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10. Recording what you have learnt


10. Recording what you have learnt

Learning and service outcomes – you will be able to:

  1. Reflect on your experience of delivering Flo telehealth as a practice team; and agree your action plan to improve and sustain provision of Flo telehealth.
  2. Complete the audit cycle, so you can target Flo in most beneficial clinical areas with appropriate selection of patients.

10.1 Structured peer observation

Ask other people what they think of how you (as an individual or team) have applied Flo telehealth, and gain feedback from colleagues and patients to reveal weaknesses of which you were previously unaware. Peer assessment is a widely used managerial technique that enables an individual to compare him or herself with the views of colleagues. It is particularly useful in areas that are difficult to define, such as your attitudes to others and your values. It may be a difficult exercise to organise but the benefits should repay the effort. You could ask your practice manager maybe to organise the peer assessment for you, or alternatively, organise it yourself. If you are working in a single-handed GP practice, you might team up with a GP or practice nurse from another practice, or work with one of your practice colleagues such as your practice manager.

10.2. Significant event audit (SEA)

You can learn a great deal from clarifying and reviewing a significant event; then making changes to minimise the likelihood of a recurrence. A SEA might occur for instance, if the practice does not organise cover for the practice nurse who oversees the Flo website to check readings and texted in responses from all patients on an at least weekly basis. So when the nurse returns tanned and rested a fortnight later they find abnormal responses that should have had a response (e.g. a patient had a persistently high BP and had not followed their dual management plan and booked in to see their GP). So the nurse instigates clinical actions; and practice manager organises cover in future if the nurse is on annual leave or off sick.

So as the RCGP advises, write up your SEA (don’t allow patients to be identified) and include:

  • title of the event
  • date of the event
  • date the event was discussed by the practice team and roles of those present
  • description of the event involving the GP, practice nurse, practice team members
  • description of what went well
  • description of what could have been done differently
  • your reflections on the event in terms of:
    • your/team’s knowledge, skills and performance
    • safety and quality
    • communication, partnership and teamwork
    • maintaining trust
  • what changes have been agreed:
    • personal issues
    • team issues
  • changes carried out and their effects.

The RCGP revalidation eportfolio for instance, has a standard form in which to record these fields, or attach your SEA report.

10.3 Undertake a clinical audit

There are many different variations of clinical audit that you can use to identify service development needs in your delivery of telehealth. You can use audit to set standards for your performance, find out how you are doing, search to find out best practice, make the changes and then re-audit the care you give to your patients.

(i) Case note analysis

This provides insight into current practice. It can be a retrospective review of a random selection of patient records (e.g. ten patients whom you signed up to contemplate stop smoking in protocol 8), or a prospective survey of consecutive patients with the same condition (e.g. ten patients whom your practice signed up with poorly controlled hypertension). This is a case note review matched against patient selection criteria, goals set in dual management plan/practice clinical protocol, success criteria, length of texting, clinical outcomes etc - as detailed in the respective AIM telehealth or practice clinical protocols.

(ii) Criteria-based audit

This compares clinical practice with specific standards, guidelines or protocols. Re-audit of changes should demonstrate improvements in the quality of patient care. You could look at the improvement in blood pressure control based on targets recommended in NICE guidance (e.g. BP<125/75 mmHg for those with CKD or diabetes in AIM protocol 10). You might compare patients on Flo telehealth with other patients who are not signed up to Flo - extracting recent BPs over same time period from their patient records.

(iii) External audit

Your CCG’s clinical telehealth facilitator might supply information about indicators of performance that may be useful in carrying out an audit e.g. of texted in readings or responses from patients. You’d still need to be involved and use the information in an audit capacity to encourage ownership and a commitment of the telehealth driven outcomes to make any necessary changes in practice.

(iv) Patient satisfaction survey

Having set standards, you might carry out a survey as a general indicator of care the participating patients have received via Flo telehealth.

Once you have completed an audit or a plan for an audit, use the checklist below to check that you have been thorough and got the most out of the audit exercise.

Table 5. Checklist of completeness of audit (download)

CPD Table 5

10.4 Team reflections – how it went

After a six month trial of Flo, why not talk things through in your practice team; then complete Table 6 checklist and complete an action plan.

Table 6. Team reflections on how well rollout of Flo went in the practice (download)

CPD Table 6

10.5 Capture time spent undertaking CPD activities and the impact

For GPs, one hour of education accompanied by a reflective record is one learning credit. If you apply that learning in practice in a demonstrable way, you can claim two learning credits for each hour of initial education – to be verified at your appraisal. The impact might relate to you, your patients or the service you provide. So the mix and match of educational activities you might complete and impact you generate is described in Table 7 below.

Table 7. Collation of educational activities and impact of learning – options for learning credits (download)

CPD Table 7

Cert1So much evidence of learning ….select up to 10 CPD credits to include in your appraisal eportfolio; the more varied the better demonstrating the wealth of your learning and service development.