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Information Governance Information for Employees Royal Cornwall Hospitals Trust. Information Governance Information for Employees Royal Cornwall Hospitals Trust. What is Information Governance?. Data Protection Act 1998 Caldicott Report Public Records Act 1958

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slide1

Information Governance

Information for Employees

Royal Cornwall Hospitals Trust

slide2

Information Governance

Information for Employees

Royal Cornwall Hospitals Trust

slide4

Data Protection Act 1998

Caldicott Report

Public Records Act 1958

Access to Health Records Act 1990

Freedom of Information Act 2000

Environmental Regulations Act 2000

NHS Confidentiality Code of Practice

NHS Records Management Code of Practice

Computer Misuse Act 1990

Common Law Confidentiality

IT Security

Information Quality Assurance

Code of Confidentiality

Local Policies/Procedures

Records Management

Information Sharing Protocols

Legislation/Policies

slide5

Data Protection Act 1998

  • 8 Principles
  • Fairness and legality
  • Permission
  • Adequacy /Relevant, not Excessive
  • Accuracy
  • Length of use
  • Access rights
  • Security
  • Transfer outside EEA
  • Caldicott Report 1998
  • 6 Principles for use and sharing
  • Justify the purpose
  • Use only when necessary
  • Use minimum necessary
  • Access – strict need to know basis
  • Individual responsibility
  • Comply with the law
  • Duty to share and protect
slide6

Information Governance

Is the way in which we handle: -

Personal and sensitive information of patients and employees.

Organizations and Individuals have a responsibility to handle personal information

Legally, Securely, Efficiently and Effectively,

Information Governance provides: -

A framework to bring together all of the requirements, standards and best practice

In handling of information.

All employees are responsible for maintaining the confidentiality of information gained

during their employment by the Trust.

slide7

Personal Information can be accessed from:

    • The patient
    • The health record
    • Colleagues
    • Personnel files/HR/Payroll
    • Electronically processed data
    • Stored images
    • Knowledge held by employee
    • Telephones
    • Fax machines – ‘Safe Haven’
    • Pieces of paper
    • Verbally
slide8

Confidentiality and Information Security

  • To obtain information without consent….
  • Is unlawful
  • Is a breach of the DPA, HRA and if obtained via
  • Hospital systems, a breach of the Computer Misuse Act.
  • May/will result in….
  • Disciplinary action
  • Dismissal
  • Civil action for damages
  • Custodial sentence
  • Unlimited fine

The RCHT monitor access to all systems. All breaches will be dealt with in accordance with the Trust’s disciplinary procedure

slide9

Top Tips

Do Not………

  • Leave your PC logged on
  • Access information on PAS
  • inappropriately
  • Leave your office unlocked
  • Include patient identifiable
  • information in the subject of
  • an email
  • Send personal data outside
  • the Trust without permission
  • Share Passwords

Do………

  • Respect confidentiality
  • Direct Police – they do not have an automatic right to information
  • Direct general enquiries
  • Check identity – this includes staff
  • Report incidents –don’t ignore them (Datix)
slide10

Role of Individual Staff

All staffs are responsible for:

All staff, whether permanent, temporary or contracted, and contractors are individually

Responsible for ensuring that they are aware of the requirements incumbent upon them

For ensuring that they comply with these on a day to day basis. Failure to follow this and the associated polices and procedures will result in the Trust enforcing its disciplinary procedure.

slide12

Disposal of Confidential Information

  • When disposing of paper-based person identifiable information or confidential
  • information and computer printouts always use ‘Confidential Waste’ sacks/shredders.
  • Floppy discs/CDs containing confidential information must be destroyed.
  • Computer hard disks are only to be destroyed/disposed of by the CITS experts within the Trust.

Confidentiality of Passwords, PIN Numbers, etc

Personal passwords, (i.e. groupwise) PIN numbers, etc issued to or created by employees should be regarded as confidential and they must not be communicated to anyone. To do so is a disciplinary offence.

This includes swipe cards, digital lock codes etc.

slide13

How long

Are

Records kept?

slide14

Trust Board agendas/minutes

30yrs

2yrs

Ordinary agendas

6yrs from end of service, at which time a summary

of the file must be kept, until individual reaches 70.

Personal files

Policies/Procedures

10yrs after life of policy/procedure- to be able

to answer complaints/litigation, using the

Policy/procedure in place at the time

Records of destruction

Permanently and not destroyed

Generally 8yrs after death/last attendance,

Unless you are a child then 26yrs or 8yrs

after death. Maternity records to these children

the same time

Health Records

Human Fertilisation

Some records 50yrs

Cancer Records

30yrs

slide19

How many patient

files lost

nationally per year

G

NHS lost 1.8 million patient records in a year

More than 5,000 confidential patient records are being lost by the NHS every day, according to new figures.

October 2012 Daily Telegraph

Among the breaches included data security records dumped in public bins and electronic records found for sale on an internet auction site.

slide20

Patient notes were found in public

places within NHS buildings, with

private documents also left in car

parks and on public transport,

In one incident at NHS Dumfries and Galloway, details of a patient appointment written on a scrap of paper was used as a bookmark in a furniture catalogue which was sent around a hospital.

slide21

NHS Surrey has been fined £200,000 by data regulators over the loss of sensitive information about more than 3,000 patients

July 2013

Regulators said NHS Surrey failed to check that a data destruction company had properly disposed of the records.

Upon investigation, the trust discovered the computer contained the health records of 2,000 children and 900 adults, plus a number of NHS human resources records.

Medical secretary sharing confidential information with relative-

Lost job

slide22

G

NHS Fines

What could be the consequences of sending a confidential

fax to wrong destination?

£60k Sending a confidential fax to wrong destination

£100k Confidential information in bag, left in pub-

-stolen-sold on

And sending a discharge letter to the wrong address?

£60k Discharge letter sent to wrong address.

St Georges Hospital, failed on THREE occasions to

ask patient if address details etc. had changed.

slide24

Video

Bricklayer of Bangladesh

slide25

MHOR(as amended 2004)

G

What Are Your Obligations?

Risk Assessment

Health Reporting

Use equipment provided

Follow systems of work

slide30

G

If This Was Printed On Your Back?

slide32

G

If This Was Printed On Your Back?

slide34

G

If This Was Printed On Your Back?

slide35

Manual Handling Budget Range

Video

Manual Handling

slide38

Most injuries in the workplace are caused by people lifting, pushing, pulling or carrying heavy loads, and making awkward movements when doing so.

In the UK alone, 54 million working days are lost each year because of back problems caused by poor technique when handling objects. This can also damage the shoulders, neck, hands, arms and feet.

Because almost everything we do involves some form of manual handling, it’s essential that we know how to do it safely to avoid getting hurt.

slide39

G

Follow Training

Decant

Ask For Help

Use Equipment

Follow Systems

Risk Assess.

Posture

Say “NO”

Which of the above should

be number one?

How Do You Prevent Manual Handling

Injuries?

slide42
The learner will be able to demonstrate their understanding of:

The categories of abuse

The indicators of different types of abuse

The process to follow when abuse is suspected

Aims
definition of abuse
Definition of Abuse

‘A violation of an individual’s human and civil rights by an act, or a failure to act, on the part of another person or persons.

Abuse may consist of a single or repeated act of neglect or failure to act or it may occur when a vulnerable person is persuaded. 4.4

definition of a vulnerable adult
Definition of a vulnerable adult

A “vulnerable adult”, is a person 18 years of age or older. Who is or may be in need of community care services by reason of mental or other disability, age or illness

AND

Who is or may be unable to take care of him or herself

OR

Is unable to protect him or herself against significant harm or exploitation

Safeguarding of Vulnerable Adults Policy and Procedures 4.1

examples of acts of omission
Examples of Acts of Omission

Inadequate assessment & planning of an individuals needs

The neglect of an individual's personal care needs

Failure to give pain relief

Not communicating with and ignoring patients & / or their relatives/carers

Too hasty discharge from hospital

a key act of omission
A Key Act of Omission

Failure to take action in your role when you suspect a person in your care has been or is being abused

Recognise abuse

Respond

Record

Report

Safeguarding is everyone's responsibility

responding to a disclosure
Responding to a Disclosure

Don’t:

Do not be judgmental (eg ‘Why didn’t you try to stop them?)

Do not break confidentiality agreed between the person disclosing the information, yourself and your line manager

Do not gossip with other staff members or service users about the information shared with you (ie: ‘It’s awful, you’ll never guess what I’ve just been told.)

50

slide49

RCHT Internal process

Ensure the person is not in danger and protect from harm

Make a factual report in the patients medical record

Simultaneously inform your line manager and document that you have done so

Discuss with manager before any decision to make a formal alert

If your line manager is the abuser or is otherwise uncontactable contact the clinical site co-ordinator on bleep 2634

When it is decided that a formal safeguarding alert is needed phone the access team on 03001234131 to make verbal alert.

ALSO

Complete a Datix web incident report

51

raising a concern whistle blowing procedure
Raising a concern (Whistle blowing) procedure

If you raise a genuine concern under this policy, you will:

not be at risk of dismissal

demotion

pay reduction

failure to renew a contract

failure to gain potential promotion or other detrimental action.

Provided you are acting in good faith, it does not matter if you are

mistaken.

52

slide51

Lead Safeguarding Nurse Zoe Mclean 0782789752 Bleep 3095

All patients with a Learning Disability or Autism must be referred to the

Acute Liaison Nurses for Learning Disabilities

Education Corridor, Treliske.

Lead Daniella Rubio-Mayer 07827903729 Bleep 3054

Email. Learning.disabilities@cornwall.nhs.uk

For Out of hours leave referrals on answer phone site co-ordinator.

Specialist Nurse for Mental Health and Wellbeing Lerryn Hogg Via: Ext 2446 or Mobile 07789 876247 Lerryn.hogg@rcht.cornwall.nhs.uk

Independent Domestic Violence Advocates

Susie Brown & Anna Onslow

Can be contacted via switch board

looked after children children in care
Looked After Children(Children In Care)
  • Looked after children are particularly vulnerable.
  • It needs to be clear as to who has parental consent.
  • The child may be in foster care or with extended family.
  • Please ensure Children in Care team are informed if a Child in Care is admitted to hospital, attends ED,or fails to attend clinic appointments.
slide53

http://www.rcht.nhs.uk/DocumentsLibrary/RoyalCornwallHospitalsTrust/Websites/Internet/OurServices/AZServices/F/FormsReviewGroup/FormsToPrint/CHA3122SafeguardingVulnerableAdultInternalAlertPreparationAndReferral.pdfQuestions?http://www.rcht.nhs.uk/DocumentsLibrary/RoyalCornwallHospitalsTrust/Websites/Internet/OurServices/AZServices/F/FormsReviewGroup/FormsToPrint/CHA3122SafeguardingVulnerableAdultInternalAlertPreparationAndReferral.pdfQuestions?

CHA3122 Safeguarding Vulnerable Adult Internal Alert Preparation and Referral

slide54

Margaret Panting Died 6 July 2001

after receiving 49 separate injuries- burns, lacerations and bruising –pathologist described significant evidence of elderly abuse

slide56

Video

Infection Control

Break The Chain

slide60

G

WHEN/HOW?

slide61

Hand

Washing

(WHEN)

slide67

Video

Wash Your Hands It Just

Makes Sense

slide69

Do You Think

This Is True

?

If It Is What Can Be Done?

infection prevention and control
5000 people die every year from hospital acquired infections.

This is roughly the amount of 11 Boeing 747’s.

Nearly one every month.

About a 3rd of these infections are preventable.

Infection Prevention and Control….
slide75

If you are

Ill

What should

You do?

slide76

Prevention is better than cure. It is a legal requirement for anyone who works in a food handling area to maintain a high degree of personal cleanliness. Food handlers should pay particular concern to their hands and hair.

slide77

Nail hygiene is essential to prevent the development

and spread of infection. They are also displayed in

public at all times so can be representative of our

overall health, well-being and personal hygiene methods.

Taking good care of your nails and maintaining

their cleanliness is very important. As many

people talk with their hands they are often

seen by many and can represent to others

an overall picture of our personal hygiene.

slide78

Personal hygiene guidelines when handling food

  • Anyone involved in running a food business should have a high standard of personal hygiene which will be reflected in appearance, dress, behavior and personal cleanliness. High standards of personal hygiene will reduce the risk of contamination and help to prevent food poisoning. The following key points must be followed by all food handlers:
  • Wash hands regularly, especially
    • on starting work
  • after using the toilet
    • between handling raw and cooked foods
    • after breaks for eating, drinking and smoking
    • after coughing, sneezing or blowing their nose
    • after touching hair
    • after handling refuse or waste materials
    • after handling cleaning chemicals
  • Cover cuts, sores and burns with clean waterproof dressings
  • Wear clean, and where appropriate, protective clothing
  • Keep fingernails short and clean and remove all nail polish do not bite nails
  • Do not wear jewellery other than a plain wedding ring
  • Do not wear strong smelling perfumes or aftershaves
slide79

Prevention is better than cure. It is a legal requirement for anyone who works in a food handling area to maintain a high degree of personal cleanliness. Food handlers should pay particular concern to their hands and hair.

  • Keep fingernails short and clean
  • Remove all nail polish
  • (chips of varnish can fall off into food, and colour can hide dirt under finger nails).
  • Do not wear jewellery (especially dangling pieces),
  • as they can fall into food.
  • Avoid strong smelling perfumes or aftershaves. 
  • Bad habits that you should avoid include:
  • Excessive handling of food.
  • Touching the rims of glasses.
  • Nail biting
  • Coughing
  • Sneezing
slide82

G

Is This Best

Practice?

slide84

A Washing Hands

B Handled by hands

C Must be washed, disinfected and dried

D 5 – 63c

E Could lead to cross contamination

F Reheating

G 2 - 4c

H Could cause anaphylactic shock

I Sausages, burgers, spinach, washed salads

J Wash hands after toilet, again on entry to food area

K 75c

L Bad Practice

M Milk

N Reduce to safe levels

O 8c and below

P 40 minutes by nurses

Q Could enable cross contamination

R 37c

1 What is the double hand method?

2 The optimum temperature for fridges is

3 Cause of most food poisoning outbreaks in this country

4 Sanitisers are designed to?

5 Core temperature of food when cooked

6 Food should be served within xx minutes at ward level

7 Leaving cleaning until the end of service could cause

8 E Coli 157 foods

9 Food poisoning bacteria will multiply readily between

10 Items that will not go through a dishwasher

11 Lactose is in which food

12 What is the optimum temperature for Pathogens to multiply

13 Legal temperature of fridges

14 Poor personal Hygiene

15 One of the most important parts of personal hygiene

16 To cook twice

17 Staph Aureous foods

18 Allergy producing foods

J

G

L

N

K

P

E

I

D

C

M

R

O

Q

A

F

B

H