Evening all 
I'm sure you are all basking in the sun...and for those deep in the depths of a factory...I'm sure the nice warm weather is bringing out the "what's the legal max work temperature???" question.


This question is not about the health record but the medical record!
apologies for lengthy email but there are a number of issues which are all pertinent to this situation,

I have inherited a company where they have had an "OH nurse" for a number of years and I am seeking some advice before I upset the HR chap completely...."no I don't have a safety pin for your buttonless trousers" was my starter for 10! the next was..."no that ear syringe will not be required any longer!" I half filled a wheely bin with leaflets on topics such as bacterial vaginosis and contraception....need I say more in this century!?...maybe I should take my knitting next time!
that sets the scene!

The medical records are not quite what I am used to..I took 20-30 at random ...given the filing system was...M goes with M, P goes with P but not in any recognisable alphabetical order!!! so Parker is filed between Pool and Preston!
lets not start with the invisible calibration certs or notes of consultations for each individual written in the diary rather than filed in individual notes! no fitness/outcomes of surveillance certs. (health records- as opposed to medical records)

Starting with the resp surveillance...there may be one baseline questionnaire (if I am lucky) which do not appear to have dates on! then several general result sheets which have details of cholesterol, BM on they do detail height however- the height measure is set with the 6 inch mark 3 inches from the floor!- so height is probably wrong!..and the only surveillance result on this form is FEV 1% and is written as % predicted all above 100% given height measure error- no surprise there then!
...no FVC, No FEV1 no actual readings - no print outs- sorry I lie...one set of print outs in 20/30 notes- obviously blank because they weren't photocopied as recommended on all trainings since year dot! again no dates!

All my notes from training say that a questionnaire should be done and the actual amount blown out documented so I can compare this year to next! As well as in depth questionnaire I always write all height, BP, actual measurements, effort, number of blows, seated/nose clip etc as well as document actual amounts blown when dealing with resp and on audio- I document details of auroscopy, category, referral to GP etc.


Audio- there are print outs of audios which are bekesey- all thrown in a drawer together - not in OH files...high insight...may not be able to find them due to shoddy filing system! Again no questionnaires, obviously any wax was dealt with by the nurse!

noise regs say 

"At the baseline examination it is important to obtain information about the individual’s job, previous noise exposures and medical history (see example questionnaire in Appendix 6). At all subsequent tests the individual should be asked about any changes in personal circumstances, work patterns and noise exposure, and any complaints relating to the ears or hearing. If changes are indicated, previous records should be revisited and amended as necessary." 

if this occurred it isn't documented.
courses I have attended for both toics in the past 10 yrs have always talked about the questionnaire, its implications on results etc 

questions- again one leads to another!

practical=does anyone have guidance on how to convert/interpret audio results as I will need to compare with the pure tones my machine does? I cant find anything with google and all my training is in pure tone not bekesey and books I have read on audio interpretation has shown pure tone graphs without zigzags!

how is Noise reg statement above interpreted by others? do others complete an audio a questionnaire each time?
most providers I work for expect one!

Is there any definitive quotable guidance which says questionnaires should be done in lung function each year?

Im sure I know the answer to this but...

Is just writing FEV1% (ratio) as percent predicated acceptable as health surveillance result?

I have the recent standards of practice on spirometry but that will not help with advising that the previous nurse did/did not follow current best practice- anyone direct me to older standards of practice which support the previous nurses practice?

Before I advise  the company in relation to standard of notes and claims which may be difficult to dispute I need to be sure of my facts!

Jacqui

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