Junior Doctors Duty/On Call Policy CLP005 Table of Contents Junior Doctors Duty/On Call Policy CLP005... 1 Why we need this Policy... 2 What the Policy is trying to do... 2 Which stakeholders have been involved in the creation of this Policy... 2 Any required definitions/explanations... 2 NHFT... 2 S1... 3 NCTL... 3 Key duties... 3 Chief Executive... 3 Medical Director... 3 Clinical Tutors... 3 Team Managers... 3 Medical HR... 3 Clinicians... 3 Nominated Clinical Team Leader... 3 Policy detail... 4 Incidents when On Call Doctor should not be contacted... 5 TELEPHONE CALLS... 6 ESCALATION PROCESS... 7 Palliative Care... 7 Responsibilities and Accountabilities... 7 Training requirements associated with this Policy... 8 How this Policy will be monitored for compliance and effectiveness... 8 For further information... 9 Equality considerations... 9 Reference Guide... 9 Document control details... 10 This document is uncontrolled once printed. Please refer to the Trust intranet for the current version. 1
Why we need this Policy As part of the Government s New Deal for Junior Doctors hours and European Working Time Directive, Trusts are obliged to reduce the number of calls made to Junior Doctors while on call. The actual working times out of hours have to be strictly followed to comply with these regulations. Any calls to the on-call doctors counts towards their working times including their travel to and back from Hospital. This is monitored for breeches by the Medical Staffing Department on a regular basis. The doctors on call at night have already done a full day s work and they are available out of hours to work. Good planning during normal working hours should reduce the need to call the duty doctor to finish routine ward work. All calls to the doctor on-call are now filtered through the nominated Clinical Team Leaders (NCTL) when available and when unavailable the nurse in charge of the team/ward will make the decision. The current on-call system in the Trust is a non-resident on-call ie. the on-call doctor is not resident in the hospital during the out of hours period. The doctor is required by terms and conditions to reside within a distance of 30 minutes or ten miles by road from their principal place of work unless an employing organisation agrees that they may reside at a greater distance. The trust provides accommodation to those junior doctors living outside this parameter during their on call period. In the event of medical emergencies where immediate medical attention is required, emergency services (999) will be contacted by the ward staff and the patient will be transferred to the nearest general hospital for immediate attention as appropriate. What the Policy is trying to do To provide Junior Doctor s with guidance to the on-call processes within NHFT. The following are intended as guidelines. Patient care clearly takes precedence over any issues that can be dealt with at a later stage. It is expected that the On-call Doctor will display good judgement and reasonableness in determining which call to deal with first. Which stakeholders have been involved in the creation of this Policy Medical Staffing Committee Trust Policy Board attendees Any required definitions/explanations NHFT Northamptonshire Healthcare NHS Foundation Trust This document is uncontrolled once printed. Please refer to the Trust intranet for the current version. 2
S1 Systmone NCTL Nominated Clinical Team Leaders Key duties Chief Executive The Chief Executive has overall responsibility for the implementation of this policy. Medical Director The Medical Director has delegated responsibility for the implementation, dissemination and monitoring of the policy. Clinical Tutors The clinical tutors have the responsibility to ensure this policy is covered in the Junior Doctor induction programme, and to monitor compliance. Breeches will be investigated in conjunction with local process. Team Managers Team Managers need to ensure all relevant staff have read and understood the policy and that the policy is kept in an easily accessible place. Team Managers need to ensure all breeches (eg. Where the Doctor does not follow policy) are reported as per Trust policy. Medical HR Medical HR have the responsibility to ensure they have read and adhere to this policy. Clinicians The clinical staff need to be fully aware of this policy and the processes within it. Clinicians should be trained in Trust approved tools eg. NEW s, to support their decision making when requesting the on-call Doctor. Nominated Clinical Team Leader Berrywood Hospital and St Mary s Hospital have a NCTL on duty at all times. The NCTL is the person nominated each shift as being responsible for the management of the hospital site out of hours. Rotas detailing the NCTL for each hospital site are kept at Berrywood Hospital Reception. As part of their responsibility out of hours, the NCTL is required to screen all ward requests for the duty doctor to determine if any other action could be taken. This document is uncontrolled once printed. Please refer to the Trust intranet for the current version. 3
Policy detail The on-call system is for emergency and urgent calls. Examples are as follows (however the list is not exhaustive): Access to Out of Hours Trust Policy If junior doctors need to access the Trust Policy Out of Hours this can be done using their Trust laptop and logging onto www.nhft.northants.nhs.uk Psychiatric/Medical Inpatient Emergencies Medical staff should only be called when someone is injured or medication and/or advice is needed. For serious self-harm attempts please refer to existing policies (CLPr008 Safe Use of Ligature Cutters and RH002 Incident Reporting Policy). The Trusts Resuscitation Policy CLP002 should be followed and the appropriate number used to call the emergency services. Deterioration in Medical (NEWS) and/or Psychiatric Condition ie. a change in a patient s mental or physical health which would cause the patient unreasonable suffering if not dealt with until the next routine visit by the Ward Doctor during working hours. Refer to Physical Healthcare Policy CLP070. The Prescribing and/or administering of Rapid Tranquilisation. The Rapid Tranquilisation policy MMP011 as per national guidance (CG25) requires that where a patient needs to be given rapid tranquilisation that the doctor should attend the ward within 30 minutes of being called. Where a patient needs rapid tranquilisation out of hours the junior doctor on call will be called and will be expected to attend the ward irrespective of the time of night. The doctor will assess the need for Rapid Tranquilisation, prescribe medication and be available following administration in case of complications. Physical Restraint The duty doctor is required to attend within 30 minutes of a patient being physically restrained in the prone position. They are required to attend to undertake a review of the patients physical condition and also facilitate a post incident review with the nurse in charge of the ward. The arrival of out of hour s admissions. The doctor should not be called routinely about a new admission before the arrival of the patient to the ward. Seclusion All staff must adhere to the Trust s CLP007 Seclusion Policy. Patients admitted out of hours. The junior doctor should ensure the following should be carried out in addition to the Mental Health examination: physical examination (using Minimum Standards for Physical Examination Policy CLP049) This document is uncontrolled once printed. Please refer to the Trust intranet for the current version. 4
Assessment of VTE (Policy for Primary Thromboprophylaxis (VTE) MMP016) Medicine Reconciliation and Prescription (Medicines Reconciliation Policy MMP034) Where the decision is taken to seclude a patient, the duty doctor should be notified at once and should attend immediately (within 30 minutes of being called) unless the seclusion is only for a very brief period (no more than 5 minutes). An initial multi-disciplinary review of the need for seclusion should be carried out as soon as practicable after the seclusion begins. If it is concluded that seclusion needs to continue, the review should establish the individual care needs of the patient while they are in seclusion and the steps necessary to bring the seclusion to an end as quickly as possible. Overdose/Unfamiliar Medication If a situation arises when a patient has taken an overdose (either intentional or unintentional; i.e the wrong dose or wrong patient administered medication). The junior doctor may be called for advice. For unfamiliar medication the doctor should check the BNF or online resources to obtain further information about the medication. The doctor on call can phone the consultant on call for further advice or clarification. The doctor on call can contact the National Patients Information Service (Toxbase) on 0844 892 0111 or www.toxbase.org. They will provide a patient specific action plan and advice on monitoring. Incidents when On Call Doctor should not be contacted Out of hours calls to doctors are channelled through the NCTL when available and when unavailable the nurse in charge of the team/ward will make the decision. In general the on-call doctor should not be called unless there is compelling reason to call immediately. Common examples are given below: Prescription Charts staff administering medicine should be aware when space is running out and bring this to the Team Doctor s attention. Staff should also ensure that medication charts are signed and dated before the end of the shift. The duty doctor should not be called to rewrite a prescription chart unless the existing chart exposes the patient to significant risk. Verbal messages for medication Doctors are reminded that instructions by telephone to a practitioner to administer a previously un-prescribed substance are not acceptable. In exceptional circumstances, where medication (NOT including Controlled Drugs) has been previously prescribed and the prescriber is unable to issue a new prescription, but where changes to the dose are considered necessary, the use of information technology such as by fax, email or electronic record may be used. When using fax or email information governance issues must be taken into consideration. This document is uncontrolled once printed. Please refer to the Trust intranet for the current version. 5
A verbal order is not acceptable on its own. The fax prescription/direction (copy of email or entry in electronic record) to administer must be stapled to the patient s existing medication chart. This should be followed up by a new prescription signed by the prescriber who sent the fax/email or S1 entry confirming the changes within normally a maximum of 24 hours (72 hours maximum Bank Holidays and weekends). In any event, the changes must have been authorised (via fax/email/s1 entry) by a registered prescriber before the new dosage is administered. It is, however, recognised that in certain situations patients may deteriorate rapidly and faxed or emailed prescriptions for new medications may be necessary to avoid compromising patient care. These should be followed up within 24 hours (72 hours max) with a hard copy. Important: It is the prescribers responsibility to ensure clinical assessment is undertaken and allergy status checked prior to prescribing. Verbal orders or faxed prescriptions for Controlled Drugs are NOT allowed, as legal requirements will not be met. Missing Patients Routinely the On Call Doctor does not need to know when a patient absconds or returns to the ward unless on return to the ward, medical attention is required or the patient is believed to pose a significant risk to themselves or others. Minor falls and accident Nursing staff should use their professional judgement as to whether medical attention is needed. If in doubt the CTL should be asked. Transfer of patients between wards Routinely the On-call Doctor need not be called unless there is a change in the patient s psychiatric or medical condition or if transfer is associated with increased risk of absconding, harm to self or others. TELEPHONE CALLS Berrywood switchboard holds all mobile and landline contact telephone numbers for all medical staff. Working Hours Internal Calls Nurse in charge on the ward may contact Junior Doctors directly Berrywood reception 9 am 5 pm South, Berrywood Hospital St Mary s Reception 9 am 5 pm North, Welland and SMH Physical Health Nurse 7.30 9pm South, Berrywood Hospital and North, Welland Centre and SMH External Calls All calls for all doctors should go to the Secretary of the appropriate Consultant This document is uncontrolled once printed. Please refer to the Trust intranet for the current version. 6
Out of Hours Physical Health Nurse 7.30 9pm South, Berrywood Hospital and North, Welland Centre and SMH Out of hours NCTL will contact the Junior Doctor direct or via Berrywood switchboard Calls from Other Medical Staff The switchboard will screen all calls out of hours and will only pass calls directly from the Physical Health Nurse until 9pm or the NCTL ESCALATION PROCESS If a Junior Doctor is not available/or decides it is not necessary to come to the ward and the NCTL feels that the doctor should attend then the escalation process should take affect. This is as follows: Psychiatry Contact switchboard and ask for the Speciality Doctor/Staff Grade on call to seek advice and support as appropriate The Speciality Doctor/Staff Grade if available will come to the site and address the problem if required Should they be unavailable to come due to already managing another emergency, the Consultant on call will be contacted to give advice and support as appropriate. Palliative Care The palliative care rotas have a two tier on call system. If the Junior Doctor on call cannot attend and the ward and the nurse in charge feels it necessary that a doctor should attend the escalation process is as follows: Contact switchboard and ask for the Consultant on call The Consultant will provide the necessary support including attendance at the ward as appropriate. Responsibilities and Accountabilities Timetables Ward Doctors must ensure a copy of their timetable is on the ward so that nursing staff can use these times to discuss any problems. Doctors should arrange crossover when attending peripheral clinics, teaching etc. Junior Doctors need to ensure they communicate with staff during the day and complete the communications book. Communicating with colleagues you must follow the GMC Guide to Good Medical Practice when you are off duty, suitable arrangements have been made for your patients medical care. These arrangements should include effective hand-over procedures, involving clear communication with healthcare colleagues. All on call junior doctors have a laptop and VPN access to S1. Junior doctors should document any advice or discussions with clinical staff in S1 including any decisions made. This document is uncontrolled once printed. Please refer to the Trust intranet for the current version. 7
Communications Book (Drs jobs list) each ward should have a book where the clinical team can record queries, blood results etc. This will ensure problems are not missed eg. If the primary nurse is busy when the doctor visits. Sites covered during on-call Psychiatric Junior Doctors who are on call will only visit trust inpatient facilities ie. Berrywood Hospital, The Sett (CAMHS) and St Marys Hospital. Palliative Care doctors who are on call will only visit Cynthia Spencer Hospice and Cransley Hospice. Training requirements associated with this Policy Training required to fulfil this policy will be provided on accordance with the Trust s training needs analysis. Management of training will be in accordance with the Trust s Statutory and Mandatory Training Policy. All Junior Doctors commencing in the Trust will receive training on this policy as part of their Induction programme. How this Policy will be monitored for compliance and effectiveness The table below outlines the Trusts monitoring arrangements for this document. The Trust reserves the right to commission additional work or change the monitoring arrangements to meet organisational needs. Aspect of compliance or effectiveness being monitored Duties Day to day compliance and policy breeches Method of monitoring Individual responsible for the monitoring Monitoring frequency To be addressed by the monitoring activities below. Via logged information Medical Staffing/North and South Clinical Tutors Compliance /breeches logged daily. Reviewed in line with Junior Doctor supervision Group or committee who receive the findings or report Consultants Group or committee or individual responsible for completing any actions Medical Director supported by Clinical Tutors European Working Time Directive Via logged information Medical Staffing Twice per year Consultants Medical Director supported by Clinical Tutors Policy Review Consultation Medical Director Annually Trust Policy Board Medical Director Where a lack of compliance is found, the identified group, committee or individual will identify required actions, allocate responsible leads, target completion dates and ensure an assurance report is represented showing how any gaps have been addressed. This document is uncontrolled once printed. Please refer to the Trust intranet for the current version. 8
For further information Please contact the Medical Director Equality considerations The Trust has a duty under the Equality Act and the Public Sector Equality Duty to assess the impact of Policy changes for different groups within the community. In particular, the Trust is required to assess the impact (both positive and negative) for a number of protected characteristics including: Age; Disability; Gender reassignment; Marriage and civil partnership; Race; Religion or belief; Sexual orientation; Sex; Pregnancy and maternity; and Other excluded groups and/or those with multiple and social deprivation (for example carers, transient communities, ex-offenders, asylum seekers, sex-workers and homeless people). The author has considered the impact on these groups of the adoption of this Policy and does not believe there are any specific equality considerations that need to be taken into account. (a) Line Managers should ensure that staff returning from maternity or paternity leave are given time to update themselves on any changes made to the policy. (b) Equality Considerations - Should the reader of this policy or any other group believe they are disadvantaged by anything contained in this policy, please contact the Equality & Inclusion Manager, who will then actively respond to the enquiry. Reference Guide The New Deal for Junior Doctors 1991, Junior Doctors Contract 2016 The European Working Times Directives (EWTD) compliance Aug 2009 Good Medical Practice, General Medical Council NICE Guidelines Rapid Tranquilisation (CG25) This document is uncontrolled once printed. Please refer to the Trust intranet for the current version. 9
Document control details Author: Approved by and date: Responsible committee: Any other linked Policies: Policy number: Version control: 2 Medical Director TPB: 21.09.2017 CLPr008 - Procedure for the safe use of ligature cutters RH002 - Incident Reporting Policy CLP002 - Resuscitation Policy CLP007 - Seclusion Policy CLP049 - Physical examination (using Minimum Standards for Physical Examination Policy CLP070 Physical Healthcare Policy MMP011 - Rapid Tranquilisation Policy NMP001 - Control of Medicines Policy MMP016 VTE (Primary Thromboprophylaxis (VTE)) Policy MMP034 - Medicine Reconciliation and Prescription (Medicines Reconciliation Policy CLP005 Version No. Date Ratified/ Amended Date of Implementation Next Review Date Reason for Change (eg. full rewrite, amendment to reflect new legislation, updated flowchart, minor amendments, etc.) 1.0 New governance of trust policies template. 2.0 21.09.2017 22.09.2017 21.09.2020 Minor changes/amendments. This document is uncontrolled once printed. Please refer to the Trust intranet for the current version. 10