I take your point that guidelines can be abused by management,
and that the sheer quantity of information is a problem. But is that an
argument for allowing chaos(where it exists)and ever increasing demand
to continue unchecked? The introduction of IT should aid the medical teams
to do their job. That includes using the most up to date information
available on best practise. If the IT systems/guidelines being used don't
reflect and support the actual practise of medical teams then obviously
something is at fault somewhere and one of the possibilities is that
the medical teams are guilty of not following best practise. (Other
possibilities obviously exist, e.g. medical teams not having the resources
to follow the guidelines, management somehow preventing change in
guidelines to meet the needs of the medical teams, etc.)
It is already the case that nurses work to protocols and there is an
assumption that they will work to protocols in the future(whether
implicit or explicit). Indeed in many cases Nurse practioners do refer
to a documented protocol to decide their pathology requests on a day by
day or even case by case basis. At least in one busy area in the hospital
medical teams are successfully coping with detailed documented protocols/
guidelines, regular updates, liaison etc. - so its not so impossible. Also,
in the A&E department they have up to 300 hypertext guidelines available
to medical staff (primarily intended for junior doctors) which cover most
aspects of 'how to deal with a particular presentation of medical
conditions'these are referred to only when guidance is required, but
nevertheless are readily available. Nearly all the nurses I have
interviewed appreciate and want better/more information to work from.
Most, if not all, pathology departments must be faced with the fact that
there are unnecessary requests for investigations and that they can only
get to the required information to identify some of them. Nurses and
Consultants I have interviewed almost universally agree that there is
considerable unnecessary requesting of pathology investigations. Many
believe this is primarily driven by Clinical Governance issues. I have
yet to determine if the junior doctors are the guilty parties or scape
goats.
Peter
Pathology Workload Officer
On Fri, 17 Jan 2003 12:01:57 -0000, Reynolds Tim (RJF) Burtonh-tr
<[log in to unmask]> wrote:
>One interpretation of the trend towards guidelines is that they are not
>there for the benefit of staff to ensure that they know the correct
>procedure: Management knows that there is no way any one individual could
>read, digest, understand and remember all of the policies and guidelines in
>place at any one time (millions of pages, given that computers now allow us
>to be as verbose as we like, without wasting any real trees); let alone
keep
>up with changes. Furthermore it would be impossible to check the guideline
>every time a procedure is carried out.
>
>The real function of guideleines is to allow an individual transgressor to
>be blamed when an error occurs, thus off-setting the institution's blame on
>an unwitting scapegoat.
>
>
>TIM
>
>***************************************************************************
*
>*********
>Prof. Tim Reynolds,
>Clinical Chemistry Department,
>Queens Hospital,
>Belvedere Rd.,
>Burton-on-Trent,
>STAFFORDSHIRE,
>DE13 0RB,
>UK.
>tel: 01283 511511 ext. 4035
>fax: 01283 593064
>email: [log in to unmask]
>alternative email for the all too frequent occasions when the NHS email
>connection doesn't work:
>[log in to unmask]
>
>***************************************************************************
*
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