Telephone advice is not easy…

As a children’s nurse, friends and family have always used me as their first point of contact when their children are poorly. A few weeks ago, it was one of those occasions. While shopping in Sainsbury’s (other supermarkets are available!) I received a telephone call from a friend asking for advice. As the focus of the call was a rash, I could offer very little advice without physically being able to see it. I was told that earlier in the week, a diagnosis had been made (the rash was due to a viral infection) and was not showing any signs of improvement as the GP had promised. It made me think about the difficulties faced by the highly criticised 111 service, which has incidentally recently been reported as steadily improving. Contrary to this, a few weeks ago, I heard that a call to 111 for pain relief advice had resulted in an unnecessary dispatch of an ambulance and full paramedic crew. This had led to a trip to an already full to capacity accident and emergency department where analgesics were prescribed and they were duly discharged home. This was the result of an overcautious telephone call handler who had highlighted a red flag symptom and dispatched an ambulance regardless of pleas not to waste anyone’s time. However had the pain turned out be caused by something more serious, the outcome may have been very different. For any health care professional to make clinical judgement during a telephone call is of course problematic, and so in some ways I can relate to the overcautious call handler. Sometimes it is better to be safer than sorry, and sometimes it better to take a risk, but the decision during a telephone call is difficult one. It made me think about our student nurses. While we teach about assessment, communication and clinical decision making, it tends to be face to face. I am sure that all student and registered nurses have been asked for telephone advice and I am sure that it hasn’t always been easy. It certainly made me think that telephone assessment is a skill that even the most experienced of nurses can get wrong and can make the best of us nervous.

I would be very interested to hear about experiences of telephone advice training for preregistration student nurses and for registered nurses.

So this was my first attempt at writing a blog…it wasn’t as scary as I thought!

http://www.england.nhs.uk/2013/06/07/nhs-111-improving/

@wlasinclair

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