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EEPD. Volume 8. Signposts.
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"It is the mark of the instructed mind to rest satisfied with the degree of precision which the nature of the subject admits, and not to seek exactness where only an approximation of the truth is reasonable" (ascribed to Aristotle Aristotle)
This volume is similar to the previous one but instead concerns the relationship between specific data items which might potentially be available in an electronic patient record (especially “Logical Prioritisation“ data items), and Guidelines from any relevant sources.
This will need to be a long term project to gradually provide the detailed documentation of exactly which electronic “Trigger Data Item(s)“ might lead to what ”Action Suggestions“, and when, and in what form, should such suggestions be provided; and, if possible, when and how the EPR might be used to check what action has, or has not been taken, both regarding individual patients and as part of regular audit of that particular topic.
(Updated 16 November 2010)
Introduction: Signposts; not Protocols or Laws.
The title of the EEPD. Volume 8. has deliberately been headed “Signposts” rather than “Guidelines” or “Protocols” since in the eyes of the public and too often of lawyers the later two terms seem to imply that such documents form “Laws” or “Rules” which all medical staff should never, ever, overrule under any circumstances.
Indeed, a study is urgently needed in which a random group of the general public - and of lawyers - are asked on a scale of one to ten how acceptable/reasonable it is for a person to decide to ignore/disobey “a protocol“, “a law“, “a signpost“, “a guideline“, “a recommendation“, “something that is binding“ and “a rule“
If the perception of the public or of lawyers is that “guidelines“ or “protocols“ have the same validity as “laws“ or ‘rules“ we have a serious situation.
While such guidelines are absolutely essential if we are to raise the general standard of care they must never be taken, (as they too often are), as if they comprised laws which must not be broken at any time, by anyone and in any circumstances.
Such an attitude is well illustrated by a recent phase in the Times newspaper which referred to some new NHS “guidelines” as being “binding” from next February”.
Or my recent experience when deciding, as a highly experienced specialist, whether it was, or was not, justified to use a prostin pessary to start the process of induction in the evening on a woman in her first pregnancy whose Pre-eclampsia was deteriorating - but not fulminating - only to be informed by the junior midwife on duty that it was against the “rules” to induce a “high risk” case in the evening.
In the event the patient did not get her prostin until the next morning and ended up with a Caesarean at 3 a.m. the following night.
At my last assessment, a clinician (doctor or practitioner, nurse or midwife) may need to take into account at least 15 factors before making a professional judgement as to what care they recommend for a particular patient at a particular time.
See www.fawdry.info/eepd/00_ima/quotes/ProfJudg.pdf for a list of some of the many factors I have briefly identified.
Signposts (or Action Suggestions) are helpful in deciding which way to travel towards a particular destination, but a signpost is not a compulsory order.
Chronological and Highly Detailed.
Being a medical practitioner these days sometimes seems rather like being expected to fly a jumbo jet with no electronic aids. And with computer only being used for the crew to enter data personally to tell them about their mistakes after the event or to document the level of passenger complaints. (As illustrated by www.fawdry.info/eepd/00_ima/scans/Jumbo.jpg√
If electronic records are eventually to be used to help overstressed practitioners to avoid medical errors in the care of individual patients, then Action Suggestions› must be provided at the appropriate time. This requires precise documentation, based on expert guidelines, as to exactly what “Trigger Items› in the electronic data might lead to what “Action Suggestions› and when and in what form such suggestions should be provided by the EPR; and, if possible, when and how the EPR might be used to check what action has or has not been taken, both regarding each individual and by a general audit.
The detail required for such documentation is illustrated by the following example: www.fawdry.info/eepd/08_gui/Sample8.pdf
Rupert Fawdry (Updated 18 Nov 2010)