child safeguarding protocol in emis web jez mccole, gp, gleadless medical centre, sheffield...

Child Safeguarding

ProtocolIn EMIS Web

Jez McCole, GP, Gleadless Medical Centre, Sheffield

@jezmccole

The ProblemLack of awareness of Safeguarding issues

Common to most busy surgeries

What is already in the busy record?

What was the point of coding it?Coding is more than just about QOF

Bringing the electronic medical record to life

Highlighted during our Three Minute Surgery

Theme 2 - Everything is ok

This theme demonstrated how professionals didn’t recognise the safeguarding issues or vulnerabilities that existed. There were 2 main reasons for this:

1. Normal for Community. In 3 cases professionals felt that the children were one of a ‘number of children like this’ in the community:

‘There are lots of other families like this in their practice area so this family would not have stood out. This is of concern…

because of the clear level of risk that there was in this family.’ (2011)

2. Misplaced Optimism. There was evidence (in 8 cases) of professionals working with an overoptimistic view of the situation. The most common reason was that they didn’t question, recognise, know or collate the family history or vulnerabilities that exist.

‘Assessments failed to consider the historical information regarding this couple. Agencies failed to consider the multiple

risk factors’ (2011)

Theme 3 - Assessment, Assessment, Assessment

1. An Assessment Mindset is seeing every encounter with a family as an opportunity to re-evaluate the situation. The lack of this was an issue in 6 cases.

2. Silo Thinking. In 6 cases professionals viewed situations in isolation, were task focused and ‘episodic’. This also highlighted where professionals didn’t consider the possible impact of the parents mental health on their parenting.

3. Downgrading of risk (4 recent cases). In these professionals closed cases when there was no evidence of any new information to inform this decision.

4. Recognition of risk by universal services. 3 cases highlighted that although universal services had contact with a family, they didn’t recognise the circumstances the children were living in.

5. Communication and information sharing was an issue in 10 reviews.

This highlights the importance of assessment and the difficulties that arise when this isn’t thoroughly completed.

Three Minute Surgery

N = 40+

Our AimsWhen any record is loaded

To present the Child Protection Status of the patient

To inform the user about Safeguarding procedures

Protocol Overview – The finished product

Protocol Ingredients

A coded record

Concepts

Connectors

Protocol Alerts (‘Zap box’)

A (well) Coded Record

Agree your codes

Used on the record of the child

[13Iv] Child is the subject of a Child Protection Plan

[13Iw] Child has been removed from a plan [13IO]

[13IS] Child is a Child in Need

[13IT] Child is no longer a Child in Need

Used on the record of a parent/guardian

[13Iy] Family member subject of a Child Protection Plan

[13Iz] Family member removed from a Child Protection Plan

THE CONCEPTS

The engines of the protocol

Interrogate the record

Change the direction of flow based on what they find

Written in the Concept Manager

Creating a Concept 1

Creating a Concept 2

Create a Protocol

Build the Protocol

Starts as a blank canvas

Add a pre-prepared Concept

Protocol Flow – Child currently on a plan

Protocol Alerts - ‘Zap’

Protocol Alerts

Safeguarding Template

Safeguarding Template

Protocol Overview – Child currently on a plan

Protocol Overview – Child no longer on a Plan

Concept & AlertNo Longer on a

Plan

Concept

Alert

Protocol Overview – The finished product

…and finally!

Program the trigger

Thank you

Update Record

Examples of other Gleadless Protocols

& ReportsLabel printing

Helicobacter eradication

eGFR African ethnicity adjuster

Metformin & Low eGFR warning

Arrhythmia check

Amiodarone Safety

QRISK checker

Folic Acid prescribing by risk factors

Diabetes reports

DMARD max med review 3months preventer

Diabetes Hypoglycaemia Risk

Driving on Hypoglycaemics

District nurse case load management Protocols

Mental Health Care Planner

Cannabis Support Alert