An important part of the preoperative or pre-procedure assessment process is giving the patient information about their operation/procedure and anaesthetic if required, and the things that they can expect to happen to them. Not only is this important for the person, but it is a requirement of the Care Quality Commission (CQC). It is expected that appropriate information is given to each patient, and that the healthcare provider can prove that the information has been provided. Failure to provide appropriate information and/or being able to demonstrate that it has been given can lead to a CQC improvement notice which obliges the health care provider to rectify the failings usually within a short time frame.
Many organisations hand out several patient information leaflets to a person who is attending the preoperative assessment department for a face-to-face consultation. It is not unusual for ten leaflets to be given to each patient. A form is then completed which records which information leaflets have been given to the patient. This form is then either filed in the patient’s notes, or kept in the preoperative assessment department so that the forms can be manually audited to demonstrate compliance with the CQC regulations.
Patients who do not attend the preoperative assessment clinic can be posted the appropriate leaflets and a similar paper record kept of which information has been given. These paper based information leaflets and audit processes are inefficient, expensive and difficult to review. If each leaflet costs 10p, then the ten leaflets will cost £1 with the additional cost of the form and the nursing time to give out the leaflets and complete the form. There may also be a postage and associated administrative cost. Auditing can only be done manually requiring an estimated five minutes per form; about one WTE admin staff member for 20,000 patients per year. The hidden costs of updating the leaflets, with a three yearly review, is considerable in terms of organisational effort.
A few Trusts have electronic systems using external providers who have standardised patient information which is regularly updated and reviewed against best practice and the latest evidence. These services have a substantial annual subscription fee which might be avoided where Ultraprep programs are used.
What Ultraprep offers
Throughout the Ultraprep programs there are links to external websites. The software of Ultraprep has been written to allow it to be extremely easy to add new links or change existing ones. It does not require any additional computer code and takes about one minute to update a link or add a new one. The clinical author of the algorithms has been able to insert approximately 140 external links to appropriate websites. This means that a patient can be provided with access to information about a range of diseases and conditions that they are asked about when completing Ultraprep. In addition, links are provided to information sources that are similar to the information given out in patient leaflets.
A healthcare provider is therefore able to demonstrate that if a patient completes an Ultraprep program they have been given access to electronic patient information in a similar way to being given paper leaflets. Ultraprep is able to audit which links are opened and by who, so that a Trust can be given audit data about the numbers of times their patients access certain websites linked through Ultraprep.
If a Trust or healthcare provider adopts this method of providing patient information, then they need to review the links and ensure that they are satisfied that the content provides the appropriate information. The links are presented in the Clinical Algorithm Sign Off Document, the CASOD. Secure access to this is given to a Trust once it has signed the Services Agreement to implement one of the Ultraprep programs.
The links are predominantly to NHS Choices and to the Royal Colleges patient information library. A patient is therefore able to read or print out any information they need. The benefit of using this method is that the information on these websites is regularly reviewed and updated and is free to access.
Using Ultraprep as the method of providing patients access to information and being able to easily audit this provides a cost effective way of achieving regulatory compliance with the CQC.
Links Built into MyPreOp
· Consent to treatment
· Eating and drinking before an operation
· Risks of anaesthesia including awareness, N+V, dental damage, sore throat, malignant hyperpyrexia, suxamethonium apnoea
· Pain after surgery
· Discharge from hospital
Medicines – NHS Choices
In addition there are multiple links to the wide variety of specific conditions that are asked about in MyPreOp e.g. angina, blood pressure, rheumatoid arthritis, jaundice etc.
The links are mainly to NHS Choices, the Royal College of Anaesthetists, the Association of Anaesthetists and the British Heart Foundation although there are links to other accredited sources of information. The links are regularly reviewed, checked and updated when required.