Corporate Telehealth / Videoconferencing: Standard Operating Procedure Document Control Summary Status: New Version: v1.1 Date: April 2016 Author/Owner/Title: Candice Morris - Programme Manager Approved by: Policy and Procedures Committee Date: 15 October 2015 Ratified: Policy and Procedures Committee Date: 15 October 2015 Related Trust Strategy and/or Strategic Aims: Provide high quality recovery focused services Respect, inspire and develop our workforce. Implementation Date: October 2015 Review Date: October 2016 Key Words: Associated Policy or Standard Operating Procedures: Skype; Videoconferencing; Telehealth; Telemed Assistive Technology Policy Information Governance Policy Contents 1. Introduction... 2 2. Purpose... 3 3. Scope... 3 4. Getting Started... 3 5. Patient Consent... 3 6. Recording of Patient Activity... 4 7. Physical Environment... 4 8. Commencing VideoConferencing Session... 5 9. Note Taking During Consultation... 5
10. Risk Management... 6 11. Process for Monitoring Compliance and Effectiveness... 6 12. References... 7 Appendix 1... 7 Appendix 2... 9 Change Control Amendment History Version Dates Amendments V1.0 20/10/2015 SOP created V1.1 April 2016 Screen shot added to indicate how such appointments should be outcomed on Rio 1. Introduction Videoconferencing has been used within the Trust by staff for non-clinical purposes. Given that sites are geographically dispersed this has saved significant time and costs from a reduction in travel to attend meetings. The Trust Board has given their approval for clinicians to use video conferencing for clinical purposes through the use of Skype. The use of videoconferencing will further enhance access to services through offering more flexibility and choice. It is widely recognised that effective use of Assistive Technologies has the potential to improve patient experience and deliver cost efficiencies. New technologies offer opportunities on four fronts by: - Transforming the way health and care is delivered and managed, responding to the way people want to live their lives - Having the potential to make our health and care systems more sustainable in the face of demographic change, delivering cost efficiencies, supporting systems integration and transforming the way health and care professionals work - Supporting new and flexible ways of working in any field and helping people to better manage or extend their working lives - Creating potential to open up new markets in health and care. Page 2 of 10
This is a new SOP that should be read in conjunction with the Information Governance Policy. 2. Purpose This SOP outlines management arrangements and best practice to support staff in using Skype for clinical consultations. 3. Scope The use of videoconferencing via Skype is available to all staff and services within the Trust. 4. Getting Started Staff wishing to use Skype for clinical and non-clinical consultations must request for HIS to set them up with an SSSFT Skype user account to do this, please log a job via the Service Desk Portal icon on your desktop. Please ensure that you test you are able to log onto Skype (immediately following account set up) to reduce the risk of technical issues on the day of the appointment. If you experience any issues logging on, please log a job via the Service Desk Portal icon on your desktop. A screenshot of where to access the test call function is shown in Appendix 1. Directory of all SSSFT users, can be identified by their usernames ending in _sssft. More information can be found on the Skype website Frequently asked questions guide can be found in Appendix 2. 5. Patient Consent All patients will be assessed by clinicians as to their suitability of having a consultation via videoconferencing. Not all patients will be suitable and clinical judgment must be used to assess suitability and capacity to consent. All patients agreeing to use this method of communication must complete a consent form (which can be obtained as a separate document on the Trust website) which should be scanned into their electronic clinical record as appropriate. Clinicians need to alert patients that they will need to set up a skype account and must also provide patients with their own Skype details. Page 3 of 10
6. Recording of Patient Activity Patient consultations and reviews through videoconferencing is still patient activity and therefore the recording of appointments and the generation of clinical notes, letters and referral letters must still be recorded / stored on the electronic patient information system. See below for screenshot of how to record the appointment type on RiO. See below for screenshot of how to record the outcome of an appointment on RiO using Telemedicine Web Camera as the consultation medium. 7. Physical Environment The conditions of the environment should be no different to when clinicians see patients in face-to-face consultations i.e. Consultations should be delivered in an area where clinical discussion cannot be overheard by others (to ensure patient privacy) and where there is minimal noise disruption. There should be an agreement by all parties that, if there are other people present in either the patient or the therapist s room and that all parties are made aware. Ensure that the seating and lighting is comfortable and maximises clarity and visibility of the person at the other end of the video service. Make sure that the webcam is set up on a stable surface. Page 4 of 10
Ensure that any patient identifiable information isn t visible i.e. on whiteboards / noticeboards and that other patient files are not in view of the camera. Remove any posters, pictures or photographs that could be distracting behind you. Any unexpected or sudden noise should be explained by the patient / clinician in order to maintain confidence in confidentiality. 8. Commencing Video-Conferencing Session Please ensure you make your first appointment using Skype longer in duration to allow for initial set up. Clinicians should introduce themselves at the beginning of the consultation and ID badges must be worn. Clinicians must check the identity of the patient by asking them to confirm their full name and date of birth before proceeding with the consultation. If there is more than one clinician in the consultation, you should confirm to the patient which clinician will be leading the consultation. Clinicians must ask whether there are any other individuals present in the room with the patient and they must be identified and details recorded as necessary. Clinicians should ask the patient their present address (where the videoconferencing session is taking place) as this may be required in the event of a crisis / emergency situation. Clinicians must ask the patient for their contact telephone number and also provide them with a contact number that the patient can get hold of them on in the event that there is a technical difficulty and connection cannot be re-established. 9. Note Taking During Consultation If clinicians plan to take notes throughout the consultation, this should be explained at the onset as this might not be visible to the patient and could be distracting. Clinicians must ensure that any clinical notes taken during the consultation must be recorded into the appropriate clinical record after the appointment in line with the Trust guidance. In the event that there are any technical communication issues which cause a disruption to the clinical session e.g. network failure, then you should contact the patient within 5 minutes on the contact number provided. It is recommended that the clinician contacts the patient using a Trust landline / Trust mobile phone. The clinician should then use clinical judgement as to whether the consultation should continue via telephone or whether reconnection should be attempted. If reconnection fails, then the session should be re-arranged at a future date. All mobile phones and landlines must be on silent / off during sessions to avoid interruptions. However, in the event of a technical failure, both parties must ensure that mobile phones / landlines are switched back on so contact can be made. Page 5 of 10
Once sessions have ended, the patient contact should be blocked to prevent contact outside of planned clinical sessions. As is usual practice, service / team contact details and any other relevant information should be given to patients. 10. Risk Management Assessment and management of risk and emergency / crisis procedures In the event of an emergency or crisis situation, clinical judgement must be used and contact must be made with the appropriate services to ensure appropriate care of the individual. Some events may require the incident reporting procedure to be followed as per Trust policy. Patients who present with moderate-high risk behaviours and situations may not be suitable for this service. Nonetheless, all patients will present some level of risk, and will have a risk assessment conducted that is consistent with all clinical work conducted in the service. All patients should have been assessed as to their level of risk, the type of risk, their individual indicators of increases in risk and this should be reviewed at every session and documented on RiO. All clinicians must have access to an emergency contact from the service and should also have available emergency contact numbers for crisis services / Single Point of Access / Duty Systems. For any assistance, please contact the Trust Switchboard. The clinician is also responsible for managing appropriate behaviour during the session, and if the clinician becomes uncomfortable with the patient s behaviour or actions during the consultation they may either address this directly with the patient or decide to end the session. Ensure there is an appropriate contingency plan in place for the sake of patient or others. This must then be recorded and discussed during clinical supervision. Where a risk of i.e. domestic violence has been identified. clinicians may wish to consider agreeing with the service user a safe word or gesture which can be indicated at times when the service user is unable to talk freely or when another person is present in the room but this information will not/cannot be disclosed. The clinician will then need to steer the meeting to an appropriate end and make alternative arrangements to see the service user. 11. Process for Monitoring Compliance and Effectiveness Individual clinicians are all professionally accountable for the quality of the care provided via Tele-health/videoconferencing portal. Standards expected of doctors do not change simply because they are communicating through social media rather than face to face. (GMC Guidance Doctor s use of social media 2013 ). The process for the ongoing monitoring of the compliance to this SOP will be through: Audit Service user evaluation Meridian Page 6 of 10
Individual feedback at the end of each consultation (e.g. are they happy to continue using the portal or would they prefer a face-to-face appointment). The use of Skype for clinical consultations should be discussed through professional s supervisory processes. 12. References N/a Page 7 of 10
Appendix 1 Test call screen shot Page 8 of 10
Appendix 2 Tele-heath/Videoconferencing Frequently Asked Questions 1. Can I use Skype for clinical consultations? Yes, you can. This would be at clinicians own clinical judgement, taking into context your previous knowledge of the patient, risk issues and contingency plan in case of crises. Written consent must be obtained from the patient and/or carer. 2. Can I use Skype to participate or contribute into meetings/cpas about my patient? Yes. This should be agreed by professionals organising/participating in the meeting and with consent from the patient. 3. Can I use Skype to review my patient from other places other than their place of residence e.g. school, place of work, etc? Yes. So long as the environment does not breach confidentiality and meets conditions of usual face-to-face environment. 4. Can I use Skype to review/assess my patient from places other than my usual work base? Yes. So long as the environment does not breach confidentiality and meets conditions of usual face-to-face environment. 5. What if other people wish to sit in on the patient consultation i.e. family member? This should be no different to a face-to-face appointment. It will be your clinical judgement as to whether it is appropriate for others to sit in the consultation taking into account patient preferences. It must be agreed by both parties as to who is in room during the consultation at the onset. 6. Am I able to take notes during the sessions? Yes, this should be explained to the patient at the onset. 7. Can I contact my patient via Skype outside arranged clinical appointments? No. Patients must be contact by telephone or in writing as is normal practice. 8. Can my patient contact me via Skype outside arranged clinical appointments? No. Patients should contact the team/service on the numbers provided to ensure that their call is dealt with in a timely manner. 9. Can I hold a session with a patient if they are out of the country? Consultations should not be provided to patients if they are outside the country and, similarly, clinicians cannot provide consultations if they are outside United Kingdom. 10. What if I feel that the patient is at risk of self-harm or getting restless during the consultation? You must use your clinical judgement as how to best to contain the risk. In the event of an emergency/crisis, contact must be made with the appropriate services. Any decision to terminate the video link must be explained to the patient and you must ensure the appropriate contingency plans are in place. Page 9 of 10
Page 10 of 10 Telehealth / Videoconferencing SOP/October 2016