PATIENT INFORMATION LEAFLET POLICY

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1 Trust Policy and Procedure Document Ref. No: PP(16)090 PATIENT INFORMATION LEAFLET POLICY For use in: For use by: For use for: Document owner: Status: All areas of the Trust All Trust staff Patient Information Directorate of Nursing & Governance Approved Contents Page No Introduction.. 2 The NHS Plan The Disability Discrimination Act 1995 Your Guide to the NHS Roles and Responsibilities Leaflet production Leaflet content Reviews Record Keeping Leaflet format Checking conformity with the policy Leaflets produced externally to the Trust Monitoring... 4 References.. 4 Appendix 1 Toolkit for producing patient information Purpose of this Document To provide guidance to Trust staff to ensure that Patient Information Leaflets are clear and easy to read and produced in a standard Trust format that meets statutory requirements. Source: Clinical Editorial Group Issue date: November 2016 Page 1 of 15

2 Introduction The West Suffolk NHS Foundation Trust is bound by Government initiatives with regards to patient information. The key initiatives are: The NHS Plan: The plan states that Patients will have far greater information about how they can look after their own health and about their local health services 1 and that Patients will for the first time also have the option of having much greater information about the treatment that is being planned for them 2. The Disability Discrimination Act 1995: Requires us to ensure we have information available in different formats to ensure it is accessible to everyone. The relevant literature states that Since December 1996 it has been unlawful for service providers to treat disabled people less favourably that other people for a reason related to their disability. Your Guide to the NHS: States that The NHS will respect the confidentiality of individual patients and will provide open access to information about services, treatment and performance and All health professionals involved in your care will give you the information you want about your condition and medication. NHS England Accessibility to Information Standards The Accessible Information Standard directs and defines a specific, consistent approach to identifying, recording, flagging, sharing and meeting the information and communication support needs of patients, service users, carers and parents, where those needs relate to a disability, impairment or sensory loss. It is of particular relevance to individuals who are blind, d/deaf*, deafblind and/or who have a learning disability, although it should support anyone with information or communication needs relating to a disability, impairment or sensory loss, for example people who have aphasia, autism or a mental health condition which affects their ability to communicate. The aim of the Standard is to establish a framework and set a clear direction such that patients and service users (and where appropriate carers and parents) who have information or communication needs relating to a disability, impairment or sensory loss receive: Accessible information ( information which is able to be read or received and understood by the individual or group for which it is intended ); and Communication support ( support which is needed to enable effective, accurate dialogue between a professional and a service user to take place ); so that they can access services appropriately and independently, and make decisions about their health, wellbeing, care and treatment In order to comply with Government initiatives and to standardise leaflets that are produced by the Trust, this policy has been developed to set out the criteria, which must be met when developing information leaflets. [*d/deaf: A person who identifies as being deaf with a lowercase d is indicating that they have a significant hearing impairment. Many deaf people have lost their hearing later in life and as such may be able to speak and/or read English to the same extent as a hearing person. A person who identifies as being Deaf with an uppercase D is indicating that they are culturally Deaf and belong to the Deaf community. Most Deaf people are sign language users who have been deaf all of their lives. For most Deaf people, English is a second language and as such they may have a limited ability to read, write or speak English.] Roles and Responsibilities Authors Leaflet production Authors should read the Patient Information Toolkit (Appendix 1 on page 5) to familiarise themselves with the production process. This advice has been developed to assist with production Source: Clinical Editorial Group Issue date: November 2016 Page 2 of 15

3 (included in toolkit). A checklist has been developed to aid with the development of leaflets, to ensure all the relevant criteria are met. Leaflet Content Authors are directed to the Patient Information Author Checklist (page 15) to ensure their leaflet meets Trust requirements. The Patient Reader Panel and the Clinical Editorial Group are there to make suggestions to improve the effectiveness of the leaflet. Suggestions should never simply be dismissed. Reviews Authors/departments should review their leaflets regularly to ensure they are still correct and notify the Nursing & Governance Directorate of any changes required. Senior Clinicians and operational/clinical managers Checking conformity of the policy The senior clinician or operational/clinical manager (dependent on the topic) is responsible for ensuring this policy is adhered to on a day-to-day basis. Clinical Guidelines that are linked to patient information leaflets should carry the relevant reference number. Leaflets produced externally to the Trust From time to time, leaflets that have not been produced by the Trust may be given to patients (eg national organisations, Royal Colleges). Before distributing these leaflets, the clinicians involved must check that they fully support the contents, as any information given out remains the responsibility of the Trust. Directorate Nursing & Governance Leaflet production The Directorate will ensure that leaflets reach the minimum standards required by the Trust via the approval of the Clinical Editorial Group. Each leaflet produced will be available on the Trust s website, unless the author can justify the reason for not doing so. Record Keeping It is important that each leaflet, produced by the Trust, can be easily tracked for updates and reviews. Each leaflet will be given a reference number which is printed on the bottom or back page, along with the date the leaflet was issued and a suitable review date, usually 2 years hence. All leaflets are recorded on a database, which includes the following information: Reference number Title Original author and department Reader panel circulation, reviews/amendment information etc Date of publication Date of review Date ratified by Clinical Editorial Group Information regarding reviews/updates etc Whether the document has been published on the website Old versions of leaflets will be retained centrally within the Trust. Leaflet Format In order to ensure the leaflets are clear and easy for everyone to read, a Trust wide format has been developed following advice from the RNIB, the Trust s external PR consultant, and Ophthalmology. All leaflets will be produced using an A5 booklet style or 3-fold format and available in A4 format on the website. Source: Clinical Editorial Group Issue date: November 2016 Page 3 of 15

4 Monitoring If a patient requires the information in another format eg easy read, translated into another language, transcribed into Braille or created as an audio recording, please contact PALS for advice. The minimum content must be adhered to. The Clinical Editorial Group meets monthly to ratify new leaflets using the author s checklist for reference. The panel is there to make suggestions to improve the effectiveness of the leaflets and ensure that suggestions from the reader panel are not simply dismissed. The Clinical Editorial Group reports to the Clinical Safety & Effectiveness Committee on a 6-monthly basis. References 1 The Secretary of State for Health, 2000, The NHS Plan, HMSO, page 88, section The Secretary of State for Health, 2000, The NHS Plan, HMSO, page 88, section Department for Education and Employment, 1999, Disability Discrimination Act 1995: An Introduction for Small & Medium Sized Businesses: Rights of Access to Goods, Facilities, Services and Premises, page 2. 4 Department of Health, 2001, Your Guide to the NHS, page 3. 5 Department of Health, 2001, Your Guide to the NHS, page 3. 6 NHS England Accessibility to Information Standards, July 2015, p16 section Tips for printed communication; p55 Appendix A Overview of standard - scope Review and Monitoring Author(s): Grace Condliffe, Admin Manager, Nursing & Governance Directorate Other contributors: Members of the Clinical Editorial Group PALS/PPI Manager (retired) Deputy Chief Nurse (retired) Approvals and endorsements: Clinical Editorial Group Consultation: Clinical Governance, Health Records, IG Steering Group Issue no: 6 File name: O:\Pink Book Editorial Group\Policies - reviewed or published\pp(16)090 - Patient Information Leaflet Policy & Toolkit.doc Nov 16 Supercedes: PP(14) 090 Equality Assessed Yes Implementation Policies will be distributed by IG Manager via Trust intranet / internet / all departments. Monitoring: (give brief details how Implementation, compliance and effectiveness of this will be done) this policy will be monitored by the Editorial Group on an ongoing basis. Other relevant policies/documents Clinical Guidelines guidance & references: Additional Information: Source: Clinical Editorial Group Issue date: November 2016 Page 4 of 15

5 Appendix 1 Toolkit for producing Patient Information Contents Page No Introduction 6 Why is good patient information important? 6 Patient and public involvement 6 Record keeping 7 Who looks after patient information for the Trust? 7 Contacts 7 The Leaflet Journey 8 How to get started 9 Writing and editing the content of your leaflet 9 Top Ten Tips for clearer writing - plain English 11 Staff, patient and public involvement 12 Approval and publication 12 Formatting and layout of leaflets user guide 13 Patient information Authors Checklist 15 Patient information leaflet templates 17 Source: Clinical Editorial Group Issue date: November 2016 Page 5 of 15

6 Introduction These guidelines are provided to give a starting point in the production of patient information and are based on examples of good practice from other hospitals and trusts and have been designed to meet the Trust corporate identity guidelines. Why is good patient information important? It helps reduce anxiety, increases knowledge and confidence and improves the overall experience of the patient, their relatives, carers etc. It helps the patient/carer to remember what they have been told by the doctor, nurse or other professional. It gives the patient/carer time to read the information and think about the issues involved and make an informed choice regarding the treatment or health care that they receive. It helps to ensure that the patient is properly prepared for procedures or operations. It allows the patient/carer to understand and learn at their own pace, about conditions, treatments, procedures, examinations, surgery and services. It can also be used as reference for the patient/carer later on. It provides appropriate information to patients on the risks and benefits of the proposed treatment or investigation and the alternatives available, before a signature on a consent form is sought. It helps patients obtain additional information about their condition. Patient and Public Involvement The NHS Plan (Department of Health 2000) highlights the need for patient and public involvement in helping to improve service delivery and the importance of good patient information that is accessible to patients, relatives, carers etc, empowering them to make choices and to give informed consent (see policy). To achieve this, the Trust has set up a Patient Reader Panel. The Patient Reader Panel is a group of people who have experienced our services and wish to contribute to the work of the Trust. The aim of this group is to ensure that: Patients and the public are involved in the development of written information, providing a user perspective in the content and production of patient literature. The language used in leaflets is user-friendly, simple and easy to understand. There is a consistent approach to patient information across the Trust and a high standard of production is achieved. It is important that staff understand that comments and suggestions made by the Patient Reader Panel will help to ensure patients and the public are provided with professional, ethical and non-discriminatory information that is accessible, reliable, valid, jargon-free and user-friendly. Their comments should not be seen as negative or derogatory. Record Keeping It is important that each leaflet produced by the Trust can easily be tracked for updates and reviews. Each leaflet will be given a reference number (which is printed on the back page or footer) along with the date the leaflet was issued and a suitable review date, usually 2-3 years hence. All leaflets are recorded on a database, which includes the following information: Reference number and version number Title Authors name Source: Clinical Editorial Group Issue date: November 2016 Page 6 of 15

7 Department/area Patient reader panel circulation, reviews/amendment/status details etc Date ratified by Clinical Editorial Group Date published Date review due Whether the document has been published on the website Information regarding reviews and reissued versions Who looks after Patient Information for the Trust? Departments/areas are responsible for developing and updating any information they feel would be useful for patients. The Directorate of Nursing & Governance will co-ordinate with authors regarding all in-house patient information and liaise with staff and the Clinical Editorial Group to ensure the information meets the Trust standards. Contacts If you have any queries about patient information leaflets, please contact: Administrative Manager Directorate of Nursing & Governance Tel: x Source: Clinical Editorial Group Issue date: November 2016 Page 7 of 15

8 The Leaflet Journey This flow chart shows the path of a leaflet from original idea to final production Need for information leaflet identified by department/area Check that information does not already exist or is not available from other sources Read the Patient Information Toolkit Produce draft of leaflet or amend previous version Consultation with colleagues and amend where appropriate Send draft version (electronically) to Nursing & Governance Directorate Nursing & Governance Directorate check formatting and send to Patient Reader Panel for feedback Nursing & Governance Directorate liaises with author regarding comments/queries from reader panel and amends as necessary Final draft sent to Clinical Editorial Group for comment and ratification Leaflet given issue/review dates and final version sent to author for implementation. Information published on Trust website Source: Clinical Editorial Group Issue date: November 2016 Page 8 of 15

9 How to get started Read all the information in the policy; the information provided is brief and useful. There is a legal requirement to ensure that the information is accurate, up-to-date and based on the best available evidence. It is strongly recommend that you use the Authors Checklist as a guide from the beginning (page 15). This way the leaflet will almost certainly meet the Trust standards on the first edit. Produce an electronic document of the information you want to be included in the leaflet. This can be in an A5, 3-fold or A4 format. Leaflet templates are available, contact the Nursing & Governance Directorate on x3500 for advice. Leave plenty of time to consult colleagues, relevant groups/committees and any departmental patient/user groups. The Nursing & Governance Directorate will ensure the information is checked for readability, plain English and grammar etc: see Top Ten Tips (page 11). Writing and editing the content of your leaflet There are two types of leaflet, these are: Leaflets about procedures or examinations (including surgery); All other leaflets (e.g. rehabilitation, physiotherapy, diet sheets) For leaflets about procedures or examinations With the introduction of the Department of Health consent forms guidance (DoH Reference Guide to Consent for Examination or Treatment (second edition) 2009 and the implementation of the Trust s Consent Policy (PP113), Trust patient information items need to include: Comprehensive and sufficient information to enable patients to come to a decision about their treatment and give valid consent. If appropriate the leaflet should include: Information about their condition and about possible treatments/investigations. The risks, benefits and alternatives of any procedure, operation, treatment or investigation. (This may include statistics of death rates.) What kind of anaesthesia is likely to be used. The side effects and risks of having treatment or not having treatment. Additional procedures the patient may also require, eg blood transfusion or the removal of particular tissue. The preparation they need, what is going to happen, where they are to go, how they will feel afterwards, what happens after the procedure, how long they will be in hospital. Information about going home, the care or equipment they may need, what follow-up care will be required and if they need to see their GP. What can go wrong, what signs to look out for and what to do. What patients can do for themselves. When they can start their normal activities again, for example, driving, sport, sex or work. Who they can contact for more information. Other information sources eg leaflets, support groups and websites. To find out further information of what should be included in patient literature see the Department of Health toolkit for producing patient information: Source: Clinical Editorial Group Issue date: November 2016 Page 9 of 15

10 In addition, the Trust requires that your leaflet contains information in the following sections: What is.. (name of procedure)? A brief explanation of what the procedure does, eg an ERCP is a medical procedure which allows a doctor to take detailed X-rays of the bile duct and/or the pancreas. Before the procedure: Any instructions on dietary changes, medication etc and what will happen on arrival at the ward. The procedure: Explanation of what will happen during the procedure. What should I expect after the procedure? Brief information on what to expect, eg discomfort, pain levels, sleepiness after anaesthesia etc. How long will I stay in hospital? Anything from 1-2 hours to long stays. Make sure you include a warning that if complications arise patients may stay a little longer than expected. What are the risks? In-depth information is not required as patients should have already discussed this (a) with their GP; and (b) in clinic. A short sentence reiterating the most common risks will be adequate. What are the alternatives? Information of any alternatives to having the procedure/treatment, including the risks. If there are no alternatives, state that the alternative would be to do nothing. Discharge advice: How to identify deterioration in their condition, whom to contact and what action to take. It should also include information for patients who have had sedation, outlining what they should and should not do for 24 hours following sedation and pain relief and useful contact telephone number(s) where appropriate. What to do if your leaflet is not about a procedure or examination If your leaflet is about rehabilitation, for example, make sure it is logically set out clearly and reads well. All information MUST: Be in plain English with minimal use of medical terms Be brief and to the point Do not: List medications specifically by name use generic names Include names of staff - only job titles Intellectual property Intellectual property is any new material, produced by mental activity, which has not yet been published by any other person. It can include items such as inventions, industrial processes, software, data, written work, designs and images. Reference should be made to any existing Trust policy dealing with intellectual property. Whilst copyright is automatic in any published work it is suggested that all leaflets contain the copyright symbol, which reinforces that the leaflet is the copyright of the Trust. It is vital however to be aware of infringing the rights of other authors and producers. Be careful not to break the rules of copyright and intellectual property. Permission should be obtained before using any text from other publications and there should be acknowledgements of material used to prepare the information item. Some organisations may ask for a fee, this can be up to 200/ 300 for the use of their information. Consider your target Varying experience of the NHS and how it works, from healthcare professional to someone with little or no experience of healthcare. Varying comprehension of scientific terms and explanations; use simple language, avoid scientific/medical language and jargon. Source: Clinical Editorial Group Issue date: November 2016 Page 10 of 15

11 Varying stress levels: some patients are calm, accepting and optimistic about procedures, others can be extremely worried. Make sure the level of detail is appropriate and use passive phrases. Be short, be simple, and be human Remember Over one million people in the UK have sight problems. Seven million people have difficulty with basic literacy and numeracy. One million people have learning difficulties. Two million people may not be able to read English. Formatting Use a minimum font size of 12 point or preferably 14 point (which is readable by a significantly greater number of people). Use a clear, uncluttered and sans serif font such as Arial. Align text to the left margin and avoid justifying text. Ensure plenty of white space on documents, especially between sections. Avoid squashing text onto a page and, if possible, include a double-space between paragraphs. Print on matt and not gloss paper. Use page numbers. If a patient requires the information in another format eg easy read, translated into another language, transcribed into Braille or created as an audio recording, please contact PALS for advice. The minimum content must be adhered to. Top Ten Tips for clearer writing - plain English These tips are reproduced from a Plain English Campaign guide to writing medical information. These are recommendations, not rules: be flexible! 1 Think of your audience, not yourself Don't try to impress people by using your language to show off; keep it as straightforward as possible. Imagine you are speaking to someone and write in that more relaxed way. 2 Use short sentences A good average sentence length ('ASL') is 15 to 20 words. Use shorter ones for 'punch'. Longer ones should not have more than three items of information; otherwise people get overloaded and readers lose track. 3 Be careful with jargon Jargon is very useful, but only if people are familiar with it. Be prepared to explain your jargon words and acronyms - will your audience know them? 4 Use 'active' verbs mainly, not 'passive' ones Using the active is shorter and clearer; using the passive can be longer and sometimes confusing. Try to write 90% in the active. The other 10% you may find the passive more suitable. 'A report will be sent to your doctor.' (passive) 'We will send a report to your doctor.' (active) 5 Don't underline or use colour It is tempting to do this, but it achieves very little. It can be distracting, making the text harder to read. Source: Clinical Editorial Group Issue date: November 2016 Page 11 of 15

12 6 Use lower case bold for emphasis Block capitals are hard to read, so don't put text in upper case. Use lower case bold. For headings, if need be, use large lower case bold. 7 Put complex information into bullet points Plan and draft your writing. If you have a lot of information to convey, make it easier for the reader by breaking it up into logical 'stepping stones'. 8 Use everyday words Big words, foreign phrases, bursts of Latin and so on usually confuse people. Consequently, it is a sine qua non of plain English not to write too polysyllabically! So, for plain English, use everyday words. 9 Write small numbers In text, write numbers one to nine as words; for numbers 10 and upwards, use the figure. But be flexible. Probably with medicines it is clearer to write 'Take 2 tablets 4 times a day.' 10 Use the 'personal touch' Any organisation, however grand, can quickly become 'we'. Then the 'customer', 'client' or 'patient' simply becomes 'you'. For example, 'An information helpline is also operated by ABC Hospital Trust for the convenience of patients.' can be written 'We also operate an information helpline for your convenience.' Staff, Patient and Public Involvement Consult your colleagues about your leaflet; they will have useful comments to make and should agree the content. A useful forum for this would be departmental meetings. If you are a healthcare student (medicine, nursing, allied professions), a fully qualified staff member in your area must check your leaflet for clinical accuracy and sign your Author s Checklist. your leaflet to the Administrative Manager for the Nursing & Governance Directorate who will arrange for your leaflet to be sent out to the Patient Reader Panel. The panel members will be looking at whether the leaflet is: easy to understand contains sufficient information free from jargon medical terms are clearly explained written in a logical order useful to patients who receive it Comments/suggestions from the Patient Reader Panel will be feed back to you for consideration and amendment where necessary. Approval and publication Submission to the Clinical Editorial Group Once a leaflet is in final draft the Nursing & Governance Directorate Administrative Manager will: Check to ensure that the leaflet has a reference number and that the details are on the database. Check to ensure that the formatting and font styles used throughout the body of the leaflet (i.e. the section headers and the body text) are compliant with Trust policy and ensure consistency of layout throughout the leaflet. Submit the leaflet to the Clinical Editorial Group for review and ratification. The group will ensure that the leaflet complies with the appropriate Trust policies and with the Patient Information Authors Checklist. Source: Clinical Editorial Group Issue date: November 2016 Page 12 of 15

13 Give the leaflet, if approved, an issue and review date; this is usually on the back page. Provide the author with a final master copy for their use/records. Convert the leaflet into an A4 PDF document which will be made available on the Trust s website (unless the author does not feel this is appropriate); Leaflet reviews A review date will be set, which will be in a maximum of three years and a minimum of one year from when the leaflet was approved by the Clinical Editorial Group. Reviews should be initiated at the appropriate time by the author/department responsible for writing the leaflet. Patient information which has not been reviewed within an acceptable timeframe will be removed from the website, as the information may be out of date. If any information needs to be amended at any time (eg due to changes in national guidance or service provision) please contact the Nursing & Governance Directorate and/or send the amendments to the administrator who will ensure that all the records and website are updated. Formatting and layout of leaflets user guide The purpose of this user guide is to explain how to create an electronic patient information leaflet. If you have any queries regarding formatting your leaflet please contact the Administrative Manager for the Nursing & Governance Directorate on x3500 for advice. Leaflets in A5 format (using Microsoft Word or Publisher) or 3-fold format can be used for patients. Leaflets in A4 format (using a Microsoft Word) will be used for publication on the Trust website and can also be used for patients if you wish. Templates for creating leaflets can be supplied by the Nursing & Governance Directorate please contact as above for advice. It is advisable to use Microsoft Publisher if your leaflet/booklet will be 8 or more pages in an A5 format. Remember to keep the layout simple so that it is clear and easy to read and understand. Remember to save any changes when you have been working on your leaflet. Details regarding the leaflet source (ie department/area), reference number, issue and review dates will be entered by the Nursing & Governance Directorate prior to sending out to the reader panel or Clinical Editorial Group. All leaflets will be the copyright of the West Suffolk NHS Foundation Trust. Entering the content of the leaflet Patient information leaflets may obviously vary considerably depending upon their purpose and content. However, it is important that they are as simple as possible and so it is recommended that the basic structure should consist of a main heading (i.e. the title of the leaflet) followed by one or more sections, each of which is preceded by a section heading. This is illustrated as follows: Patient Leaflet Title Introduction/Procedure Text Risks/Benefits/Alternatives NB: This section must include the risks of the alternative treatment. Also if there is no alternative please include a statement to this effect. Source: Clinical Editorial Group Issue date: November 2016 Page 13 of 15

14 Treatment/Procedure Text Complications Text After Care/Discharge Advice Text on after care/discharge advice; please provide advice or use standard statements suggested below: o You will be given a Post Procedure leaflet which will explain after care and what to do after your discharge. o Useful contacts for practical help post discharge. (eg support groups, websites, helplines) o Medical concerns If you have any medical concerns, contact the ward, your GP or if you would like to discuss your concerns with a qualified practitioner call NHS 111. For further tips on writing your leaflet, please see Top Ten Tips for clearer writing (page 11). Leaflet numbering When your draft leaflet is completed, send an electronic version to the Administrative Manager for the Nursing and Governance Directorate for this next stage. All patient leaflets have a unique reference/version number which identifies the leaflet and its issue number. These reference numbers will be entered and managed by the Nursing and Governance Directorate. Each leaflet has an issue date and a review date. The latter date indicates the date by which the leaflet should have been reviewed by the author/department and revised if necessary and re-issued. Alternatively, the leaflet should be withdrawn if it is out of date or no longer in use. Source: Clinical Editorial Group Issue date: November 2016 Page 14 of 15

15 Patient Information Authors Checklist Author: Trust Code: Title: FORMAT 1. Has the leaflet been produced in the Trust format? 2. Does the leaflet have a Trust reference number? 3. Does the leaflet have a date of issue? Yes No N/A 4. Does it have a suitable review date? (maximum review period 3 years, 12 months recommended for new leaflets) 5. Has a copy of the leaflet that this one replaces been provided for archiving? (for reference in case of legal claim) State location: PI Database, Nursing & Governance Directorate CONTENT 6. Does the leaflet provide information on any preparation required? 7. Does the leaflet provide a clear and simple explanation of the procedure/treatment? Yes No N/A 8. Does the leaflet describe any risks involved with the procedure/treatment and offer any alternatives? 9. Does the leaflet provide discharge advice, what to do when the patient goes home, whom to call if they experience problems? 10. Does the leaflet provide information on how to get to the hospital, if appropriate? 11. Is the leaflet free of discrimination? (gender, age, religion etc.) COMPLIANCE WITH CLINICAL GUIDELINES 12. Does the leaflet content reflect the approved Clinical Guideline on the procedure concerned? Guideline: CONSULTATION Ref. No: 13. Have all interested parties been adequately consulted and does the leaflet represent the consensus view (including those who must apply the leaflet to their daily work)? Yes No N/A Yes No N/A Groups consulted: (please give job titles) 14. Has the leaflet been checked for readability and plain English by the Public & Patient Reader Panel and have their comments influenced the leaflet? 15. Has a copy been passed to the Clinical Editorial Group? Author Signature: Date: NB: If you are a healthcare student (medicine, nursing or allied professions) a fully qualified member of staff must check your leaflet for clinical accuracy and sign below: Name of qualified member of staff Signature Approved by Clinical Editorial Group Print Name: Date Signature: Source: Clinical Editorial Group Issue date: November 2016 Page 15 of 15

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