Sharing experiences of using Near Me in paediatrics services Follow up learning webinar Wednesday 24 June 2020, 2.00-3.30pm Please ensure your microphone and video and turned off Improvement Hub Enabling health and social care improvement
Lesley Macfarlane Improvement Advisor Healthcare Improvement Scotland
Microphones will be muted Microphones will be muted during the presentation. Please ensure your video is turned off. Use these buttons if you would like to turn on your microphone and video to ask a question.
Using the chat box Use the chat box to ask a question or share your thoughts.
Raising your hand You can also raise your hand to ask a question during the Q & A sessions.
Webinar recording This webinar will be recorded and everyone who registered for the session will receive a link to the recording. It will also be posted on the ihub Twitter account. @ihubscot
Clare Morrison National Near Me Lead Scottish Government
Near Me : enabling consultations by video Clare Morrison, National Near Me Lead, Scottish Government
Covid response: rapid scale up February w/c 7 June Technical Service Individual 300 calls/week 16,446 calls/week set up processes training
Setting up Near Me Technical Service Individual set up processes training
Training • Technical skills (how to use Near Me) • Video consulting skills (for clinicians) • Practices processes and other resources https://learn.nes.nhs.scot/28943/coronavirus-covid-19/remote-consulting
Functions bar
Mute sound/camera
Chat function
Share screen
Clinical examinations Changing camera direction: Use rear camera not selfie camera
Three way calls: adding Use invite button Add from waiting area
Three way calls: joining If you are a provider in the waiting area too Add from waiting area
Notify / receptionist role
FAQs Waiting areas: paediatrics or adult? Paediatrics guidance at tec.scot
Dr Fiona Barnes Associate Specialist in Paediatrics NHS Ayrshire & Arran
NHS Ayrshire & Arran Implemented Near Me in: Neurodevelopmental Follow-up Clinic What have been the enablers? What’s worked well? Staff support Allows multidisciplinary review We overcame our challenges by: What have been the challenges? • Trial and error Technological hitches! • Consulting with others using service Any top tips? Allow plenty of time
Neurodevelopmental Clinic Top Tips for Preparing to Attend Anywhere Ensure you have good Wi-Fi connection and that your device is well charged before the appointment. Ensure you have access to Google Chrome or Safari. Please use a well-lit room. This makes it easier for the clinicians to see your child accurately. Have your baby/child dressed in vest and nappy with their bare feet. This will help the physiotherapist to see exactly how they are moving. We may ask you to encourage certain movements with your baby/child so they need to be able to move easily and freely. We may need you to have your hands free to position your baby/child during the session. If so, please be able to prop your device securely so we can see your child when you’re not holding your phone/ tablet or laptop. It may be helpful to have a selection of toys available to motivate them during the session. Please do not record the session or take screenshots, unless discussed and agreed with the clinic team. Following the session, we will write up notes in your child’s records in the same way as we do following face-to-face appointments. In the event of any technical issues arising, a member of the clinic team will phone you.
PREPARATION!!!
Prior to consultation • Proforma • Portal • Growth Charts • Advice sheets from Therapists • BNFc • Phone numbers
Start of consultation • Chairperson – Clinician • Additional Staff enter waiting room as if patient (phone number) • Portal • ? Second screen • Time delay
During consultation • Introduction • Explain Procedure • Switch to phone if necessary • 2 Adults if possible • Patient to remain on call when staff member leaves
Be aware! • Chat function visible to everyone including patient • Bright clothing for twins • Allow enough time between patients for things to go wrong (which they will!)
Troubleshooting • Patient mic not working - Muted - Too many tabs open on phone/tablet • Patient camera not working - Zoom • Screen freezing - Refresh
Following consultation • Therapists e-mail report to be included in letter • Dictation • Proforma to scanning department for Portal • PMS • Letters and advice leaflets to parents
Dr Stefan Unger Paediatric Respiratory Consultant NHS Lothian
NHS Lothian Implemented Near Me in: April 2020 What’s worked well? What have been the enablers? • • MDT reviews of complex patients Internet connections outside hospital • • Children/Teenagers interaction Early log in by team/parents • • Efficient quick checks of medicines Direct contact prior to appointment What have been the challenges? We overcame our challenges by: • • IT - Internet connections/Parents cannot connect Feedback from parents/children • • MDT flow; Mixed NM/Telephone/FtF clinics Clinics from home (good internet) • • Cultural differences? MDT timetable -allotted time/good communication • • Incident that highlighted limitation of NM Preparation advice to parents/carers Plan going forward: Any top tips? • • Leaflet for children/young people Contact number • Wording awaiting sign off – 3 months trial period Clinic co-ordinator Design underway (Edinburgh Children’s Hospital Charity (ECHC)) • MDT timetable • Leaflet for parents / carers • Red flags
NHS Lothian Awareness of the limitations Paediatric respiratory examination during NM Example incident What’s possible What’s not possible Young person with CF • General • ‘Feeling’ whether a • Reviewed with NM/phone appearance child is unwell • Presentation later within 48hr to A&E • Skin rashes • Breathing sounds significantly unwell – leading to admission • Chest shape • Auscultations • Acute on chronic symptoms • Throat exam • Abdominal (limited) examination On review - red flags: • Work of breathing • Spinal examination • Previous DNA’s • Movement • ENT • Last review > 6 months prior to appointment • Mental health issues in the family
NHS Lothian Implemented Near Me in: April 2020 What’s worked well? What have been the enablers? • • MDT reviews of complex patients Internet connections outside hospital • • Children/Teenagers interaction Early log in by team/parents • • Efficient quick checks of medicines Direct contact prior to appointment What have been the challenges? We overcame our challenges by: • • IT - Internet connections/Parents cannot connect Feedback from parents/children • • MDT flow; Mixed NM/Telephone/FtF clinics Clinics from home (good internet) • • Cultural differences? MDT timetable -allotted time/good communication • • Incident that highlighted limitation of NM Preparation advice to parents/carers Plan going forward: Any top tips? • • Leaflet for children/young people Contact number • Wording awaiting sign off – 3 months trial period Clinic co-ordinator Design underway (Edinburgh Children’s Hospital Charity (ECHC)) • MDT timetable • Leaflet for parents / carers • Red flags
Dr Tushar Banerjee Consultant Paediatrician NHS Western Isles
NHS Western Isles What’s worked well? What have been the enablers? • • Effective Triaging Familiarity of parents to use app and software for • Previous experience of using Technology Assisted communication • Remote Consultation (TARC) Pre clinic personalised plan and Structured • Reduced DNA and waiting time in out-patient assessment What have been the challenges? We overcame our challenges by: • Lack of familiarity of using the system among some • Resilience and ability to use the system in diverse stakeholders setting • IT/Technological issues • Innovation of a scoring system that need further • Lack of detailed information in the primary care evaluation in bigger sample size referral Any top tips? • Aim to develop personalised management plan right from the triage level • Determine patient suitability using clinical criteria for Near me clinic • Explain to parents about the TARC, taking consent and to generate a realistic expectation • Working in partnership with parents, maintain professionalism and be a good listener • Have a telephone backup/chat box use/email in the event of a system failure
Panel Q & A
Dr Chris Driver Consultant Paediatric Surgeon NHS Grampian
Near Me and Paediatric Surgery in a Remote Environment Chris Driver Royal Aberdeen Children’s Hospital
What is remote? • remote can be… – geographical – social – transport link related
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