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National Guidelines onAccessible Health andSocial Care Services
people caring for people
A guidance document for staff on theprovision of accessible services for all
Title: National Guidelines on accessible health and social care services - aguidancedocumentforstaffontheprovisionofaccessible services for all
Document reference number: V.1
Approvaldate: June2014
Revisiondate: June2016
Documentdevelopedby: NationalAdvocacyUnit, HSEinpartnershipwiththeNationalDisabilityUnit, HSEandtheNationalDisabilityAuthority
Contact details: Caoimhe Gleeson NationalSpecialistinAccessibility NationalAdvocacyUnit Email: [email protected]
ISBN: 978-1-906218-80-5 Thisdocumentissubjecttoreviewandmaychangeatanytime
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NATIONAL GUIDELINESAccessible Health and Social Care Services
Contents
Acknowledgements 1 Foreword 2
1. Introduction 4 1.1 Providingresponsivecareforserviceusers 4 1.2 SomekeyfactsaboutdisabilityinIreland 4 1.3 Arangeofsolutions 62. Purpose 7 2.1 Purposeofguidelines 7 2.2 Structureofguidelines 7
3. Scope 9
4. Legislation and related policies, procedure and guidelines 10 4.1 Overviewoflegislationandotherrelatedhealthcarepolicy 10 4.2 TheNationalHealthcareCharter,YouandYourHealthService 10 4.3 FutureHealth,AStrategicFrameworkforReformoftheHealth
Service20122015 11 4.4 IntegratedCareGuidance:Apracticalguidetodischargeand
transferfromhospital 12 4.5 TheEqualStatusActs20002008 12 4.6 Part3,DisabilityAct2005 13 4.7. NationalDisabilityAuthorityCodeofPracticeandGuidance 13 4.8 NationalConsentPolicy 14 4.9 TheNationalEmergencyMedicineProgramme 15 4.10 Other 15
5. GlossaryofTerms/Definitions 16 5.1 Glossary 16 5.2 AppropriateTermstoUse 18 5.3 Abbreviations 19
ii
6. RolesandResponsibilities 21 6.1 AllStaff 21 6.2 Seniormanagementrole 21 6.3 AccessOfficerrole 23
Part One: Guidelines for all Health and Social Care Settings1. Guideline One:Developingaccessiblehealthandsocialcareservices 26 1.1 Ask,Listen,Learn,Plan,Do 26 1.2 Examplesofpolicies,proceduresorguidelinesforstaff 29
2. Guideline Two:Developingdisabilitycompetence 30 2.1 Buildingcapacityandunderstandingforallstaff 30 2.2 Onlinetrainingresource 31 2.3 Tailoreddisabilitytraining 31 2.4 Professionaleducation,trainingandprofessionalstandards 31
3. Guideline Three:Accessibleservices-generaladvice 32 3.1 Donotassume-ask 32 3.2 Makinganappointment 32 3.3 Showflexibilitywhenschedulingappointments 33 3.4 Missedappointments 34 3.5 Planvisitsforroutinecheck-upsorsurgeryinadvance 34 3.6 Queuingtobeseen 35 3.7 Fillingforms 35 3.8 Informationandnotices 36 3.9 Mobilityaids 36 3.10 Focusontheperson 36 3.11 Concurrenttherapeuticorcareneeds 36 3.12 Maintainconfidentiality 37 3.13 Health Promotion 37 3.14 IntegratedDischargePlanning 38
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NATIONAL GUIDELINESAccessible Health and Social Care Services
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4. Guideline Four: Communication 42 4.1 Generalprinciplesofgoodcommunication 42 4.2 Establishhowthepersonpreferstocommunicate 43 4.3 Notifyrelevantstaffofthepreferredmethodofcommunication 43 4.4 Communicatingwiththeperson 43 4.5 Communicatingwithapersonwhoisunabletostandorwhousesawheelchair 45 4.6 Communicatingwithapersonwithspeechdifficulties 45 4.7 Communicatingwithapersonwhohasavisualimpairment 46 4.8 CommunicatingwithapersonwhoishardofhearingorDeaf 48 4.9 Communicatingwithapersonwholipreads 50 4.10 CommunicatinginwritingwithaDeaforhardofhearingperson 51 4.11 CommunicatingwithapersonwhousesIrishSignLanguage 52 4.12 IrishSignlanguageinterpreters 53 4.13 Deafinterpreters 54 4.14 IrishRemoteInterpretingService(IRIS) 54 4.15 DeafPeerAdvocates 54 4.16 Communicatingwithapersonwhoisdeafblind 55 4.17 Communicatingwithapersonwithanintellectualdisability 55 4.18 Othercommunicationchallenges 57 4.19 Communicationboards 59 4.20 Communicationpassports 59 4.21 Lmhsigns 60 4.22 Inductionloops 60 4.23 Communicationaidsaspartofcommunicationstrategy 60 4.24 Provideinformationaboutcommunicationaidsavailable 60
5. Guideline Five:Accessibleinformation 61 5.1 Whyprovideinformationinanaccessibleformat? 61 5.2 Informationaboutaccessibilityofpremisesandservices 61 5.3 Providinginformationindifferentformats 62 5.4 Sometipsonwritteninformation 62 5.5 Largeprint 63
iv
5.6 Usepicturesandsymbols 63 5.7 EasytoRead 63 5.8 Website 63 5.9 Videoandaudio 64 5.10 Braille 64 5.11 Furtherinformation 65
6. Guideline Six:Accessiblebuildingsandfacilities 67 6.1 Generalinformation 67 6.2 Providinginformationaboutaccessibilityofpremisesandfacilities 68 6.3 PointstoconsiderAchecklistforaccessiblebuildingsandfacilities 68 6.4 Furtherinformation 75
7. Guideline Seven: Consent 77 7.1 Generalprinciplesofconsent 77 7.2 Whatisvalidandgenuineconsent? 77 7.3 Importanceofindividualcircumstances 78 7.4 Informingthepersonbeforegettingconsent 78 7.5 Howandwheninformationshouldbeprovided 79 7.6 Howshouldconsentbedocumented? 80 7.7 Capacitytoconsent 81 7.8 Emergencysituations 82 7.9 Consent,childrenandyoungpeople 82
8. Guideline Eight:Roleoffamilymembersandsupportpersons 83 8.1 Roleoffamilymembersandsupportpersons 83 8.2 Righttoprivacy 84 8.3 Discharge 84 8.4 Carerneeds 84 8.5 Advocacy 84
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NATIONAL GUIDELINESAccessible Health and Social Care Services
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PartTwo:Guidelinesforspecificservices9. Guideline Nine: AccessibleGPsurgeries,healthcarecentresandprimarycarecentres 86 9.1 Planservicesforall 86 9.2 Yourpremises 87 9.3 Appointments,openinghours,waitingrooms 89 9.4 Waitingtobeseen 90 9.5 Fillingforms 91 9.6 Examinationandtreatment 91 9.7 Consent 92 9.8 Communicationwithpatientsandserviceusers 92 9.9 Information 95 9.10 Continuityofcare 95 9.11 Homevisits 96 9.12 Familymembersandcarers 96 9.13 Referral and sharing of information 97
10. Guideline Ten:Accessiblehospitalservices,includingout-patientdepartments 98 10.1 Ask,listen,learn,plan,do 98 10.2 Whototalktowhendevelopingthecareplan? 99 10.3 Identifyexistingcareprotocols 100 10.4 Prepareinadvance 100 10.5 Inthehospital 101 10.6 Dischargefromhospital-integrateddischargeplanning 105
11. Guideline Eleven:Accessibleemergencydepartments 106 11.1 Onarrival 106 11.2 Communication 108 11.3 Accessibilityrequirements 109 11.4 Waitingtobeseen 111 11.5 Familyorcarersupport 112 11.6 Assignedstaff 112 11.7 Explainmedicalproceduresclearlyandaccessibly 112 11.8 Integrateddischargeplanningfromtheemergencydepartment 113
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12. Guideline Twelve:Accessiblematernityservices 115 12.1 Introduction 115 12.2 Non-judgmental 116 12.3 Planningforspecificrequirements 116 12.4 Antenatalservices 122 12.5 Givingbirth 123 12.6 Careintheward 124 12.7 Post-natalcareandafterdischarge 125 12.8 Dischargeandfollow-up 126 12.9 Post-nataldepression 127 12.10Goodpracticeguidelinesforwomenwithspecificdisabilities 127
References 133
AdditionalUsefulResources 159
Appendix 1:Accessibilitychecklist 165 Appendix 2: Coreprinciplesofaqualityservice 166 Appendix 3:Disability-thenumbers 168 Appendix 4: MembershipoftheHSEUniversalAccessSteeringCommittee 173
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NATIONAL GUIDELINESAccessible Health and Social Care Services
vi
Acknowledgements
Wewouldliketotakethisopportunitytothankallofthosewhogavetheirtimesogenerouslyindevelopingthisdocument.Wewouldliketoacknowledgeinparticularthehardwork,guidanceandpatienceofthemembersoftheHSEUniversalAccessSteeringCommitteeandallthosewhoseexpertiseandexperiencewascriticaltothedevelopmentofthisdocument.
Thanksalsotoallofthestaffandserviceuserswhomadesubmissionsduringtheconsultationphaseofthisworkandwhoweresignificantstakeholdersinthedevelopmentoftheseguidelines.
Wewouldalsoliketothankinadvanceallthosewhowill,inthecomingmonths,readandimplementtheguidelines.WehopethattheNationalGuidelinesonAccessibleHealthandSocialCareServiceswillbeausefulguideforstaffand,inturn,willmakearealdifferencetotheserviceusersexperienceofhealthandsocial care services in Ireland.
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Foreword
The DisabilityAct2005isapositiveactionmeasure,whichprovidesastatutorybasisformakingpublicservicesaccessible.Itgiveseffecttotheunderlyingprinciplethatmainstreampublicservicesprovidedtothegeneralpublicmustalsoservepeoplewithdisabilitiesasanintegralpartoftheservicetheyprovide.
Thehealthserviceisobligedtoensurethatitsbuildings,itsservices,theinformationitprovides,andhowitcommunicateswithpeople,areallaccessibletopeoplewithdisabilities.TheseGuidelinesofferthepracticalguidancetomakethatareality.
Thisdocument,theNationalGuidelinesonAccessibleHealthandSocialCareServiceshas been writtentogivepracticalguidancetoallhealthandsocialcarestaffabouthowtheycanprovideaccessibleservices.Whiletheseguidelinesrefertospecificdisabilities,ifwetakestepstoroutinelyprovideaccessibleservicesforall,wewillpositivelyinfluencetheexperienceofeverybodywhousesourservices.
TheethosofaccessibilityisreinforcedbyAFutureHealth,AStrategicFrameworkforReformoftheHealthService2012-2015,publishedbytheDepartmentofHealthinNovember2012;bylegislationsuchas the DisabilityAct2005,theEqual Status Acts 2000 2008,bytheNational Healthcare Charter You and Your Health Serviceandthemanyotherhealthandsocialcarepoliciesandprocedures.
Theguidelinesdescribeastandardtowhichwecanaspire.Theydetailwhatobligationsareinstatutetoprovideaccessibleservices.Theyalsoserveasaresourceforhealthandsocialcareprofessionalswhomaybeplanningservicesinthefuture.
Manyofthekeyinitiativesoutlinedintheguidelinestomakeservicesmoreaccessiblearecostneutral.Consideration,compassionandopencommunicationarefree.Timespentidentifyingapersonsneedsisaninvestmentinsafe,effectivecarewhichcanpreventunnecessaryriskstotheindividualandthestaffmember,andnegativefeedback.
Wehopethattheguidancewillhelpallstafftobuildontheirexistingknowledgeandtorecognisethatpeoplewithdisabilitiesareoftenexpertsinwhattheyneed.ThekeymessagereinforcedthroughouttheguidelinesisAsk,Listen,Learn,PlanandDo.
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NATIONAL GUIDELINESAccessible Health and Social Care Services
2
WelookforwardtoservicesworkinginpartnershiptoensurethattheNationalGuidelinesonAccessibleHealth and Social Care ServicesmakeapositivedifferencetotheexperienceofallthosewhouseIrelandshealthandsocialcareservices.
TonyOBrien SiobhanBarronDirector General Director HealthServiceExecutive NationalDisabilityAuthority
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1. Introduction
1.1 Providing responsive care for service users
Itisimportantthathealthandsocialcareservicesprovideappropriateandresponsivecareforallserviceusers.Inthecourseoftheirlives,somepeoplewillhaveregularinteractionwiththehealthandsocialcareservices.Theymayhaveadisabilityoraprolongedillness,orbecauseofapre-existingconditionmaybemorevulnerabletootherillnesses.Manypeoplewhohavecontinuouscontactwithservicesdonotconsiderthemselvesill.
AnunderstandingoftheneedsofserviceuserswithdisabilitiesisimportantforeverypersonemployedorcontractedbytheHSE.1Thisunderstandingwillhelpensurethatpeoplewhoworkinthehealthandsocialcareservices,inwhatevercapacity:
areequippedwiththeknowledgeandskillstoidentifyandwherepossiblemeettheneedsofpatientswithdisabilities
designpremisesandsystemswiththoseneedsinmind communicatewithserviceusersinwaysthatareappropriatetotheirneeds
1.2 SomekeyfactsaboutdisabilityinIreland:
TheNationalDisabilitySurvey2006reportedthatbetweenoneinfiveandoneintenpersonshasalong-termdisability.Mostpeoplewillexperiencesomedegreeofdisabilityoverthecourseoftheirlife;however,aspeoplegetolder,theproportionofpeoplewithadisabilityrises.Basedonthefollowingstatistic,thenumberofpeoplewithadisabilitywillincreaseinthecomingyears:
Eachyearthetotalnumberofpeopleovertheageof65yearsgrowsbyaround20,000personsandthepopulationover65yearswillmorethandoubletooveronemillionby2035.Peoplearelivinglongerthoseagedover65yearsincreasedby14%since2006.2
Disabilitymaybeclassifiedintoanumberofgroupings,forexample: physicaldisability sensorydisabilityimpairedsight,impairedhearing,orimpairedspeech intellectualdisability mental health conditions
1 TheHSEisintheprocessofreformandwilltransitionintoanewcommissioningagency.Theseguidelineswillbesubsumedbythisnewagency.2 HSEAnnualReportandFinancialStatements2012.www.hse.ie
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NATIONAL GUIDELINESAccessible Health and Social Care Services
The NationalDisabilitySurvey2006showedthatthemostcommonformsofdisabilityinIrelandare,inorderoffrequency:
1. Difficultieswithmobilityordexterity 2. Pain 3. Mentalhealthdifficulties 4. Memorydifficulties 5. Breathingdifficulties 6. Hearingloss 7. Impairedvision 8. Intellectualdisability
Disabilitiesvaryintermsofthenatureanddegreeofdifficultyexperiencedforeachindividual.Somepeopleexperiencemorethanonekindofdisabilityatthesametime.Ingeneral,the numberofpeoplewithsomedegreeofimpairmentismuchlargerthanthenumberswithtotal loss of function.
Weneedtobeawarethattherearebothvisibleandhiddendisabilities Visibledisabilities:Sometimes,itisveryobviousthatapersonhasadisability,suchasablind
personwhousesawhitecaneorsomeonewhousesawheelchair Hiddendisabilities:Itisnotimmediatelyobviouswhensomeonehasahiddendisability.
Notallpeoplewhohaveavisualimpairmentneedawhitestickoruseaguidedog.Someonesappearancewillnottellyouiftheyhaveepilepsy,oriftheyarelikelytogetpanicattacks
Extractfrom:NDAdocumentProvidingpublicservicestopeoplewithdisabilities.
ASelf-StudyGuide ThemostcommontypesofdisabilityinIrelandaremobilitydisabilities About184,000peoplehavedifficultywalkingmorethan15minutes About31,000peopleuseawheelchair.Manymorepeopleabout83,000usewalkingaids,
or a stick OthercommondisabilitiesinIrelandaredealingwithpain,difficultyrememberinginformation,
orhavingmentalhealthdifficulties Somepeoplearebornwithadisability Manymorepeopledealwithatemporarydisabilitybecauseofinjuriesorillness
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1.3. A range of solutions
Wherepossible,itisimportanttoofferarangeofsolutionsthatmeettheindividualneedsofpeoplewithdisabilities.Somethingthatworkswellforapersonwithapartiallossoffunctionmaynotbethebestsolutionforsomeonewithamoreseveredifficulty.Forexample,someonewhowalkswithdifficultymayfinditeasiertomanagestepsthanaramp,oncethereisahandrail,whileawheelchairuserwouldneedaramptonegotiateachangeinlevel.
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NATIONAL GUIDELINESAccessible Health and Social Care Services
2. Purpose
2.1 Purpose of guidelines
The purpose of these guidelines is to: assisthealthandsocialcareproviderstocomplywithlegalobligationsundertheEqual Status
Acts,theDisabilityAct2005,theassociatedstatutoryCodeofPracticeonAccessibilityofPublicServicesandInformationprovidedbyPublicBodies,andhealthandsocialcarepolicyandprocedures
assisthealthandsocialcareproviderstomeettheprinciplesoftheNational Healthcare Charter, You and Your Health Service
assisthealthandsocialcareproviderstomeettheprovisionsoftheNational Standards for Safer Better Healthcare 2012 (HIQA)
providearesourceforAccessOfficerstosupporthealthservicestaffrespond totheaccessrequirementsofpeoplewithdisabilitiesinallhealthandsocial care settings
provideaguidancedocumentforuseineducationandtraininginrelationtodisability,accessibilityandcustomercare
provideareferencemanualforallstaffinallhealthandsocialcaresettings
2.2 Structure of guidelines
TheguidelinesaredividedintotwosectionsPartOneincludesguidelinesforuseinallhealthandsocialcaresettingsandPartTwoincludesguidelinesforspecificserviceareas.
Whileeachguidelinecanbeusedasastand-alonedocument,agreaterunderstandingcanbeachievedbyreadingalloftheguidelinedocuments.
Part One: Guidelines for all health and social care settings
Guideline One: Developingaccessiblehealthandsocialcareservices Guideline Two:Developingdisabilitycompetence Guideline Three: Accessible services - general advice Guideline Four: Communication Guideline Five: Accessible information Guideline Six: Accessible buildings and facilities Guideline Seven: Consent Guideline Eight: Roleoffamilymembersandsupportpersons
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PartTwo:Guidelinesforspecificservices Guideline Nine: AccessibleGPsurgeries,healthcarecentresandprimarycarecentres Guideline Ten: AccessibleHospitalServices Guideline Eleven:AccessibleEmergencyDepartments Guideline Twelve:Accessiblematernityservices
The guidelines contain links to further information and resources, as well as contact details fordisabilityorganisations.
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NATIONAL GUIDELINESAccessible Health and Social Care Services
3. Scope
TheseGuidelinesweredevelopedinapartnershipbetweentheNationalDisabilityAuthorityand the Health Service Executive, and with input from an Advisory Group, drawing on:
research evidence focusgroupsandinterviewswithpeoplewithdisabilitiesandtheirorganisations feedback on drafts
Abackgroundpaper,commissionedbytheNDA,setsoutthematerialthatunderpinsthisguidance.Thispapersummarisesresearchfindings,reviewsotherguidanceonhealthservicesanddisability,andconsidersthepointsraisedintheconsultationwithIrishdisabilityorganisations.
TheGuidelinesareavailableinpaperandelectronicformat,andhavelinkstoothersourcesofguidanceandinformationseeResourcessection.
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4. Legislation and related policies, procedure and guidelines
4.1 Overview of legislation and other related healthcare policy
Itisalegalrequirementtoprovideaccessiblehealthandsocialservicesforserviceusers.Thefollowingsection,whilenotexhaustive,setsoutthekeypiecesoflegislationandpolicywhichareimportantinprovidingaccessibleservicesforpeoplewithdisabilities.
The NationalGuidelinesonAccessibleHealthandSocialCareServicesarewrittento
complementexistingpolicies,proceduresandlegislationgoverninghealthandsocialcareinIreland.TheguidelinesdonotreplaceotherpoliciesoftheHSEorindeedcontraveneexistinglegislationinanyway.
TheseguidelinesshouldbereadinconjunctionwithothergoverningdocumentsoftheHSEandthelegislationsothatstaffcanprovidethebestpossibleservicetoallpatientsandserviceusersofhealthandsocialcareservices.Mattersappropriatetootherprocedureswillcontinuetobetreatedinthesamemannerandinaccordancewiththeseagreedprocedures.
Examplesofrelevantdocumentsinclude:National Consent Policy; National Healthcare Charter; Equal Status Acts 2000 2008; Integrated Care Guidance: A practical guide to discharge and transfer from hospital; Your Service Your Say Policy and Procedure for the Management ofConsumerFeedbacktoincludeComments,ComplimentsandComplaints;OnSpeakingTerms;theMedicalCouncilGuidetoProfessionalConductandEthicsforRegisteredMedicalPractitioners;theDisabilityAct2005andtheHealthAct2004.
The NationalGuidelinesonAccessibleHealthandSocialCareServiceswillbereviewedatregularintervalstoensurethatthecontentofthedocumentisinlinewithnewpolicychangesordevelopmentsinhealthcare.
Thefollowingaresomeofthekeydocumentsforyourinformation.
4.2 The National Healthcare Charter, You and Your Health Service
The National Healthcare Charter, You and Your Health ServicewasdevelopedfollowingwideconsultationwithandinputfromtheIrishpublic,serviceusers,staff,thevoluntaryandstatutorysector,patientadvocacygroupsandindividualadvocates,themanagementteamoftheHSE,theDepartmentofHealth,theHealthServicesNationalPartnershipForumandregulatorybodies.
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NATIONAL GUIDELINESAccessible Health and Social Care Services
Theresultofthisconsultationisacharterdocumentwhichsetsouteightprinciplesofexpectationandresponsibilitywhichunderpinhighquality,people-centredcare.ThefirstprincipleofthecharterAccesssetsoutourcommitmenttoprovidehealthandsocialcareserviceswhichareorganisedtoensureequityofaccesstoallwhousethem.Thecharteralsoclearlyacknowledgesthatpatientsandserviceusershaveresponsibilitiestomeetsothattheyareactiveparticipantsintheircare.
4.3 FutureHealth,AStrategicFrameworkforReformoftheHealthService 2012 2015
Future Healthwillallowthehealthandsocialcareservicestomovetowardsanewintegratedmodelofcarethattreatspatientsatthelowestlevelofcomplexitythatissafe,timely,efficient andasclosetohomeaspossible.Inprovidingaccessiblecare,asoutlinedintheseguidelines,serviceswillsupportthegoalsofFuture Healthtoprovidecarethatispreventative,plannedandwell-coordinated.
Extractfrom:FutureHealth,AStrategicFrameworkforReformoftheHealthService 2012 2015
Keeping People Healthy:Thesystemshouldpromotehealthandwellbeingbyworking acrosssectorstocreatetheconditionswhichsupportgoodhealth,onequalterms,forthe entirepopulation.
Patient-centredness:Thesystemshouldberesponsivetopatientneeds,providingtimely,proactive,continuouscarewhichtakesaccount,wherepossible,oftheindividualsneeds andpreferences.
Lack of Integration:Weneedmuchbetterintegrateddeliverysystemsbasedonmulti-disciplinarycare.Thiswillreducecostsandimprovequality.
Achievingintegratedcaremeansthatservicesmustbeplannedanddeliveredwiththepatientsneedsandwishesastheorganisingprinciple.Itispreferablethatthetermintegratedcareratherthanintegrationbeusedsothatitisclearthatthefocusiswhereitshouldbei.e.onpatientsandfamiliesandtheservicestheyneedratherthanonfundingsystems,organisationorprofessionals.Eachofthesewillbeimportantleversinenablingandfacilitatingintegratedcarebuttheyinthemselvesarenottheobjectives.
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Inpracticalterms,thismeansthatservicesmustrecognisethatpeoplewithdisabilitieshaveadegreeofexpertiseintheownrequirementsandthat,bytheapplyingtheguidelinesAsk,Listen,Learn,Plan,Do,servicescanprovidemoreintegratedcare.(SeeGuidelineOne:DevelopingAccessibleHealthandSocialCareServicesformoreinformation).
Differenthealthservicesettingsorspecialtiesshouldnotoperateasindividualsilosunlessthereisgoodreason.Liaisonbetweenprofessionalsisimportanttoidentifytheservicesneededforindividualsandtoenableprofessionalstodeliverintegratedcarethatiscentredontheindividualandtheirneeds.Thisshouldhappeninwhateversettingthoseneedsaremetfromtimetotime.Forexample,whereappropriate:
Teamsworkinginprimary,specialist,rehabilitationandhospitalcarecansharetheirknowledgeandexperiencesothatperson-centredcarebecomesthenorm
Thosetreatinggeneralillnessescanliaisewiththoseprovidingspecialistcareorsupportfortheunderlyingdisability;and
Hospitalscanputinplacedischargeplanningandfollow-upwiththepersonsGPandspecialistdisabilitysupport,toensurecontinuityofcareandsupportondischarge.Thisisessential,especiallyforthosewithasevereandprolongeddisability
4.4 Integrated Care Guidance: A practical guide to discharge and transfer from hospital
Professionals should refer to the Integrated Care Guidance: A practical guide to discharge and transfer from hospital.3
4.5 The Equal Status Acts 2000 2008
TheEqualStatusActs2000-2008 4applytoallservicesinthepublic,voluntaryandprivatesectors.TheseActsmakediscriminationongroundsofdisabilityillegal.
TheActsalsorequirereasonableaccommodationsofpeoplewithdisabilitiesandallowabroadrangeofpositiveactionmeasures.Servicesandpremisesmustreasonablyaccommodatesomeonewithadisability.However,theyarenotobligedtoprovidespecialfacilitiesortreatmentwhenthiscostsmorethanwhatiscalledanominalcost.Whatamountstonominalcostwilldependonthecircumstances,suchasthesizeandresourcesofthebodyinvolved.
3 Thispracticalguidetointegratedcareisdesignedtosupporthealthcareproviderstoimprovetheirdischargeandtransferprocessesfromtheacutehospitalsettingbackintothecommunityandthereby,supportthedeliveryofhighqualitysafecare.TheNationalIntegratedCareGuidancehasbeendevelopedbytheNationalIntegratedCareAdvisoryGroupundertheauspicesoftheQualityandPatientSafetyDivision.http://www.hse.ie/eng/about/Who/qualityandpatientsafety/safepatientcare/integratedcareguidance/IntegratedCareGuidancetodischargefulldoc.pdf
4 TheEqualStatusActs20002008promoteequality,makessexualharassmentandharassment,victimisationandcertainkindsofdiscrimination(withsomeexemptions)acrossninegroundsillegal.Oneofthesegroundsisdisability.
http://www.hse.ie/eng/about/Who/qualityandpatientsafetysafepatientcare/integratedcareguidance/IntegratedCareGuidancetodischargefulldoc.pdfhttp://www.hse.ie/eng/about/Who/qualityandpatientsafety/safepatientcare/integratedcareguidance/IntegratedCareGuidancetodischargefulldoc.pdfhttp://www.hse.ie/eng/about/Who/qualityandpatientsafety/safepatientcare/integratedcareguidance/IntegratedCareGuidancetodischargefulldoc.pdf
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NATIONAL GUIDELINESAccessible Health and Social Care Services
Thedefinitionofdisabilitycoversthebroadrangeandkindsofdisability,andisnotlimitedtopeoplewithmoreseriousdifficulties.Itisbroadlydefined,includingpeoplewithphysical,intellectual,learning,cognitiveoremotionaldisabilitiesandarangeofmedicalconditions.FurtherinformationontheEqualStatusActs20002008isavailablefromtheEqualityAuthorityhttp://www.equality.ie/en/Publications/Information-Publications/Your-Equal-Status-Rights-Explained.html.
4.6 Part3,DisabilityAct2005
Part3,DisabilityAct2005(AccesstoBuildingsandServicesandSectoralPlans)coversthepublicsector,anditsfocusisonthosewhoexperiencemoresignificantdifficulties.5Itsetsoutwhatpublicbodiesmustdowherethisispracticableandappropriate,asfollows:
Mainstreamservicesmustincludepeoplewithdisabilities Whereapersonwithadisabilityrequestsit,theymustbegivenassistancetouseaservice Publicservices,incommunicatingwithpeoplewithdisabilities,mustuseappropriateformsof
communicationwhencommunicatingwithpeople;forexample,withpeoplewhohaveproblemswithvision,problemswithhearing,orthosewhohaveanintellectualdisability
Publicareasmustmeetminimumstandardsofaccessibility.Byend2015,theymustmeetthestandardssetoutinPartMoftheBuildingRegulations2000and,byJanuary12022,theymustmeetthestandardssetoutinPartMoftheBuildingRegulations2010;and
Thegoodsandservicesprocuredmustbeaccessibletopeoplewithdisabilities Underthelegislation,asapublicbody,thehealthservicemusthaveatleastoneAccessOfficerto
provideorarrangetheprovisionofassistanceandguidanceforpeoplewithdisabilitieswhentheyare accessing its services.
TheHealthServiceExecutivehasaNationalComplaintsOfficer(referredtoasanInquiryOfficerintheact)whodealswithappealsandcomplaintsaboutfailuretoprovideaccessibleservices,premises,informationorcommunication.ThereisafurtheravenueofappealtotheOmbudsman.
4.7 NationalDisabilityAuthorityCodeofPracticeandGuidance
ThereisastatutoryCodeofPracticeonAccessibilityofPublicServicesandInformationprovidedbyPublicBodies6whichgivesguidanceonhowtocomplywiththeDisabilityActrequirements.CompliancewiththeCodeofPracticeistakenascompliancewiththeAct.
5 Thelegaldefinitionofdisabilityinrelationtoapersonmeansasubstantialrestrictioninthecapacityofthatpersontocarryonaprofession,businessoroccupationintheStateortoparticipateinsocialorculturallifeintheStatebyreasonofanenduringphysical,sensory,mentalhealthorintellectualimpairment
6 http://nda.ie/Good-practice/Codes-of-Practice/Irish-Code-of-Practice-on-Accessibility-of-Public-Services-and-Information-Provided-by-Public-Bodies-/
http://nda.ie/Good-practice/Codes-of-Practice/Irish-Code-of-Practice-on-Accessibility-of-Public-Services-and-Information-Provided-by-Public-Bodies-/
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Forfurtherinformation,seetheGuidetotheDisabilityAct2005 (http://www.justice.ie/en/JELR/Pages/Guide_to_Disability_Act_2005).
TheNationalDisabilityAuthoritysaccessibilitytoolkit(http://accessibility.ie)containsgeneralinformationonhowtomakeservices,buildings,informationandwebsitesmoreaccessibletopeoplewithdisabilities.Thiswebsiteisupdatedregularly.
4.8 National Consent Policy
Extract from the National Consent Policy: Consentisthegivingofpermissionoragreementforanintervention,receiptoruseofa
serviceorparticipationinresearchfollowingaprocessofcommunicationinwhichtheserviceuserhasreceivedsufficientinformationtoenablehim/hertounderstandthenature,potentialrisksandbenefitsoftheproposedinterventionorservice.7
TheneedforconsentextendstoallinterventionsconductedbyoronbehalfoftheHSEonserviceusersinalllocations.Theethicalrationalebehindtheimportanceofconsentistheneedtorespecttheserviceusersrighttoself-determination(orautonomy)theirrighttocontroltheirownlifeandtodecidewhathappenstotheirownbody.
Itincludessocial,aswell,ashealthcareinterventionsandappliestothosereceivingcareand
treatmentinhospitals,inthecommunityandinresidentialcaresettings.Howtheprinciplesareapplied,suchas,theamountofinformationprovidedandthedegreeofdiscussionneededtoobtainvalidconsent,willvarywiththeparticularsituation.Exceptinemergencysituations,aninterpreterproficientintheserviceuserslanguageisrequiredtofacilitatetheserviceuseringivingconsentforinterventionsthatmayhaveasignificantimpactonhisorherhealthandwellbeing.Wherepracticable,thisisbestachievedinmostcasesbyusingaprofessionalinterpreter.
Knowledgeoftheimportanceofobtainingconsentisexpectedofallstaffemployedorcontractedbyhealthandsocialcareservices.Toensurethattheyareawareoftheirobligationswhenseekingconsentandforguidanceonobtainingvalidconsentfrompeoplewithdisabilities,staffshouldreadthe National Consent Policy.
7 NationalConsentAdvisoryGroup,HSE.NationalConsentPolicy.May2013HSE
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NATIONAL GUIDELINESAccessible Health and Social Care Services
4.9 The National Emergency Medicine Programme Professionals should refer to The National Emergency Medicine Programme A strategy to
improve safety, quality, access and value in Emergency Medicine in Ireland. This document giveshelpfuladvicespecifictotheEmergencyMedicineprogrammerelevanttoaccessibility.
4.10 Other
The UNConventionontheRightsofPersonswithDisabilities(CRPD),whichwasadoptedon13December2006andsignedbytheIrishGovernmentinDecember2007,hasnotyetbeenratified.Thisandemerginglegislation,suchastheAssisted Decision Making (Capacity) Bill and the HealthInformationBill,mayimpactonthecontentofguidelinesandrequirethemtobereviewedattheappropriatetime.
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5. Glossary of Terms / Definitions
5.1 Glossary
IntheseGuidelines,thetermaccessiblemeansuser-friendlyforpeoplewithdisabilities.
Accessiblebuilding Anaccessiblebuildingisonethatpeoplewithdisabilitiescanreadilyenter,movearound,use
comfortablyandexitsafely.
Accessiblecommunication Accessiblecommunicationmeanscommunicatingwithpeoplewithdisabilitiesinwaystheycan
readilyfollow.
Accessibleinformation Accessibleinformationmeansthatpeoplewithdisabilitiescanreadilyaccessandunderstandit.
Accessibleservice Anaccessibleserviceisonewhichisgearedtoservepeoplewithdisabilitiesalongsideother service users.
Disability Thelegaldefinitionofdisability,assetoutintheDisabilityAct2005,usedinrelationtoaperson
meansasubstantialrestrictioninthecapacityofthatpersontocarryonaprofession,businessoroccupationintheStateortoparticipateinsocialorculturallifeintheStatebyreasonofanenduringphysical,sensory,mentalhealthorintellectualimpairment
Easy to read EasytoReadisthetermforverysimplifiedtextwithpictures,whichisimportantforpeoplewith
literacyproblemsorlimitedEnglish.
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NATIONAL GUIDELINESAccessible Health and Social Care Services
Health and Social Care Professional Healthandsocialcareprofessionalisgenerallyusedasanumbrellatermtocoverallthevarious
healthandsocialcarestaffwhohaveadesignatedresponsibilityandauthoritytoobtainconsentfromserviceuserspriortoanintervention.Theseincludedoctors,dentists,psychologists,nurses,alliedhealthprofessionals,socialworkers.
Plain English Awayofpresentinginformationthathelpssomeoneunderstanditthefirsttimetheyreadorhearit.
Service user Weusethetermserviceusertoinclude: Peoplewhousehealthandsocialcareservicesaspatients Carers,parentsandguardians Organisationsandcommunitiesthatrepresenttheinterestsofpeoplewhousehealthandsocial
careservices;and Membersofthepublicandcommunitieswhoarepotentialusersofhealthservicesandsocial
care interventions
Thetermserviceuseralsotakesaccountoftherichdiversityofpeopleinoursociety,whetherdefinedbyage,colour,race,ethnicityornationality,religion,disability,genderorsexualorientation,andwhomayhavedifferentneedsandconcerns.
Weusethetermserviceuseringeneral,butoccasionallyusethetermpatientwhereitis mostappropriate.
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5.2 Appropriate Terms to Use
Whenwritingorspeakingaboutpeoplewithdisabilities,itisimportanttoputthepersonfirst.Catch-allphrases,suchastheblind,theDeaforthedisabled,donotreflecttheindividuality,equalityordignityofpeoplewithdisabilities.
Listedbelowaresomerecommendationsforusewhendescribing,speakingorwritingaboutpeoplewithdisabilities.
Some examples of appropriate terms:
Term no longer in use: Term Now Used: thedisabled peoplewithdisabilitiesordisabledpeople wheelchair-bound personwhousesawheelchair confinedtoawheelchair wheelchairuser cripple,spastic,victim disabledperson,personwithadisability thehandicapped disabledperson,personwithadisability mentalhandicap intellectualdisability mentallyhandicapped intellectuallydisabled normal non-disabled schizo,mad personwithamentalhealthdisability suffersfrom(forexample,asthma) has(forexample,asthma)
ReproducedfromtheNDA Guidelines on Consultation Source:MakingProgressTogether,2000-PeoplewithDisabilitiesinIrelandLtd.
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NATIONAL GUIDELINESAccessible Health and Social Care Services
5.3 Abbreviations
ASL AmericanSignLanguage BSL BritishSignLanguage CD CompactDisc DCSP DirectorateofClinicalStrategyandProgrammes DHSSPS DepartmentofHealth,SocialServicesand
PublicSafety
DVD Digital Versatile Disc ECN EmergencyCareNetwork ED EmergencyDepartment EDD Estimated Date of Discharge EDIS EmergencyDepartmentInformationSystems ELOS EstimatedLengthofStay EM EmergencyMedicine EMA EmergencyMultilingualAids EMP EmergencyMedicineProgramme GAIN GuidelinesandAuditImplementationNetwork GP General Practitioner HIQA HealthInformationandQualityAuthority HSE HealthServiceExecutive IRIS IrishRemoteInterpretingService ISL IrishSignLanguage IT InformationTechnology LIU LocalInjuryUnit MRI MagneticResonanceImaging MRSA Methicillin-resistantStaphylococcusaureus NALA NationalAdultLiteracyAgency NCBI National Council for the Blind of Ireland NDCS NationalDeafChildrensSociety NDA NationalDisabilityAuthority NECS NationalEmergencyCareSystem NHS National Health Service NICE National Institute for Health and Clinical
Excellence
20
NPSA NationalPatientSafetyAgency PA Personal Assistant PDD Patient Discharge Data PHN Public Health Nurse PPG Policy,ProcedureorGuideline SCIE SocialCareInstituteforExcellence SDU SpecialDeliveryUnit SLIS SignLanguageInterpretingService UK UnitedKingdom UN UnitedNations US UnitedStates UNCRPD UnitedNationsConventionontheRightsof
PersonswithDisabilities WC WaterCloset
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NATIONAL GUIDELINESAccessible Health and Social Care Services
6.1 AllStaff
Eachmemberofstaffworkinginhealthandsocialcareserviceshasaresponsibility,relevanttotheirownrole,toensurethatservicesareaccessibletopeoplewithdisabilities,andthattheirinteractionsandcommunicationwithpeoplewithdisabilitiesareappropriate,respectful,andaredeliveredinwaysthatpeoplewithdisabilitiescanreceiveandunderstand.
Medical,nursing,andotherprofessionalandtherapystaffhavearesponsibilitytolistenandtocommunicateappropriately,andtotakeaccountofconcurrentissuesinrelationtothepersonsdisabilityintheirtreatmentprogrammes.
Receptionistsandadministrativestaffhavearesponsibilitytoensurethatpeoplewithdisabilitiesareinformedofappointmentsandarecalledfortheirturninwaysthatcanbereceivedandunderstood.
Careassistants,porters,cateringandcleaningstaffwhointeractwithpatientsandserviceusersinthecourseoftheirworkhavearesponsibilitytocommunicateinwaysthatcanbeunderstood.
Maintenanceandcleaningstaffmaymaintainaccessibilityofbuildingsandfacilitiesbyensuringthattherearenoobstructionswhichcouldhinderaccessibilityorcauseahazard.
Frontlinestaffshouldseektoresolve,atalltimes,concernsandqueriesfrompatientsandserviceusersatthefirstpointofcontactwiththepatient/serviceuserand/ortheiradvocate.Wherethisisnotpossible,theyshouldseekadvicefromtherelevantlinemanagerorfromaspecialistdisabilityorganisation,dependingontheissue.Iftheissuecannotberesolvedatthislevel,furtheradvicecanbesoughtfromtheAccessOfficer.
6.2 Seniormanagementrole
Seniormanagershavearesponsibilitytosupportandpromotetheprovisionofaccessibleservicesforallserviceusers.Allhealthandsocialcaremanagementshouldaimtoensurethatthecapacityoftheserviceisdevelopedtofullysupportpeoplewithdisabilitiesinmainstreamhealthservices.Thefollowingarekeytasks/responsibilitiesforseniormanagers: Tocomplywithallpolicies,proceduresandlegalobligations:
EnsurecompliancewithlegalresponsibilitiesundertheEqual Status Acts 2000 2008 and the DisabilityAct2005.
6. Roles and Responsibilities
22
Toprovideleadershiptootherstaff: Setoutrolesandresponsibilities Ensureallotherstaffaccessappropriatedisabilitytraining Ensureaccessofficer(s)areinplaceandarereleasedforandhaveaccessedappropriatetraining;
and EnsurethatstaffareawareoftheNationalHealthcareCharterandthe8principlesof
Access,DignityandRespect,SafeandEffectiveServices,CommunicationandInformation, Participation,Privacy,ImprovingHealth,Accountability,theavailabilityoftheseguidelines andotherrelevantpolicies
Toensurethatallmainstreamserviceplanning,servicedeliveryorperformanceevaluationsystemsaredevelopedsothatservicesareaccessibleforallserviceusersandsupportcompliancewiththerelevantpolicies,procedures,guidelinesandlegislation:
Integrateaccessibilityintoserviceplanningineachservice;forexample: Build-insystemstoensuretheindividualsneedsareco-ordinatedacrossdifferentlevelsor
centres of care Developpatientandserviceuserinformationsystemsthatensurethattheaccessibility
requirementsofserviceusersandinformationonmanaginganypre-existingconditionscanfollowthroughtheirpatientjourneyacrossdifferenthealthservices
Ensurethatdeliveringonaccessibilityrequirementsisbuiltintosystemsformanagingandmonitoringperformanceofstaffanddepartments;and
Budgettomeetaccessibilitycommitments
Toensurethat,aspartoftheregularplanningcycle,seniormanagerssetgoalsandclearprioritieswhichwillallowthemtomeetlegalrequirementsandenhanceaccessibility:
Setgoalsandclearprioritiesforachievingaccessibility Setkeyperformanceindicatorsorcomplywiththeprovisionofdataforexistingnational
performanceindicatorsonaccessibility Ensuretherearepoliciesand/orprotocolsthatsetouthowaccessibilityistobeachievedin
eachlocalarea;and Putinplaceasystemforreportingandreviewingwhathasbeenachievedandforplanningand
agreeingthenextsteps
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NATIONAL GUIDELINESAccessible Health and Social Care Services
6.3 AccessOfficerrole
TheappointmentofAccessOfficersisalegalobligationunderPart3oftheDisabilityAct2005. TheActrequiresthatAccessOfficersbeappointedtoallsiteswherethegeneralpublicusehealthandsocialservices.TheActalsoextendstoorganisationsthathaveaserviceagreementwith theHSE;forexample,thoseorganisationsthatarefundedunderSection38and39oftheHealth Act 2004.
Section26(2)oftheDisabilityAct2005requireshealthandsocialcareservicestoauthoriseatleastonememberofstafftoactasanAccessOfficer,toprovideorarrangeforandco-ordinatetheprovisionofassistanceandguidancetopersonswithdisabilitiesinaccessingitsservices.Pleasenote,thisisnotspecificallytheroleofstafffromDisabilityServices,andstafffromanybackgroundshould be considered.
GiventhattheHSEprovideshealthandsocialcareservicesinhundredsoflocationsthroughout
thecountry,accessofficersarenecessarywherethereareserviceusers,patientsandclients;forexample,hospitals,primarycarecentres,healthandsocialcareclinicsand/orlocationswherehealth and social care is delivered.
Theroleisnotlimitedtophysicalaccess,suchascarparking,rampsorwheelchairaccess,butextendstoallaspectsofthepatient/serviceuserjourneyincludingtheprovisionofaccessibleinformation,consultationsandprocedures,appointmentsandapplicationsforserviceprovision.
Itisthedutyandroleofallhealthandsocialcareprofessionalsatalllevelstoattendtothe accessneedsofpeoplewithdisabilities.AccessOfficerswillnotreplacethisduty.Rather,AccessOfficerswillprovideadditionalsupporttofrontlineservicestoattendtotheaccessneedsofpeoplewithdisabilities.
Mostaccessanddisabilityissuesarealreadybeingmanagedeffectivelybyfrontlineservicesonaday-to-daybasis.Thisrolewillnottakefromthisexistingpractice.Ininstanceswhereanissuecannotbedealtwithlocally,thismattercanbereferredtotheNationalSpecialistinAccessibilityforfurthersupport.TheHSEappointedaNationalSpecialistinAccessibilityin2010whoseroleistoprovideguidance,adviceandstrategicsupportinthepromotionofaccesstomainstreamhealthservicesforpeoplewithdisabilities.
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Peoplewithdisabilitiesfacemanybarriersinaccessinghealthandsocialcareservices.Someofthesebarriersareowingtoapoorphysicalenvironment.However,mostoftheexistingbarriersareowingtoalackofunderstandingofhowtoaccommodateapersonsdisability.AccessOfficerswillplayakeyroleinsupportingtheorganisationtoaddresssomeofthesebarriersand,indoingso,inensuringgreateraccessibilityforpeoplewithdisabilities.Theroleisdesignedtosupporthealthservicestaffrespondtotheaccessrequirementsofpeoplewithdisabilitiesinallhealthandsocialcaresettings.Accessofficerswillbeprovidedwithon-goingcomprehensivetraining,informationandresourcesmaterialstoenablethemcarryoutthisrole.
TheroleofanAccessOfficerinhealthandsocialcareservicesistosupporthealthservicestafftorespondtotheaccessrequirementsofpeoplewithdisabilitiesinallhealthandsocialcaresettings.ThemaindutiesofanAccessOfficerareto:
Respondtoanddealwithrequestsfromhealthservicestaffforassistanceregardingaccessissueswheresuchrequestshavenotbeendealtwithorcannotbemanagedatthefirstpoint of contact
Advisehealthservicestaffontheprovisionofinformationinanaccessibleformat Developprotocolsforrespondingtospecificrequestsforassistanceanddocumenthowsuch
assistance can be sourced Disseminateinformationonbestpracticeregardingaccessibility Liaisewithrelevantdisabilityorganisationsifnecessaryand/orsupportfrontlineservicestodo
soasappropriate Logandappropriatelyrecordresponsestorequestsandqueries Promoteawarenessoftheroleofaccessofficerasappropriate LiaisewiththeNationalSpecialistinAccessibilityand ItisnottheroleofanAccessOfficerto: Provideone-to-oneadvocacyforpeoplewithdisabilities Relievefrontlinestaffoftheiraccessresponsibilitiestopatients/clients/serviceusers Beaonestopshoponallmattersofdisability;and Dealwithcomplaints(theseshouldbedirectedthroughYour Service, Your Say).Iftheissue
cannotberesolvedorthepatient/serviceuserisnotsatisfiedwithhowtheissuehasbeendealtwith,s/hecanreferthemattertotheHSEcomplaintssystem,Your Service, Your SayormayrefertheissueonwardstotheOfficeoftheOmbudsmanortheOfficefortheOmbudsmanforChildren.FurtherdetailsofYourService,YourSayareavailableonwww.hse.ie
Title
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NATIONAL GUIDELINESAccessible Health and Social Care Services
25
Part One
Guidelines for all Health and Social Care Settings
Theguidelinesdescribeastandardwhichwecanaspireto.Theyarewrittenintheknowledgethatservicesmaynothavefinancialresourcestoimplementallmeasuresoutlined;however,thereisanobligationonindividualstoensurethattheyknowwhatisrequiredofthembylaw.Theyalsoserveasaresourceforhealthandsocialcareprofessionalswhomaybeplanningservicesinthefuture.
Manyofthekeyinitiativesyoucantaketomakeservicesmoreaccessiblearecostneutral.Consideration,compassionandopencommunicationarefree.Timespentidentifyingapersonsneedsisaninvestmentinsafe,effectivecarewhichcanpreventunnecessaryriskstotheindividualandthestaffmember.
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Developing accessible health and social care services 1.1 Ask, Listen, Learn, Plan, Do
Mainstreamsystemsandpracticesshouldbedesignedtoensurethattheyareaccessibleforallservicesusers.Whendevelopingaccessibleservices,thefollowingapproachmaybeofassistancetoyou:Ask,Listen,Learn,Plan,Do.Figure1isacirculardiagramwhichisavisualrepresentationoftheAsk,Listen,Learn,Plan,Doprocess.Italsodemonstratesthecyclicalorrecurringnatureofthisprocess.
Ask Listen
Learn
Plan
Do
Fig. 1: Developing
accessible services
1. Guideline One
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NATIONAL GUIDELINESAccessible Health and Social Care Services
Ask
Consultwithindividuals,advocates,disabilityorganisationsandstaffworkingcloselywithindividualstoidentifypatientandserviceuserneedsinyourarea.8
Asksimplequestionstofindoutifserviceusershaveanyspecificrequirementsthatmustbeaccommodated;forexample,Isthereanythingwecandotoassistyou?
Becomeawareofwhatcouldconstituteobstaclesordifficultiesforpeoplewithdisabilitiesusingyourservices
Withtheconsentofthepersonwithadisability,familymembers,carersorsupportworkersmayalsobeabletoguideonanyspecificneeds
Listen
Recognisethatpeoplewithdisabilitiesandstaff,familymembers,personalassistants,advocatesanddisabilityorganisationsworkingcloselywithindividualsareoftenexpertsinpatientandserviceuser needs.
Listenattentivelytotheirfeedback Listentoanysuggestionsmadeforaddressingtheirrequirements
Learn
Ensurethatyouhavesufficientinformationtohelpyoutoimproveserviceprovision. Completeanynecessaryresearchsothatyoucanlearnabouttherequirementsofindividuals Readtherelevantpolicies,procedures,guidelinesandlegislation
8 TheNationalAdvocacyUnitprovidesguidanceonserviceuserinvolvementandparticipation.
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Plan
Whileitwillnotalwaysbepossibletomeetpatientorserviceuserrequirements,healthandsocialcareservicescanstrivetounderstandserviceuserneedsand,wherereasonable,practicalandappropriate,theycanmakepositivechangestohowservicesareprovided.Whereappropriate:
Setoutaprogrammeofactiontoaddressidentifiedissues Developaplaninconsultationwithrelevantpeopletosupportyoutomaketheservicesyou
providemoreaccessible Setoutclearprotocolsandguidanceforstaff Buildincoordinationacrossdifferentlevelsofcare Setoutrolesandresponsibilities Establishandembedpolicies
Do
Adoptpoliciesandprotocolsthat: setoutthestandardstepstofollowtoachieveaccessibleservices;and integrateaccessibilityintoyourgeneralprotocolsforserviceprovision Implementtheadoptedpoliciesandprotocols Provideclearleadership Provide training and mentoring Establishsystemstomonitorandreviewdeliveryinpractice Offerafeedbackandcomplaintsmechanism Ensurefeedbackinformsreviewofpoliciesandpractices Afteraperiodoftimeitwillbenecessarytobeginthecycleagain
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NATIONAL GUIDELINESAccessible Health and Social Care Services
1.2 Examplesofpolicies,proceduresorguidelinesforstaff
Whenanagreedstandardpolicy,procedureorguideline(PPG)isinplaceandimplemented,staffareawareofwhattheycandolocallytomakeservicesmoreaccessible.PleasenotethattheHSEPPGs are available on the intranet site.
Examplesofpolicies,proceduresorguidelines(PPGs)whichareadvisableforservices,orwheretherearepre-existingnationalhealthandsocialcareservicePPGswhichstaffshouldadoptandapplylocally,aredetailedbelow:
Identifyingapersonsaccessibilityrequirements Reviewingpre-admissionplanning,in-patientcareanddischargeplanningtoensurethatthey
areaccessible(SeeIntegrated Care Guidance: A practical guide to discharge and transfer from hospital)
Co-ordinationofcareacrossGeneralPractice(GP)andhospitalservicesandliaisonwiththeteamdealingwiththepersonsprimarydisability,whereappropriate,andmaintainingconfidentialityasisrequireddependentonthecase
Patientconsent(SeeNational Consent Policy)anddecision-making Evacuationinanemergencyfromhealthorsocialcaresettings Ensuringthatbuildingsarewell-maintained,thatallaccessibilityfeaturesareoperatingcorrectly Ensuringthattherearenoobstructionswhichcouldhinderaccessibilityorcauseahazard
30
Developing disability competence 2.1 Buildingcapacityandunderstandingforallstaff
Allhealthandsocialcarestaffshoulddisplayapositiveattitudetowardsserviceusers.Appropriatetrainingiskeytoensuringthatstaff:
areawareofthepatientandserviceusersneedsintheareaofaccessibilityandspecificaccessibilityconcernsforpeoplewithdisabilities,and
developthecompetenceandconfidencetoaddresstheseeffectively
Peoplewithdisabilitiescanfacearangeofaccessibilityproblemsorbarriers.Forexample: buildings transport equipment failuretocommunicateinappropriateways lack of accessible information attitudes ignorance discrimination
Disabilitytrainingcanhelpstaffrecognisethesebarriersandlearnpracticalwaysinwhichtheycanbe addressed.
Localmanagersshouldfacilitatecapacitybuildingforstaff.Thiscanbedonebyarrangingawarenesstrainingwhichincludesgeneralmaterialonaccessibleservicesandcommunication,aswellastailoredtrainingrelatingtothespecificroleandsetting.
2. Guideline Two
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NATIONAL GUIDELINESAccessible Health and Social Care Services
2.2 Online training resource
TheNationalDisabilityAuthoritysDisabilityEqualityTraininge-learningisavailableonlineat elearning.nda.ie,andalsoonHSELand.ie,theHSEsonlineresourceforLearningandDevelopment(www.hseland.ie)underPersonalDevelopment.Thiscourseisfreeofcharge;ittakesaboutanhourandahalftocompleteandprovidesageneralintroductiontocustomerserviceforpeoplewithdisabilities.
2.3 Tailoreddisabilitytraining
Insomeinstances,itcanbehelpfultohavetrainingwhichistailoredtoinformparticipantsaboutaparticulardisability.Forexample,DeafawarenesstrainingcanexplorecommunicatingwithDeafpeopleinmoredepth.
2.4 Professional education, training and professional standards
Professionaleducationandtrainingandcontinuousprofessionaldevelopmentofhealthandsocialcarepersonnelshouldroutinelyincludetrainingonaccessibilityasanintrinsicpartof their curriculum.
Medical,nursingandtherapyschools,professionaltrainingbodies,suchasthecollegesofprofessionalspecialties,andregulatorybodies,suchastheIrishMedicalCouncil,havearoletoplayinthisregard.Standardssetbyprofessionalbodiesshouldmakeprovisionforaccessibilityissues.
Staffprovidinggeneralhealthandsocialcareneedtoreceiveappropriatetrainingtoallowthemtocompetentlysupportpatientsandserviceuserspresentingfortreatmentofmedicalconditionsotherthantheirdisability.
Clinical,nursingandalliedhealthprofessionalsshouldreceivetraininginmanagingtheinterplayofdifferentmedicalconditionsand,inparticular,whereapersonsdisabilitymayimpactontheircareplan;forexample,howtocarefor:
Apatientwithaspinalinjurywhentheyareinhospitalwithanunrelatedcondition,astheymayneedadditionalsupportsregardingposture,bowelcareandavoidanceofpressuresores;or
Apatientwithacognitiveimpairmentwhopresentswithafracturedhip,whentheymayforgetthattheyneedtoimmobiliseit;or
ApatientwhoisinlabourwhentheyareDeaf
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Accessible services - general advice 3.1 Donotassume-ask
Peoplewithdisabilitiesaregenerallyexpertsontheirspecificaccessibilityrequirements.Noteveryonewithadisabilityneedsassistanceandanaccessibilityneedmaynotbeapparent,soitisimportantto:
Askeachpersoniftheywouldlikeassistanceandaboutanyspecialrequirementstheymayhave Askforinstructions,ifanofferofhelpisaccepted Listenattentivelytowhattheirrequirementsareandhowtheycanbeaddressed Allowthepersontohelpanddirectyou,ifyoudonotknowwhattodo.Thepersonwillindicate
thekindofhelpthatisneeded Notbeoffendedifyourhelpisnotaccepted,asmanypeopledonotneedanyhelp;and Documentanyrelevantaccessibilityorcommunicationresourcesorrequirements
Donotassumethatapersonwithadisabilitywouldbeunabletoanswerquestionsabouttheirhealthortheirsymptoms.Askthepersonthemselvesinthefirstinstance.
3.2 Making an appointment
Identifyanyaccessibilityrequirements Whenbooking,forexample,appointmentsorprocedures,contactthepersonandprovidethemwith
anopportunitytoinformyouofanyaccessibilityrequirements.
Primarycontactforappointmentsisusuallybyletter.However,whereservicesareawareofadisability,primaryand/orfollow-upcontactshouldbeappropriatetothepersonsneeds,andmaybemadebyletter,telephone,email9ortextmessage.
Establishfromserviceuserstheirpreferredmethodofcommunication,takingintoconsiderationtheirlevelofdisability;forexample,itmaybenecessaryforapersonwithavisualimpairmenttoreceivecommunicationviaemailortelephoneinsteadofletter.
Itisimportanttonotethatthemethodofcommunicationmaybedifferentforeachpersondependingontheirdisability.Also,twopeoplewiththesamedisabilitymayhavedifferentcommunication needs.
3. Guideline Three
9 ItisimportantthatwhereelectroniccommunicationcontainspersonalconfidentialinformationthatitisencryptedinaccordancewiththerelevantHSEInformationTechnology(IT)PolicyandProcedures.
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NATIONAL GUIDELINESAccessible Health and Social Care Services
Two way appointment systems Manyappointmentsystemsareone-wayonlyorrequireapersontotelephoneiftheywantto
changetheirappointment.TheseareinaccessibletopeoplewhoareDeaforhaveimpairedspeech.Itisessentialtohaveatwo-waysystemsothatallserviceusersmayrespond;forexample,tocancelorchangeanappointment.Thismaymeanreviewingtheexistingresponsemethodsinanarea.Haveasysteminplacetoensurethatsuchmessagesarerespondedtopromptly.
Using text messages Whereavailable,useamobilenumberoratelephonelandlinethatacceptstextmessages.(Please
notetextmessageservicesarenotavailableinallareasatpresent). Publicisethenumberinyourserviceuserinformation;forexample,onyourwebsiteandinyour
hospital,GPsurgeryorhealthcentre Iftextisthemethodused,alwaysgiveaquickacknowledgmenttoatextmessage,evenif
youdonotknowtheanswertothequestionthatisasked,sothatthepersonknowsyouhavereceived their message
3.3 Showflexibilitywhenschedulingappointments
Pleasenotethatthefollowingsectiondoesnotmeanthatpreferentialtreatmentwillbegiventopeoplewithdisabilities,butratherthatservicesshouldexerciseconsiderationforthecircumstancesofacasewhereappropriate.
Setting an appointment time Wherepossible,servicesshouldbeflexibleaboutappointmenttimesandvisitinghourswherethey
impactontheprovisionofaccessibleservices.Forexample: Earlymorningappointmentsmaybeunrealisticforpeoplewhoneedmoretimetogetreadyor
whoneedacarerorPersonalAssistanttohelpthem Findingaccessibletransportmayalsobemoredifficultearlyinthemorning Alaterappointmentmayfacilitatefamilymembers,personalassistants,orsupportpersons
toaccompanyapersonwithadisabilitytoattendanappointmentortobetheretoassistwithfeeding,drinking,orusingthetoiletasnecessary
Minimising the waiting times for an appointment Itmaybeappropriate,whenpossible,tominimisewaitingtimesforapersonwithadisability
whentheyareattendingforappointmentswheretheirdisabilitymaycausethemtoexperience
34
unnecessaryanxiety,distressorpain.Forexample,apersonwithacognitivedisabilitymaybecomeagitatedordistressedinanewenvironmentorfindremaininginoneplaceforalong timedifficult.
Itcanbehelpfultotakethisintoconsiderationwhenschedulingappointments;forexample, thefirstappointmentafterlunchmayhavetheshortestwaitingtime.Itcanbehelpfulto scheduleappointmentswithaninterpretersothatwaitingtimesandcostofinterpretiveservices are minimised.
Allow additional time for appointments where necessary Someserviceusersmayneedmoretimetocommunicateeffectivelywithyou.Schedulelonger
appointmentswherenecessary;forexample;incaseswherethepersonhasacognitiveimpairmentorimpairedspeech,orthepersoncommunicatesthroughlip-readingorviaaninterpreter.
Allowenoughtimeforapersonwithadisabilitytogetfromoneplacetoanotherather/his ownpace.
3.4 Missed appointments
Whenapersonwithadisabilitymissesanappointment,itcanbehelpfultocheckwhether thiswasduetoinaccessibleinformationortoaninaccessiblebuildingorservice.Actonthefeedbackprovided.
3.5 Planvisitsforroutinecheck-upsorsurgeryinadvance
Wherethereisapre-plannedvisit,suchasaroutinecheck-uporpre-plannedsurgery,itispossibletoidentifyandplaninadvancetomeetanyaccessibilityrequirements.
Contactthepersonbeforeadmissionandprovidethemwithanopportunitytoinformyouofanyaccessibilityrequirementstheywillhaveontheday.
Apre-visitmaybehelpfulinsomesituationstofamiliarisethestaffandpatient.Forexample, pre-visitstoahospitalorcliniccanhelpbuildtrustforapersonwithanintellectualdisability,sothattheyaremorecomfortableandincontrolwhentheyareadmittedtohospitalorwhentheyattend for treatment.
Letotherstaffknowwhenandwherethepersonisarrivingandwhattheplanis.
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3.6 Queuingtobeseen
VisualDisplayUnitsinwaitingroomsandpublicareascaninformpeopleofappointments,directions,informationorqueuinginformation.Avisualsystemcouldbeaticketmachine,avisualdisplayorawhiteboard.
Ifpossible,havebothanaudibleandvisualsystemforlettingpeopleknowtheirturn.ThisistoensurethatpeoplewithimpairedvisionandpeoplewhoarehardofhearingorDeafareawarethattheyarebeingcalledfortheirturn.
Ifyouuseaticketsystemforthequeue,ensurethattheticketmachineisataheightwhereawheelchairuserorapersonofshortstaturecanreachit(andthatthereisanalternativeforpeoplewhoareblind).
Informpeoplehowtheywillbecalledandthelocationofthevisualdisplayunits,sothattheycansitwheretheycanseeorhearwhentheyarecalled.
Intheabsenceofavisualdisplayunitinthewaitingroom,makesurethatpeoplewithimpairedvisionorthosewhoareDeaforhardofhearingareinformedwhenitistheirturntobeseen.
3.7 Filling forms
Askifthepersonneedsassistancefillinginaform. Servicesshouldalsoconsiderhavingeasy-grippensavailableforthosewithmanual
dexterityproblems.
Ifthereceptionistscounteristoohigh,forexample,forawheelchairuser,youmayneedtosteparoundittocompleteyourbusinesswiththepatient/serviceuser.
Aclipboardcanbehelpfulforpeopleunabletoreachthecounterwhenfillingoutformsor signing documents.
36
Ifpossible,itmaybehelpfultoprovidetheoptionfortheformtobeaccessedandcompletedon-lineinadvanceofanappointment.
3.8 Information and notices
Provideinformationabouthowyoucanaccommodatesomeonesdisability;forexample: Contactdetailsforthepersonwhowilldealwithqueriesaboutaccessibilityifyoucannotanswer
theirquery Thesymbolforahearingloop,ifavailable AnoticeaboutyourpolicyonGuideDogsandAssistanceDogs;and AnoticeontheprovisionofanIrishSignLanguageInterpreteronrequest
3.9 Mobilityaids
Manypeoplewithphysicaldisabilitiesrelyonmobilityaids,suchasmanualandelectric wheelchairsormobilityscooters,andwalkingaids,suchascrutches,walkingframesandwalkingsticks. Do not:
movemobilityaidswithoutpermissionfromtheowner(unlesstheyarecausinganobstructionwhichurgentlyneedstobemoved)
pushapersonswheelchairortakethearmofsomeonewalkingwithdifficulty,withoutfirstaskingifyoucanbeofassistance
leanagainstapersonswheelchairwhentalkingtothem.Forawheelchairuser,theirchairispartoftheirpersonalspace
3.10 Focus on the person
Duringaconsultation,focusontheperson,nottheirdisability.Therecanbeariskthatclinicianscouldattributesymptomstoapersonsunderlyingdisability,andthusmisssomesignsofanunrelated health condition.
Takethepersonspresentinghealthcondition/clinicalneedsintoconsideration. Giveconsiderationtotheirunderlyingdisabilityandthepotentialimpact(ifany)ofthesameon
thepresentinghealthconditionand/ortheircareplan Beflexibleinordertoaddressindividualneeds
3.11 Concurrent therapeutic or care needs
Anindividualsprimarydisabilityorotherpre-existingconditionmayinvolvespecifictreatmentorcareprotocols.Itisimportanttoknowaboutthesewhendiagnosingandtreatinganothercondition.
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NATIONAL GUIDELINESAccessible Health and Social Care Services
Talktotheperson,theircarer,GP,consultantorkeyworkerintheirdisabilitysupportserviceasappropriate,astheyareimportantsourcesofinformation
Identifyanyspecificcareortherapeuticrequirementsrelatedtoexistinghealthconditionsortotheirdisability,suchasrequirementsinrelationtopersonalcare,feeding,lifting,posture,preventionofpressuresoresorbowelcare
3.12 Maintainconfidentiality
Confidentialityisabasicprincipleintheprovisionofhealthandsocialcare.
Apersonsprivacycouldbecompromisedifthereisintimateorsensitiveinformationbeingconveyedordiscussedwiththirdpartieswithouttheirconsent.
Healthandsocialcareprovidersshouldbemindfulofthiswhencommunicatingwiththirdparties,suchasfamilymembers,personalassistants,staff,advocatesetc.Staffshouldusetheirdiscretiontoensurethattheydonotcompromisetheindividualsrighttoconfidentiality.
Relyingonchildrenandfamilymemberstointerpretortranslateisnotrecommendedonethicalandlegalgrounds.ThedocumentOn Speaking Terms(http://www.hse.ie/eng/services/publications/)givesmoreinformationonthis.However,theremaybesomesituationswherethisisunavoidable;forexample,anemergencysituationwhereafamilymemberisaskedtotranslateforaDeafserviceuser.However,thisshouldbetheexception.Childrenshouldnotbeaskedtointerpretortranslatefortheirparents.
3.13 Health Promotion
Allpatientsandserviceusersshouldbeconsideredinthedevelopmentofanyhealthpromotionstrategy:
Providehealthpromotioninformationandguidanceinarangeofaccessibleformats Ensurepeoplewithdisabilitiesareincludedinanypopulationscreeningprogrammesandhealth
checksasdeemedclinicallyappropriate;forexample,amammogram
Healthscreeningpremisesandequipmentshouldbedesignedsothatallpatientsandserviceuserscanusethem.Ifthisisnotthecase,effortsshouldbemadetoofferanalternative.Forexample,aMagneticResonanceImaging(MRI)scanrequiresapatienttoremainstillforaperiodoftime;somepatientsmayneedsedationpriortoundergoingthisscan.
http://www.hse.ie/eng/services/publications/
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3.14 Integrated Discharge Planning
Toensureserviceusersaredischargedortransferredsafelyandontimerequiresfullassessment
oftheirindividualhealthcareneeds,planningandcooperationofmanyhealthandsocialcareprofessionals.10
MakeaplanforcontinuityofcareandsupportafterdischargeinaccordancewiththeIntegrated Care Guidance: A practical guide to discharge and transfer from hospital.ThefollowingninestepsaretakenfromthedocumentDischarge and transfer from hospitalThe nine steps quickreferenceguide.
DischargeandtransferfromhospitalTheninestepsquickreferenceguide.
Step one:Beginplanningfordischargebeforeoronadmission Preadmissionassessmentsconductedforplannedadmissionstohospital,suchaselective
procedures,oralternativelyatfirstpresentationtothehospitalforunplannedadmissions. Mostaccuratepreadmissionmedicationlistshouldbeidentifiedpriortoadministrationof
medicationinthehospital Priorhistoryofcolonisationwithamulti-drugresistantorganism,example,Methicillin-resistant
StaphylococcusAureus(MRSA)orhealthcareassociatedinfectionshouldberecordedinhealthcarerecord,andhealthcarestaffinformedasperlocalhospitalpolicy
Timelyreferralsaremadetomultidisciplinaryteamandreceiptofreferralsrecordedonintegrateddischargeplanningtrackingformwithin24hoursofreceivingreferral NOTE: this includes referrals from hospital to primary care services
Eachserviceusershouldhaveanestimatedlengthofstay(ELOS)/estimateddateofdischarge(EDD)identifiedwithin24hoursofadmissionanddocumentedinthehealthcarerecord,relatedtotheestimatedlengthofstayrequired(SpecialDeliveryUnit,2013)
Step two: Identify whether the service user has simple or complex needs Theserviceusersneedsareassessedeitherpriortoadmissionoronfirstpresentationand
indicatewhethertheserviceuserhassimpleorcomplexneeds. TheELOS/PredictedDateofDischarge(PDD)isdeterminedbywhethertheserviceneedsare
simpleorcomplex Theserviceuserisplacedonanappropriateclinicalcareprogrammecarepathway,relevantto
theserviceusersdiagnosis,tosupportseamlesscareandmanagement
10ExtractfromIntegratedCareGuidance:Apracticalguidetodischargeandtransferfromhospital.
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Step three: Develop a treatment plan within 24 hours of admission Allserviceusershaveatreatmentplandocumentedintheirhealthcarerecordwithin24hoursof
admission,whichisdiscussedandagreedwiththeserviceuser/familyandcarers. Thetreatmentplanincludesareviewofpreadmissionagainstadmissionmedicationlist,witha
viewtoreconciliation Changestothetreatmentplanarecommunicatedtotheserviceuserandrelevantprimarycare
servicesasappropriate,anddocumentedinthehealthcarerecord
Step four: Work together to provide comprehensive service user assessment and treatment Themultidisciplinaryteamcomprisesoftheappropriatehealthcareprofessionalstoproactively
planserviceusercare,setgoalsandadjusttimeframesfordischargewherenecessary. Regularmultidisciplinaryteammeetingsorcaseconferencesforcomplexcarecasesareheld
whereappropriate Rolesandresponsibilitiesforproactivemanagementofdischargeareclarified
Stepfive: Set a predicted date of discharge / transfer within 24 48 hours of admission TheELOS/PDDisidentifiedbytheadmittingconsultantinconjunctionwiththemultidisciplinary
team,duringpreassessment,onpostadmissionwardroundorwithin24hoursofadmissiontohospital(forsimpledischarges)and48hours(forcomplexdischarges),anddocumentedinthehealthcare record.
TheELOS/PDDisagreedbyspecialtyandproactivelymanagedagainstatreatmentplanbyanamedaccountableperson(SDU,2013)
TheELOS/PDDisdisplayedinaprominentposition ChangestothetreatmentplanandELOS/PDDaredocumentedinthehealthcarerecord
(SDU,2013)
Step six: Involve service users and carers so they make informed decisions and choices Thetreatmentplanissharedwiththeserviceusers,andtheyareencouragedtoaskquestions abouttheplan. Developinformationpackforserviceuser/carer,example,medicationslist,careofany
indwellingdevicessuchasintravascularlinesorurinarycatheters,woundcareand instructionsfortheserviceusertosharewiththeirGP,communitypharmacistandotherrelevanthealthcareprovider
Counselandeducatetheserviceuser,consideringtheneedsofserviceuserswithpoorvision,hearingdifficulties,cognitivedeficits,culturalandlanguagebarriers.
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Step seven:Reviewthetreatmentplanonadailybasiswiththeserviceuser Practitionerstalktotheserviceuserdailyaboutprogress. Thetreatmentplanismonitored,evaluatedandupdated(wherenecessary)andchangestothe
treatmentplanandELOS/PDDaredocumentedinthehealthcarerecord(SDU,2013) Anyproblemsoractionsrequiredareidentifiedandareescalatedorresolvedasnecessary
Step eight: Useadischargechecklist2448hoursbeforedischarge Thefamily/carers,PrimaryCareTeam/GP,PublicHealthNurse(PHN)andotherprimaryand
communityserviceprovidersarecontactedatleast48hoursbeforedischargetoconfirmthattheserviceuserisbeingdischargedandtoensurethatservicesareactivatedorreactivated.
Dischargearrangementsareconfirmed24hoursbeforedischarge(SDU,2013) Clinicalteamsconductdischargingwardroundsatweekends(SDU,2013) Processinplacefordelegateddischargingtooccurbetweenclinicalteamsortoother
disciplines,withinagreedparameters(SDU,2013)
Step nine: Make decisions to discharge / transfer service users each day Eachserviceuserdischargeiseffectednolaterthan11amonthedayofdischarge(SDU,2013). Dischargemedicationreconciliationanddevelopmentofthedischargemedication
communicationtakesplaceinaplannedandtimelyfashion,preferablyonthedaybeforetheserviceuserleavesthehospital
PrimaryCareservicesandhomelessnessservicesshouldbenotifiedwhenaserviceuserwhoishomelessorlivingintemporaryorinsecureaccommodationisduefordischarge
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Helpful tips
Whileitisimportanttorespectthepersonsprivacy,itisalsoimportantthatfamilymembers,carers,supportpersonsorthoseassistingthemunderstandkeyinformationfortheirsafety;forexample,whatmedicationshouldbetakenandwhen,andunderwhatconditionsthepersonneedstoreturntothehospital
Liaisewiththepersonandothersasappropriate(theirfamily,carers,relevantserviceproviders,includingdisabilityservicesorthemedicalteam)arounddischargearrangements,aftercareandfollow-up.Confirmdischargearrangementsasappropriate
Prepareaninformationpackandprovideinformationandeducationtotheserviceuserandthefamily/carerintheappropriatelanguage,verballyandinwrittenform.Thisshouldbeprovidedinaformatthatisaccessibletothem,wherepossible.Seepage37-38intheIntegratedCareGuidanceforwhatinformationtoincludeinaninformationpack.
Iffollow-upisrequired,ensurethatacommunicationmethodappropriatetotheserviceusersaccessibilityneedsisidentifiedpriortodischarge
Signpostapersontowardsdisabilityorganisationsforsupport,informationaboutbenefitsandservicesthattheycanavailofinthecommunityand,wherepossible,tellthemwhotocontactinspecialistdisabilityservices
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Communication
4.1 General principles of good communication
Figure 2: Albert Mehrabians Communications Model
Communicationismadeupof7%verbalcommunication(whatwesay),38%vocalcommunication(howwesayit),and55%non-verbalcommunication(bodylanguage).Whenapersonhasadisability,itcanimpactsignificantlyonhowtheycommunicate.Thiscouldinclude,forexample,someonewithimpairedspeechorhearing,someonewithlimitedornolanguage,orsomeonewhosecommunicationisimpairedbecauseofdementiaorbraininjury.
Failuretomakeappropriateprovisionforapersonscommunicationdifficultymayresultinavoidableseriousrisksanderrorsforboththepatientandhealthcareprovider.
Thissectionprovidesguidanceoncommunicationunderthefollowingheadings: Communication skills Communicatingwithapersonwhohasadisability Communicationaidsandappliances
Remembercommunicationshouldbenon-judgmental,unbiasedandrespectful.Treatanadultwithadisabilityasyouwouldanyotheradult.
4. Guideline Four
7%verbal
(wordsonly)
38%vocal
(includingtoneofvoice,inflectionand othersounds)
55%nonverbal
(bodylanguage)
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COMMUNICATION SKILLS
4.2 Establishhowthepersonpreferstocommunicate
Establishthepersonspreferredmethodofcommunication.Thiscanbedonewhencontactisfirstmadewiththeservice.
Apersonwithasignificantdisabilitymayhaveafamilymember,carerorsupportpersonwhocanprovideguidanceontheappropriatemethodsofcommunicationinsituationswherethepersoncannotdosothemselves.Thismightincludeinformationonaspecificcommunicationaidanddevicewhichmakescommunicationwiththepersonpossible.
IncaseswhereEnglishisnotthepersonsprimarylanguage,itmaybenecessarytoarrangeforaprofessionallytrainedinterpreter.Itmaybehelpfuliftheinterpreterhasanunderstandingofhowthechosenmethodofcommunicationworksorifnecessarytotaketimetounderstand.
4.3 Notifyrelevantstaffofthepreferredmethodofcommunication
Informationonapersonspreferredmethodofcommunicationshouldbepassedontorelevantstaffsothatpeopledonothavetorepeattheirrequirementsateachstageoftheserviceuserjourney.Thisinformationshouldbeincludedinthepatientschartor(withthepersonsconsent)inasignattheirhospitalbed.
4.4 Communicating with the person
Active Listening Communicationisatwo-wayprocess.Wherepossible,alwayscommunicatedirectlywith
theindividual,ratherthantheircarer,supportpersonorinterpreter.Beawareofindividualdifferencesanddiverseneeds
Itisimportanttonotonlylisten,buttohearthemessage Givecommunicationthetimeneededsothatstaffandthepatient/serviceusercan
communicateandunderstandwhatisbeingcommunicatedbytheother.Apersonwhoisunabletospeakortohear,whohasdifficultyprocessingorretaininginformation,orwhocannotreadmayrequiremoretime.Aswithallinteractionswithpatientsandserviceusers,moretimemayalsoneedtobefactoredintocommunicatebadnewsinasensitiveway
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Verbalcommunication Speakclearly,conciselyandslowly Useplainlanguagethatiseasytounderstand.Ifyoumustuseamedicalterm,explainwhatit
meansfirst Give accurate information
Effectivequestioning Askonequestionatatime(avoidbombardment) Givethepersontimetorespondwithoutunnecessaryinterruption Givethepersontimetoaskquestions Donotbeafraidtoaskthesamequestiontwice.Repeatwhatyouhavesaidwhenapersonis
havingdifficultyunderstanding,andverifythattheyhaveunderstood Phrasingquestionsinawaythatapersoncangiveasimpleyesornoanswercanbehelpful
in some situation
Non-verbalcommunication-positivebodylanguage Facethepersonyouarecommunicatingwith Maintaineyecontact(althoughthismaynotbepossibleorcomfortableforsomepatients/
serviceusers) Non-verbalcommunication,suchasgestures,facialexpressionsandappropriatetouch,canbe
importantwhencommunicatingwithpeoplewhoareexperiencingcommunicationsdifficulties Gesturesandfacialexpressionscanbeusedtoexpressanemotion.Forexample,athumbs-up
canbeanacceptablewayofreassuringapersonthatthingsareallright
Use visual aids Drawings,diagramsorphotographsareausefultoolincommunicatinginformation.Theycanbe
particularlyusefulincommunicatingwithsomeonewhoisDeaforhardofhearing,orsomeonewithanintellectualdisabilityorabraininjury
Give information to take away Peoplewithdisabilitiescanfinditusefultohavetheinformationyouhavecommunicatedtothem
orallygiventotheminaformattheycanreviewlater;forexample,apersonwithacognitiveimpairmentmayneedwritteninformationtohelpthemrememberanyinstructionstheyreceived.Thisisparticularlyimportantforinformationaboutfollow-upcare,exerciseormedication
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WritedownwhatyouhavesaidinplainEnglishclearly,conciselyandaccurately Avoid using jargon and technical medical language Alwaysexplainanyabbreviations Remembertypedinformationiseasiertoreadthanhandwriting Wherepossible,provideinformationinanaccessibleformatsuitabletotheindividuals
needs.Thiscouldbeinlargeprint(changethefontsize),bye-mail,bytextmessageorwherepracticableinaudioformat
COMMUNICATINGWITHAPERSONWHOHASADISABILITY
4.5 Communicatingwithapersonwhoisunabletostandorwhousesawheelchair
Positionyourselfateyelevelbysittingbesidetheperson.Ifthisisnotpossible,standastepbacksothatthepersondoesnothavetostraintheirnecktoseeyou,orcrouchdownifappropriate.
4.6 Communicatingwithapersonwithspeechdifficulties
Talktothepersonasyouwouldtalkanyoneelse,andlistenattentively.
Askthepersontohelpyoutocommunicatewithherorhim.
Ifthepersonusesacommunicationdevice,suchasamanualorelectroniccommunicationboard,askthepersonhowbesttouseit.Thesedevicescanprovidevisualinformationthatmakeslanguageaccessibleforpeoplewithspeechimpairments.
Allowtimetogetusedtoapersonsspeechpattern.
Allowtimetoreplyasitmaytakethepersonawhiletoanswer.Waitforthepersontofinish,ratherthancorrectingorspeakingfortheperson.
Askshortquestionsthatrequirebriefanswers,oranodyesorno.
Neverpretendtounderstandifyouarehavingdifficultydoingso.Ifyoudonotunderstandwhatthepersonissayingtoyou,letthemknowthis.Askthepersontorepeatthemessage,tellyouinadifferentway,orwriteitdownifpossible.
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Repeatwhatyouhaveunderstoodandallowthepersontorespond.Theresponsewillguideyourunderstanding.
Makeeyecontactwiththepatientorserviceuserevenwhensomeoneelseisinterpretingforthem.
4.7 Communicating with a person who has a visual impairment
Bepunctual.Lackofpunctualitycancauseapersonwithsightlossunnecessarystress.
Rememberalsothatthepersonmaynotbeabletoseewhetheryouhavearrived. Alwaysletapersonwithsightlossknowwhenyouareapproaching.Asuddenvoiceatclose
rangewhentheydidnothearanyoneapproachcanbeverystartling Speakfirstfromalittledistanceawayandagainasyoudrawcloser.Saytheirnamesothatthey
knowyouarespeakingtothem Greetapersonbysayingyournameandwhatyourroleis.Donotassumetheyknowwhoyou
are,eveniftheyknowyou
Talkdirectlytotheperson,byname,ratherthanthroughathirdparty.
Dotrytospeakclearly,facingthepersonwithsightlosswhileyoudoso.
Donotassumewhathelptheyneed.Beforegivingassistance,alwaysaskthepersonfirstiftheywouldlikehelpand,iftheydo,askwhatassistanceisneeded.
Apersonwithavisualimpairmentmayrequestsightedguideassistancesothatthepersoncanfindher/hiswayaroundtheemergencydepartmentortothetoilet.Ifapersonwithsightlosssaysthattheywouldliketobeguided:
Offerthemyourelbow Keepyourarmbyyourside,andthepersonwithsightlosscanwalkalittlebehindyou,holding
yourarmjustabovetheelbow Whenassisting,itishelpfultogivecommentaryonwhatisaroundtheperson;forexample,the
chairistoyourright Ifyouhavebeenguidingablindpersonandhavetoleavethem,bringthemtosomereference
pointthattheycanfeel,likeawall,tableorchair.Tobeleftinanopenspacecanbedisorientatingforapersonwithnovision
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NATIONAL GUIDELINESAccessible Health and Social Care Services
Ensurethattheyknowwhatisaroundthem.Describewhatisintheroom,includingequipment,anddescribetheroomfromlefttoright.Giveclearinstructionsaboutthelocationoftoilets,drinksmachines,anystepsorotherfeatures,suchaschangesinfloorsurfaces
Donotassumethatapersonusingawhitecaneorguidedogistotallyblind.Manypeoplewithsome remaining vision use these.
Donotassumethat,becauseapersoncanseeonething,theycanseeeverything.Ifnecessary,askthepersoniftheycanseeaparticularlandmarkorobject.
Neverdistractaguidedogwheninharness.
Donotpointifyouaregivingdirections.Giveclearverbaldirections;forexample,thedooristoyourleft.
Ifyouhavebeentalkingtoapersonwithsightloss,tellthemwhenyouareleaving,sothattheyarenot left talking to themselves.
Explainprocedurestosomeonewhocannotseewhatyouaredoing. Clearlyexplainalltheproceduresandwhatwillbedonestep-by-step Ifapersonisaskedtolieonanexaminationcouch,giveclearverbalinstructionsaboutwhatwill
happen,wherethecouchisandwhatthepersonshoulddo Tellthepersonwhatpartsoftheirbodyyouwillexamineandwhereyouwilltouch Ifyouaregivinganinjectionoraneedleprick,explainwhereyouwillputtheneedleandwhatwill
happen(forexample,drawingblood,insertingadriporgivingsedation) IfapersonishavinganMRIscanorx-ray,explainallproceduresclearlyandletthepersonknow
whenyoumovebehindascreenorintoanotherroom
Whenservingfood,staffshould: Tellpeoplethatthemealhasarrivedandhasbeenplacedinfrontofthem Identifythefoodontheplateusingtheclocksystem,ifapersonhasavisualimpairment;for
example,themeatisatsixoclock,beansatthreeoclockandpotatoatnineoclock
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Helpful hints Iffoodisservedonatraythathasagoodedge,anythingspilledwillstayonthetray Agoodcolourcontrastbetweenadrinkanditscontainerisusefultoavoidaccidents-brightly
colouredcupsmaybeseenmoreeasily.Forexample,aglassofwatermaynotbeeasilyseen;teainawhitemugiseasiertoseethaninabrownmug
TheNationalCouncilfortheBlindofIrelandhasdevelopedspecificinformationresourcesforhealthcareprofessionals,whichcanbeaccessedathttp://www.ncbi.ie/information-for/health-professionals.Thetopicscoveredinclude:
For All Health Professionals GuidingaPersonWithaVisionImpairment GettinginTouchWithourServices
NursingStaff AssistingAdultsWithSightLossinHospital AssistingChildrenWithSightLossinHospitalandatthe
DoctorsSurgery CareStaff PracticalTipsforCareStaff LeisureActivitiesforDayCentres
PublicHealthNurses OlderPeopleWithSightLossLivingatHome PracticalTipsforCareStaff
Occupational Therapists OlderPeopleWithSightLossLivingatHome PracticalAdviceforEverydayLiving ChangesinYourOwnHome
4.8 Communicating with a person who is hard of hearing or Deaf
Apersonshearingmaybeaffectedatanystageoftheirlife,fromthetimeofbirthorintheirlateryears.Lossofhearingmaybeaninvisibledisability.
PeoplewhohavegrownupwithhearinglossmayhaveIrishSignLanguage(ISL)astheirprimarymeansofcommunication,andthesearetermedtheDeafcommunity.AsEnglishisconsideredtheir
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secondlanguage,somehavedifficultywithwrittenEnglish.ItisimportanttouseplainEnglish,andtoprovideinformationinsimple,concreteterms.Visualaidsarealsohelpful.
Peoplewhoexperiencehearinglossastheygrowoldermayrelyonhearingaids,onlip-readingoronwritteninformation.TheygenerallywillnothavelearnedIrishSignLanguage.
LearningafewbasicsignsofIrishSignLanguagecanhelpDeafpeoplefeelathomeandwelcome.The Irish Deaf SocietyhasproducedaDVDcalledEverydaysignedvocabularyinmedicalsettings for service user care,andabookletofBasic Medical Signs for Irish medical institutions on common medical sign language for service user care.YoucanfindbasicsignsandinformationaboutIrishSignLanguageclassesonwww.IrishDeafSociety.ie
InthePalliativeCaresetting,thetypeofinformationthatneedstobeconveyedcanbedifficult.Manypatientswishtoknowabouttheirdiagnosisorprognosis;however,othersmayprefertonegotiateagradualdisclosureofinformation.Muchofpalliativecarepracticeisaboutsymptommanagement,requiringaccuratehistorytaking.ThiscanbemoredifficultwhenaserviceuserisDeaf.Inthisregard,itisimportanttoensurethatanISLInterpreterisavailabletointerpret.
Itisthoughtthat,whenapersonisdying,thepersonmaystillbeabletoheardespitebeingveryweakandmainlysleeping,andmanyhealthcareprofessionalscontinuetospeakwiththepersontoprovidethemwithreassuranceandsupport.WhenapersonisDeaf,itisimportanttobemindfulthatotherformsofcommunication,suchastouch,mayconveyemotionalsupport.However,itcanbehelpfultocheckwiththepersonortheirfamilyinadvanceastowhetherornottheywouldbecomfortablewithtouch.
General points
Askifsomeonecanhearyouclearly;donotassumethattheycan Askthepersonwithahearingdifficultyhowtheywanttocommunicate.Thiscouldbespoken
English,writtenEnglish,IrishSignLanguageorcommunicationappropriatetosomeonewhoisdeafblind
Youmayneedtotapthepersonsarmgentlytogettheirattention.Iftouchisnotappropriate,youmayneedtouseanotherapproach;forexample,inthecaseofaburnvictimyoumightwaveyourhandintheirlineofsightorswitchalightonandoff
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Wherepossible: - provideinductionloopsystemsforhearingaidusersoraportablelisteningdeviceforhardof
hearingserviceusers,andtestthemregularly - providewrittenversionsofanyaudionoticesandcommunications - supporttheinformationgiveninconversationwithwrittenhandouts - andprovidediagramsorpictureswhichmaybeusefulinsupportingtext. Makesurethatonlyonepersonspeaksatatime Usegestures,bodylanguageandfacialexpressionstoemphasisethesenseofwhatyouare
tryingtocommunicate;forexample,nodratherthansayinghmmmtoshowyouarelistening.Takecarethatthesedonotappearover-exaggeratedorpatronising
4.9 Communicating with a person who lip reads
Get and keep the persons attention Gainthepersonsattention;forexample,tapthepersonsarmgentlytogettheirattention,wave
yourhandintheirlineofsightorswitchalightonandoff Talkdirectlytotheperson
Position yourself well Positionyourselfthreetosixfeetfromthepersonandatthesamelevelasthem Makesureyourfaceisingoodlightwhileyouspeak.Donotstandwithalightorawindow
behindyouasshadowsmaymakeitdifficulttoreadyourlips Checkwiththepersonthattheycanseeyouclearly Minimiseanybackgroundnoise
Assist the person to see your face and lips Makesuretheyhaveaclearviewofyourfaceandlips Donotcoveryourmouthorhaveanythinginorcoveringyourmouth;forexample,chewinggum,
pen,paper,hands Keepyourheadstillwherepossible Stoptalkingwhenlookingdownoraway
Speak clearly Letthepersonknowthetopicofconversationandsignalanychangeintopicbypausing Speakatamoderatepaceandmaintainanormalrhythmofspeech
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Donotshoutbecausethiscandistortyourlippatterns Donotover-emphasisemouthmovementsasthiswilldistortyourlippatterns Sentencesorphrasesareeasiertounderstandthansinglewords Ifawordorphraseisnotunderstood,usedifferentwordswiththesamemeaning
Assist the person to understand Knowthatlipreadingistiring Allowtimeforthepersontotakeinwhatyouhavesaid Usenaturalbodylanguageandfacialexpressionbutavoidexaggeratedgestures CheckwiththeDeaforhardofhearingpersonregularlytoensuretheyunderstand.Some
healthcareprovidersmakethecommonmistakeofpresumingDeaforhardofhearingpeoplecanlipread.Thisisnotalwaysthecase.Evenifthepersoncanlipread,accuracyinlipreadingisestimatedat30%,resultingindisproportionatelyhighratesofmiscommunicationandmisunderstanding.Thismayhaveveryseriousimplicationsformedicationmanagementorinthefollowupcareofacondition
Someofwhatyousaymaybemissedsupplementwhatyousaywithwritteninformation,notesanddiagrams.Whenyouwritesomethingdown,useplainEnglish
4.10 Communicating in writing with a Deaf or hard of hearing person
Askthepersonhowtheywouldprefertocommunicate Penandpaper,textmessaging,e-mail,speedtextandwrittenhandoutsofinformationprovided
areusefulwaystocommunicatewithsomeonewhoisDeaforhardofhearing Ifusinge-mailortextmessagestoarrangeanappointment,ensureanye-mailsystemortext
messageservicecanreceivereplies(ratherthanano-replynumberore-mailaccount)sothatpeoplecanrespondandcandiscussaccessrequirementsforanupcomingappointment.Ifnot,makealternativearrangementstoenableareply
Alwaysfollowclearprintguidelines.(Seethewww.ncbi.ieforfurtherinformation) Ifthepersonwantstocommunicatebynote-writing: - Bepatient,itmaytakelonger - AlwaysuseplainEnglish - Ensureyourhandwritingisclearandlegible - Allowthepersontokeepownershipofthenotes - Askthepersonspermissionifyouwanttousethenotesaspartoftheirtreatmentplan;and - Treatallhandwrittencommunicationsasyouwouldaprivateconversation
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4.11 Communicating with a person who uses Irish Sign Language
SomeDeaforhardofhearingpatientsandserviceusersuseIrishSignLanguage(ISL)astheirfirstlanguageandpreferredmethodofcommunication.NoteveryonewhosignswilluseISL;forexample,someonefromEnglandwhoisonholidaywilluseBritishSignLanguage(BSL),anAmericanwilluseAmericanSignLanguage(ASL),andtheyareallverydifferent.
Patientsandserviceusersareentitledtorequestandbeprovidedwithaqualifiedsignlanguageinterpreter.Whiletheonusisontheserviceusertorequestaninterpreter,itistheresponsibilityofstafftomakethearrangements.Staffshouldroutinelyletserviceusersknowthat:
theyhavetherighttoaninterpretertoassistincommunication thereisnocosttotheserviceuser;and staffwillarrangefortheinterpreter
Itisconsideredgoodpracticeforservicestoarrangeaninterpreterwithoutbeingpromptedincaseswhererepeatvisitsarenecessaryorwhereitisknowninadvancethattheserviceuserneedsone.
Notprovidingaqualifiedsignlanguageinterpreterwhendeliveringcaretoapatientorserviceuserplacesthehealthorsocialcareproviderinaprecarioussituation:
informationmaybemisinterpretedormisunderstoodwhichmayleadtoapotentialadverseoutcomeforthepatientorserviceuser;or
thelackofprovisionofaqualifiedsignlanguageinterpretermayresultininvalidconsentforinvasivemedicalorsurgicalprocedures
Aninterpretermayalsobenecessaryiftheprimarycareroradvocateofapatient/serviceuserisDeaf;forexample,Deafparentswithachildwhocanhear.
TheHSEguidancedocumentonusinglanguageinterpreters,On Speaking Terms,isavailableonwww.hse.ie
IfitisnotpossibletogetanIrishSignLanguageinterpreterinanemergencyoronshortnotice,itcanbehelpfultohaveastandardpre-preparedlistofwrittenquestions,picturesandsymbolsthatyoucanusetocommunicatewithapersonwhoisDeaf.Thequestionsorpicturesshouldreflecttheusualquestionsyouaskwhensomeoneisadmittedtohospital,suchaswheredoesithurt?,doyouhaveprevioushealthconditionsthatweshouldknowabout?,orareyouonany
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medication?MakesurethatthequestionsarewrittenclearlyandinplainEnglish.
TobookandISLinterpreter,seewww.slis.ieore-mailbookings@slis.ie.Youmayneedtobookaninterpreteruptotwoweeksinadvance.
4.12 Irish Sign language interpreters
SignlanguageinterpretersaretheretotranslatebetweenIrishSignLanguageandEnglish.TheyinterpretforboththeDeafpersonandhealthandsocialcarestaff.
ProfessionalIrishSignlanguageinterpreters: WorktoaCodeofEthicsandProfessionalConductwhereconfidentialityisacorevalue Translatenotonlythewordsbutalsotheculturalmeanings;and Aretrainedtobeimpartial.Donotexpectthemtogiveapersonalopinionofapatient
Theinterpreterisnotacaseworkeroranadvocate.Theymayintervene,forexample,toasksomeonetosignorspeakmoreslowly,toclarifyunderstandingortoaskthatinformation berepeated.
WiththeconsentoftheDeafpersonandwherepossible,providetheinterpreterwithbackgroundnotesandinformationinadvance.Thiswillenabletheinterpretertocarryouthigherqualityinterpretation.
Allowextratimewhenworkingthroughaninterpreterespeciallyinmedicalsettingswheretermsmaynotbeeasilyunderstood.
MakesurethattheinterpretersitsnexttoyouandthattheDeafpersoncanseebothofyouclearly.
DirectwhatyousayandmakeeyecontactdirectlywiththeDeafperson,notwiththeinterpreter.
Givetheinterpretersufficienttimetotranslatewhatiscommunicated.Rememberthataninterpreterhastointerpreteverythingthat