3. Rapid Impact Assessment summary report

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1 Audit Risk Level: Medium (Risk level will be added by EQIA steering group) 3. Rapid Impact Assessment summary report Each of the numbered sections below must be completed Interim report Final report x (Tick as appropriate) 1. Title of plan, policy or strategy being assessed. Pre-operative assessment for breast surgical patients. 2. What will change as a result of this proposal? Currently all patients attending for surgery under general anaesthetic in breast theatres are preassessed in clinic by staff nurses using standard LUHT documentation. Preassessment is time-consuming and puts pressure on the service. Approximately 40% of patients having breast surgery are aged 55 or under and have no significant health issues (anaesthetic categories ASA 1 or 2), and are having minor to intermediate surgery. A new pre-operative assessment document has been developed for this group in compliance with NICE guidelines and LUHT recommendations which has be designed to streamline the process while eliciting all necessary clinical information. The main impact on patients is that they are requested to complete part of the document themselves before proceeding to a short clinical assessment with a nurse. Patients are shown into a quiet area for a short explanation and are given the opportunity to ask questions. They are then asked to fill in the patient questionnaire part of the document, with assistance if necessary. Any further questions arising are dealt with when the clinic nurse returns to complete the assessment process. It is anticipated that in due course patients who qualify for the shortened process will be assessed at the appointment when they are given the date for surgery thus avoiding a return visit for a separate pre-assessment appointment. The document is the result of collaboration between nursing, surgical and anaesthetic colleagues, and patient feedback has been taken into consideration. The document is currently being trialled and is being evaluated on an ongoing basis by the anaesthetic team. 3. Briefly describe public involvement in this proposal Patient feedback was sought during a short pilot and indicates a high level of acceptability. Some modifications have been made to the document and to the process as a result of the feedback. 4. Date of RIA 15 th April

2 5. Who was present at the RIA? Identify facilitator and any partnership representative present Name Job Title Date of RIA training Christine Wallis Programme April 2012 leader, sexual health (Facilitator) Laura Morrice Surgical nurse practitioner Laura Maguire Staff nurse Matt Royds Consultant anaesthetist Clair Baldie Consultant anaesthetist Alan Fisher Clinical effectiveness facilitator May Evidence available at the time of the RIA Evidence Available? Comments: what does the evidence tell you? Data on populations in need Yes Over-assessment in clinics not best use of staff time; inconvenient and timeconsuming for younger, healthier patients. Data on service Yes Inclusion criteria to guide patient selection. uptake/access Data on quality/outcomes Yes Ongoing assessment by anaesthetists indicates acceptability in terms of admission on day of surgery. Research/literature evidence Variations from standard LUHT pre-op assessment document currently in use throughout different areas of LUHT Patient experience information Yes Feedback sought from patients during initial pilot Consultation and involvement findings Yes Pilot versions of document amended according to patient feedback Good practice guidelines Yes NICE guidelines and LUHT recommendations complied with Other (please specify) 2

3 7. Population groups considered Older people, children and young people Women, men and transgender people (include issues relating to pregnancy and maternity) Disabled people (includes physical disability, learning disability, sensory impairment, long term medical conditions, mental health problems) Minority ethnic people (includes Gypsy/Travellers, non-english speakers) Potential differential impacts Patients >55 outwith inclusion criteria therefore older people unaffected. Children treated at RHSC therefore not affected. Younger patients (16-25) will tend to fall within inclusion criteria thus stand to benefit from streamlined process. No gender bias in the patient questionnaire. The pre-assessment process begins with the nurse introducing herself and going over the form and explaining what is required. A general offer of help with filling in the form is made. Patients with additional needs will be offered assistance as appropriate. Patients attending with interpreter would be given assistance with form by interpreter. Telephone interpretation services are available. If necessary a return appointment for pre-assessment will be arranged with an interpreter present as for the current standard process. Patients are not required to state ethnicity. This information is held on Trak. Refugees & asylum seekers People with different religions or beliefs Lesbian, gay, bisexual and heterosexual people As for minority groups Patients are asked to state their religion. The main implications or surgery are for Jehovah s Witnesses who do not wish to receive blood products. It is essential to identify this group with respect to obtaining informed consent and for planning surgical and anaesthetic management. Questions are neutral. People who are unmarried, married or in a civil partnership Questions are neutral. 3

4 People living in poverty / people of low income Homeless people People involved in the criminal justice system People with low literacy/numeracy People in remote, rural and/or island locations Literacy can be low in this group and patients will be offered help as appropriate see below. A generic offer of help is made at the beginning of the process and a nurse will support patients as appropriate with filling in the form. Carers (including parents, especially lone parents; and elderly carers) Staff (including people with different work patterns e.g. part/full time, short term, job share, seasonal) Carers may be involved in helping patients to fill in the form. They may themselves be affected by any of the factors which affect patients such as poor literacy. Patient accompanied by carer will be offered the same support by clinic nurse as patient attending alone. All grades & disciplines of staff involved in preassessment and admission on day of surgery need to be familiar with new document and process. OTHERS (PLEASE ADD): 8. What positive impacts were identified and which groups will they affect? Impacts Affected populations Patients fulfilling inclusion criteria spend less time in clinic Patients and in most cases should be able to be preassessed Carers without having to make a return visit to clinic for a separate appointment. This will be particularly beneficial for people with work or domestic commitments, people on a low income, those living in remote or rural locations and for carers who may have other demands on their time. Feedback indicates that patients are generally positive about the new documentation which it is hoped will engender a feeling of inclusiveness in patients own care planning. Regular consultation with the staff groups involved in preassessment and the planning and delivery of care has resulted in the development and refinement of a document Anaesthetic team Preassessment nurses Ward nurses 4

5 which is simple to use, clear to interpret and identifies all pertinent issues. There is a resulting service improvement in terms of significant saving of time in clinics without adversely affecting care delivery on the day of surgery. 9. What negative impacts were identified and which groups will they affect? Impacts Affected populations Patients are requested to fill in the form themselves. Patients with poor literacy Those with poor literacy skills may feel embarrassed or skills wish to conceal difficulties. The form is in English. Interpretation services are available to all patients as appropriate, but a return visit may be necessary if the patient wishes to have an interpreter present. These individuals are more likely to require full support to complete the form and may need a return appointment if there is pressure of time on staff. Non-English speakers, limited English proficiency. Disabled people 10. What communications needs were identified? How will they be addressed? People in the groups identified above may require assistance to fill in the form. Patients are seen in a quiet, private area to encourage them to express communication needs and a general offer of help with the form is made as part of routine explanation. Assistance is provided as required based on the patient s wishes and the judgement of the preassessment nurse. It should be possible to provide a list of common medical terms in translation for non- English speakers to assist with complete ting the form. This would be particularly beneficial for patients who normally communicate well in English but who find it more difficult if they feel stressed, or who do not know the English for medical terms. It is proposed that the most frequently requested interpretation services are identified to assess demand. 11. Additional Information and Evidence Required All staff groups concerned have been consulted with in the preparation of the document. It has now been extensively trialled and modified in response to feedback from patients, preassessment staff, ward nurses and the anaesthetic team, and is now in what should be the final version. Assessment is ongoing and communication has been kept open with all staff groups for further feedback. 5

6 12. Recommendations A further patient satisfaction survey following the introduction of the final version of the preassessment questionnaire should be carried out to confirm patient acceptability. Consider provision of medical terms in other languages. 13. Specific to this RIA only, what actions have been, or will be, undertaken and by when? Please complete: Specific actions (as a result of the RIA) Who will take them forward (name and contact details) Deadline for progressing Review date Assess use of translation services in breast clinic. Laura Morrice September How will you monitor how this policy, plan or strategy affects different groups, including people with protected characteristics? The working group will meet again at the beginning of June 2013 to review the project and assess whether any significant issues have arisen or any minor modifications are required. If indicated a date will be set for further review. Manager s Name: Laura Morrice Date: 30 th April 2013 Please send a completed copy of the summary report to: James Glover, Head of Equality and Diversity James.Glover@nhslothian.scot.nhs.uk Note that you will be contacted by a member of NHS Lothian s impact assessment group for quality control and/or monitoring purposes. 6

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