PHA 221 Flashcards
pharmacy law and ethics
what is a remote consultation?
= a type of consultation between a patient and healthcare professional that involves a complete episode of care which does not need face-face contact.
examples of remote consulting
- telephony
- video consultation
- online ‘written’ consultations - online questionnaire
Cons of remote prescribing
- delayed or missed diagnoses
- over or under investigation of patients
- increased burden for clinicians to make judgement remotely
- reduction in therapeutic relationships between patients and clinicians
- missed opportunity to identify subtle cues during face to face consultations.
benefits of remote prescribing
- save patient time, reducing the need to travel
- patients who are digitally literate and happy to consult remotely
- patient groups who experience difficulty with social interactions
- may find it easier to explain their symptoms using online consultations tools or explain embarrassing problems in a remote prescribing setting
The CONSULT Guide
Consider - whether the consultation is remote or not
Organise - and check if technology is in place
Necessary - ensure all necessary info is to hand
Start - initiate the consultation effectively
Undertake - work through the consultation
Listen - consider patient needs and agree next steps
Terminate - close the consultation appropriately
CONSIDER
- is video call clinically required? - dermatological issue
- is a phone call sufficient? - new meds phone call is appropriate
- does the patient have capacity to participate?
- is a remote consultation of any benefit?
ORGANISE
- What software or hardware is required? - lighting / confidentiality
- is the connection stable and appropriate?
NECESSARY
- Have you got all necessary info to hand?
- Do you need any additional paperwork or info?
- Do you have a consultation open? - record info in the moment
- note which method of consultation you used
START
- identity check - age, name, date of birth
- Location - safe space to talk, private space to talk, check location
- Call back methods - check how to contact the patient if tech fail, advise call back
- Check - hear clearly, visual assessment
- Acknowledge- help build rapport
- Inform - share you are taking notes, let them know of any other screens
UNDERTAKE
- usual structured process - idea , history taking, expectations, concerns
- Consider if appropriate ‘in the moment’ - face to face appointment
- Regular check in - if patient needs any support
LISTEN
- Consider patient preference
- shared decision
- document any preferences and next steps
TERMINATE
- summarise and check
- check patient understanding
- ask if they need me to clarify anything
- any questions
- make patient aware you are ending the call and wait for them to disconnect first
PACE mnemonic - managing emotions
Probe - discover what the issue is
Alert - try to progress if the patient is shouting
Challenge - state the terms of the consultation
Escalate - following through on your statement
Principle 1
- patient safety = first priority
- consider if remote prescribing is appropriate
- raise concerns if the device or system your are working in does not have adequate patient safety safeguards
Principle 2
- understand how to identify vulnerable patients and how to protect them
- any safeguarding or capacity concerns - makes remote consultations less appropriate
Principle 3
- tell patient your name, role and professional registration details
- establish a dialogue and make sure patient understands how the remote consultation is going to work
- patient history and potentially face - to face appointment
Principle 4
- explain you can only prescribe if safe to do so
- can’t prescribe without sufficient info about patient
- if you can’t prescribe because its unsafe - signpost to other services or offer face to face appointment
Principle 5
- obtain informed consent and follow relevant mental capacity
- test of materiality when obtaining informed consent
Principle 6
- undertake an adequate clinical assessment access medical records or test results
- physical exam based on presenting symptoms
Principle 7
- give patient info about all options available - patient friendly language
- also include options that aren’t appropriate via remote methods
Principle 8
- appropriate arrangements for aftercare
- unless patient objects - share all relevant info with other healthcare professionals involved in the patients care
Principle 9
- keep notes that fully explain and justify the decisions you make
- may include refusing to prescribe if further assessment required for the patient
Principle 10
- stay up to date with relevant training, support and guidance when consulting in remote context
