO-ORDINATOR - Mature, confident - a good chairperson, clarifies goals, promotes decision-making, delegates well.
IMPLEMENTOR - Disciplined, reliable, conservative & efficient.
COMPLETER FINISHER - painstakingly conscientious and anxious, searches our errors and omissions.
Others:
SHAPER - Challenging, dynamic, thrives on pressure. Has the drive and courage to overcome obstacles.
MONITOR EVALUATOR- Sober, strategic and discerning. Sees all options and judges accurately.
TEAM WORKER - Co-operative, perceptive and diplomatic. Listens and averts friction.
SPECIALIST - Single-minded, self-starting, dedicated. Provides knowledge and skills in rare supply.

Explain the term CPD

Continuing Professional Development

State the features required of appropriate objectives for CPD (in full - not just the mnemonic)

SMART -
Specific.
Measurable.
Achievable.
Relevant/Realistic.
Time specific.

Clinical professionals, in addition to doctors, with whom a medical secretary may need to liaise

Practice nurse/other types of nursing professionals.
Therapists - physio, occupational etc.
Phlebotomists.
Pharmacists? (clinical?).

Reasons which would justify a GP in removing a patient from his/her practice list

Unreasonable behaviour.
Substance abuse.
Violence towards staff.
Moves our of catchment area.
Irretrievable breakdown of patient/Doctor relationship.
Unrealistic demands from patient.

Ways in which information is shared internally within a hospital

Intranet.
PAS.

Things to check when handling the discharge of a patient from hospital

Patient informed of consultant's decision.
Pro-forma letter prepared.
Discharge letter prepared for GP - either posted/given to patient to hand over.
Copy of pro-forma letter to pharmacy for medication/dressings etc.
Ambulance booked.
Care plan discussed and arranged.
Patient advised by doctor on what to do at home.
Medications/dressings etc given to patient.
Follow-up appointment made.
Patient escorted to discharge area if appropriate.
Patient entered ad discharged on PAS

Examples of skills required of a medical secretary

Accurate word processing.
Medical Audio.
Communication skills - written & oral.
Administrative & organisational .

Examples of qualities desirable in a medical secretary

Friendly.
Team player.
Considerate.
Reliable.

Why it is important for a med secretary to have these skills & qualities

Is often the first point of contact with patients.
Is often a vital channel of information between healthcare team members.
Colleagues, patients & outside agencies all depend on his/her contribution to ensure the service for them.

Typical tasks undertaken daily by a med sec

Dealing with post.
Answering telephone.
Making appointments.
Typing letters.
Preparing clinics.
Managing diaries & more ( see syllabus/notes).

Important pieces of advice for a new assistant re: dealing with incoming post

Do not open letters marked "Confidential" unless authorised.
Check all envelopes carefully before disposing .
Be aware of what would be a "suspicious" package (almond smell, unusual appearance etc).
Pass on urgent mail immediately to recipient & draw their attention to it.
Date stamp all mail with date received.

The difference between Special Delivery and Recorded Delivery

Special Delivery quarantees delivery by a certain time and provides proof of delivery.
Recorded Delivery provides proof of delivery but does not quarentee delivery time.

Important points about answering the telephone well

Take name & number early so you can call back if cut off.
Use a special message pad to help ensure you get all important info
Keep a pen by the phone.
Speak clearly - not too colloquial/fast/quiet.
Put a "smile" in your voice - make sure you sound helpful & friendly.
Try to answer promptly - within a few rings.

Important points re: being accountable for cash at work

Keep records of all transactions.
Make sure you are accurate - check all calculations.
Keep financial matters confidential.

Important points when managing petty cash

Ensure petty cash vouchers are completed for every withdrawal.
Ensure receipts are attached to each voucher.
Keep cash in a locked box & in a secure place.
Keep the key separate & secure.

Important points re: stock control (eg stationary)

Keep accurate stock records - stock in/out.
Set minimum & maximum stock levels for each item stocked.
Always reorder when/before minimum level is reached.
Check stock frequently against records.
Have one/two people responsible for issuing stock.
Stock requisition forms can be used to help control & record issue of stock.

Extra responsibilities you may have as a secretary in private practice

Clinical - eg organise investigations.
Liaise with NHS.
Maintain waiting room etc.
Sending bills to patients.
Chasing up late payments.
Receiving payments from patients.
Keeping practice accounts (book keeping).
Acting as chaperone.
Ordering/managing supplies.
Managing the practice

Patient's route from GP (Primary care) to hospital (Secondary Care)

Patient visits GP, who decides to refer to a specialist.
GP writes to specialist & either request an appointment with the specialist.
Patient is given an appointment and attends Out Patient Department.
Specialist decides on treatment or surgery.
If patient agrees,Patient is put on Waiting List.
Patient placed on waiting list.
Patient called for surgery/treatment .
Patient attends pre-assessment clinic.
Admission.
Inpatient care or day-case.
Discharge or death.
Community support if necessary.
Follow-up clinic if necessary.
Discharge

4 different types of hospital admission

Elective.
Emergency.
Directly arranged by a GP.
Compulsory.

Hospital Case Notes

IDENTIFICATION SECTION, -
Hospital's name and code number (usually printed),
Patient's name & address, status, telephone No.,
Postcode,
Date of Birth,
GP information,
Name of consultant,
Hospital No.,
Patient's occupation,
Patient's religion,
NHS number,
Next of Kin information.

MEDICAL SECTION, -
For doctor's use only,
History of present complaint,
Past medical history,
Family history,
'Patient complained of...',
On examination...,
Differential diagnosis,
Investigations,
Treatment.

NURSING SECTION -
Observations of nursing staff recorded when patient admitted...
Nursing record,
Temperature,
Pulse,
Respiration,
Graphic records on special sheets (drugs, fluid balance, temperature/pulse/respiration etc.,
Blood pressure.
Micturition & bowel function,
Intake & output charts (record of all fluids taken orally or by transfusion and excreted),
Drug prescription chart.

CORRESPONDENCE SECTION-
Usually includes:
GP's referral letter,
Consultants' reports to GP,
Copies of letters to & from other consultants & professionals.

OTHER INFORMATION-
May also contain:
Prescription charge,
Social history,
Theatre/surgical operation sheet,
Consent form,
Anaesthetic form.

Procedures which must be carried out if a patient dies in hospital

A member of the team contacts patient's relative/representative.
Body is taken to hospital mortuary.
Dr informs patient's GP as soon as possible by telephone/lette.r
Administrator works with Dr responsible to ensure all essential procedures are correctly completed - including Death Certificate, hospital register of deaths.
Relatives of the deceased may visit/call and need to be dealt with.
supportively by administrative and medical staff.

Things to check before registering a new patient with a GP

Practice is taking on new patients.
Patient lives within required area.
Patient has fully/correctly completed registration form.

Things a medical secretary would typically responsible for doing with Primary care medical record

Scanning and summarising records for new patients.
Retrieving patient files for doctors to refer to in clinic (surgery).
Fling patient records away after use.

Differences between a group and a team

Team members work together towards the same goals : Group members may work independently with separate goals.
Team members communicate & share information/skills: Group members might not.
Team members support each other in resolving problems : Group members might not.
Team members are usually involved/consulted in goal setting/decision making : Group members may simply be allocated tasks, unaware of impact on the rest of the group.
Team members should feel encouraged to express their ideas/views : Group members may be cautious about doing this - afraid to ask questions.
Team members understand each other's role & contribution : Group members may be unaware of others' roles and therefore perhaps suspicious of each other's motives.

Examples of teams found in a healthcare setting

Primary Health Care Team.
Multidisciplinary Team.
Temporary team/task force.

Features of an effective team members

Work towards team & individual goals, have a common goal(s) to which all are committed.
Understand goals can be achieved using mutual support.
Members are consulted and use their talents & experiences to contribute to achieving team objectives.
Take responsibility & accept credit for team's actions jointly.
Each take responsibility for achieving team's goals.
Communicate effectively with each other.
Encourage new ideas.
Accept feedback from other team members.
Are likely to be involved in team goal setting & therefore feel motivated to helping to achieve goals.

Features of an ineffective team

Work independently - perhaps not towards the same goal(s).
May not be involved in goal setting/decision -making & therefore perhaps not highly motivated to achieve.
May be unaware of what others are doing.
May not communicate well - not fully understand what is happening within the group.
May be afraid to ask questions/say what they really think.
Lack support to help resolve.

possible causes of conflict within a team

A perceived breach of trust.
An unresolved disagreement escalates.
Miscommunication leads to misunderstandings.
Personality clashes.
Differences in cultural values/social background between members.
Underlying stress & tension.
A combination of the above.

Suggestions to help resolve conflict within a team

Develop an attitude of resolution.
Arrange a time & place to talk.
Set the stage - plan your approach.
Gain an understanding of the issues.
Listen actively and with empathy.
Generate solutions .
Generate a shared "win-win" vision.
Test your idea/solution out.

Benefits of teamwork in a healthcare setting

Everyone contributes/shares knowledge & skills.
Allows division of labour.
Everyone works towards the same goal.
Patients can less easily play one member off against another.
Communication is improved.
Enhances mutual esteem & allows people to learn about others.

ways in which a diary (paper or electronic) serves as a management tool

To record daily appointments.
Looking ahead to plan - eissug find a suitable time for a meeting.
Recording regular events - eg a monthly meeting (ensures that time is kept free etc).

Why it is important that secretary and doctor's diaries must link

to avoid double bookings happening.

Advantages of using a computerised diary system

Everyone involved can access the diary from a computer - so it can be updated remotely - avoiding the need to meet regularly to compare entries.
Administrators can access other excecutives' diaries - makes setting up suitable meeting dates easier.
Reminders can pop up on screen to help you remember meetings etc.
Can save time writing to other people to organise meeting dates - the system can automatically email their diary system and ask them to confirm or decline.
Less paperwork - no need to print off day's appointments if everyone has access to a computer.
Can be password protected for security.
Can highlight a conflict of arrangements - help avoid accidental double bookings.

Disadvantages of using a computerised diary system

Not everyone likes other people being able to access their diary.
There may be security issues around others having access to a person's diary.
The system may crash/malfunction.
Some people are not able/comfortable with computer use.
If information is not regularly updated, double bookings may still occur.
Sometimes what looks like "free time" in the diary may be when the person concerned intended to do quiet work - can be annoying to find a meeting scheduled in (can out overcome this by blocking out working periods).

Tips for successful time management

Prioritise (must/could/should or urgent/important - "Get the big rocks in first" etc).
Divide large tasks.
Use planning aids.

Examples of 'time stealers' at work (_'factors which may adversely affect workload management')

Interruptions by telephone.
Interruption by personal visitors.
Meetings.

Examples of planning aids

Diaries.
Schedules.
Action plans.
To do lists.

Informal admissions

Any person 16 years old or above may request to be admitted to hospital.
A person under 16 years can be admitted at the request/with permission of the parent or guardian.
Patients re free to discharge themselves if they wish...
Unless the doctor in charge decides that they would endanger their own health/safety or that of others.

Compulsory Admission & Detention

The Mental Health Act 1983-
Rules on the condition under which a patient may be compulsorily admitted to hospital.

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