Introduction
The purpose of this SOP is to layout the process in which clinicians working within Severnside will utilize SMS texting, video consultations and sharing of appropriate photos for the benefit of patient care.
Objectives of the procedure
Background
In Summer 2020 as part of the country’s response to the Covid19 pandemic, video consulting was introduced into the service. Video consults enable a more favourable mode of consulting for patients if clinical episodes of care can be closed without the patient needing to travel. This has also had an environmental benefit as a result of reduced car journeys.
In addition, Severnside IUC has utilised the use of photos within IUC via AccuRx and nhs.net email. This SOP supersedes the previous SOP (July 2020 “images in Severnside IUC”)
SMS texting provides another reliable means to communicate with patients and their carers/ families.
This SOP aims to describe the processes by which these three modes of communication are used within Severnside IUC.
The Standard Operating Procedure
Adastra enables clinicians to complete video consulting (which is not recorded) via desktop computers in IUC within the Adastra programme.
AccuRx provides a secure (nhs.net email mediated) platform that enables clinicians and operational colleagues to send text messages and receive photos.
Severnside permits clinicians to use video consulting or photos as an additional layer of assessment if it is likely to safely resolve the clinical episode without a face-to-face assessment. Clinicians should continue to use recorded telephone lines for the majority of the remote clinical assessment.
Video Consulting
Video consults should be carried out via Adastra and not via other media, such as FaceTime. The video consultation itself is not recorded, but a log the video has been done is in the event list.
To carry out a video consultation:
- Click into the patient’s record. You should see a button on your consultation screen. Press the button and you will get a disclaimer box for patient consent. Click yes.
- Next step is to send a video link to the patient. You can do this either via text or email from within Adastra depending on how the patient wants to receive the link. You only need to complete one of these. Then press next.
- You will then see a pin on your screen (this will also be above the video screen). You will need to provide the patient with the pin so they can access the video consultation.
- Press start.
- The patient needs to click the link, enter the pin and click ‘join call’.
- You are ready to go. To finish the video consultation press
Tips for clinicians:
- Try to practise using it in advance (logins/ technology/ training etc)
- Make a thorough assessment over the phone before deciding to use the video functionality (telephone is recorded, video is not)
- Seek the patient’s consent before initiating a video consultation
- Be clear what the video will achieve (eg check general appearance, look at respiratory effort, examine skin etc)
- Maintain patient confidentiality – use as private an area as possible that is not easily overlooked by others
- If your clinical shift is being observed, ensure that you inform the patient that another clinician will be present for the video assessment, and identify them by name and role before the video consultation begins
- Involve carers/ family members/ where consent is obtained to assist less IT literate patients (perhaps elderly/ care home patients)
- Encourage the patient to ensure good mobile phone reception, and good lighting in the area.
- Smile when you see the patient – it makes a difference.
- Convert the episode of care to a face-to-face assessment in one of Severnside’s IUC bases if the patient needs to be seen still following the video assessment (perhaps poor connection/ bad light/ tech failure)
- Wear an ID badge, so the patient can see you are who you say you are.
- Revert to telephone to complete your consultation (this is recorded)
- Raise an IT enquiryin the event of hardware problems (missing webcam, equipment not working etc) for the team to investigate
- Generally, don’t consult via video for viewing intimate areas. However, there may be exceptional circumstances where you need to, in which case please DO refer to the document: “Key principles for intimate clinical assessments undertaken remotely in response to Covid 19”, to minimise risk
- Don’t push video consulting where patients are not happy to do it
- If you have technical issues with video consulting, please liaise with the Host, Assistant Shift Manager or Shift Manager for advice and support. Or complete a BrisDoc IT-Support form (for enquiries that need a response >24hrs)
We have access to video consulting within AccuRx as a back-up should Adastra fail and the Shift Manager advises to use AccuRx. Details for how to access this can be found in Appendix 1.
Supporting documents
Principles of safe video consulting in general practice during COVID-19
SMS texting
SMS texting provides another reliable means to communicate with patients and their carers/ families.
Common uses for SMS texting within IUC include:
- Confirmation that a prescription has been issued – the chemist it’s been sent to and the NHS number to enable the pharmacist to draw the prescription from the NHS spine
- To confirm appointment details
- To share important details like Severnside “patient line”
- To confirm location of appointment
- To reinforce self-care advice
- To inform a patient not answering their phone that a clinician is attempting to call them in exceptional circumstances (a worrying lab test result) and to share the direct call back number for Severnside IUC (patient line)
General points:
- Text messaging should only be sent via the Accurx platform (via nhs.net login)
- Text messages should be sent to mobile phone numbers
- The patients telephone number should be checked against the spine option that automatically populates from Accurx
- Patient identifiers should generally be avoided if the patient is not expecting a text message (unless previously agreed during a telephone conversation)
Text messaging is completed within AccuRx for both clinical and operational colleagues. Use the following link to login to the system from a desktop computer: https://fleming.accurx.com/login (Available as a link via Brisdoc.co.uk/weblinks)
Access should only be via the nhsmail link.
Once logged on, clinicians should ensure the correct organisation is selected, either “Severnside Integrated Urgent care service” or ”“BrisDoc Healthcare services OOH” (ID code Y03662); either will do. You can do this by selecting the drop-down tab to the left of your name at the top of the screen. You may need to search for this the first time you do it by selecting “join an organisation”.
The reply to text function should default to “no”. However, where you have agreed for a photo to be sent via text reply, this can be moved to yes – see below.
Photos
During a consultation it may be necessary and appropriate for the patient to send an image to support the consultation and clinician’s decision making. Please refer to the “Key principles for intimate clinical assessments undertaken remotely in response to COVID-19 Version 1 – July 2020” for the appropriate use of images to clinically assess patients
The following process is to enable a photograph to be received in the IUC service and reviewed by the consulting clinician:
- Operational colleagues are able to facilitate requesting photos and attaching these to the Adastra record for viewing. Please discuss with the Shift Manager if this process is in action. The SoP ‘Attaching an image to an Adastra Case Record’ explains this process fully and can found on Radar
- If the operational team cannot support with requesting photos this will sit with the triaging clinician. The clinician will advise the patient they will receive a text message with a link to reply with up to five attached photos. Clinicians are expected to gain and to document patient consent in the Adastra notes before commencing this process
- Clinicians should login to Accurx via BrisDoc Weblinks using their own NHS net email address. Where not possible, they should liaise with the Shift manager for this to be sent via the consultation@nhs.net account
- The clinician (or shift manager) will send the text to the patient via the ACCURX platform, you must select the option underneath the text to allow the patient to reply to your message.
- We recommend that the text states the following:
“Please click the link below to share the photo that was agreed during your consultation. Please be advised by sending the image you are consenting to the clinician at Severnside IUC viewing it for the purpose of your consultation. We will never share or store your image; it will only be available to the clinician that has asked you to share it. Please avoid sending any images that contain an intimate body part”
- It is easy to create a template using the “manage templates” option on the top menu
- Once sent, the Clinician should access the email account used to login to Accurx to view the images, these will arrive as a “link” to view the image on the AccuRx secure cloud (not as an image)
- Once seen and assessed we recommend that the email with links is deleted from the nhs.mail account. The links will only be active when accessed from this email account, and will become inactive if forwarded to other email addresses, to protect the data from being shared
- Once the photo has been seen and assessed by the clinician, the patient should be called back to discuss the appropriate management plan
If you would like a second opinion on an image, please try and speak to a clinician at the same base as you; this is because you are not able to forward the photo link via email for security reasons. On occasion, you may need a clinician at another base to look at the photos, in these circumstances please advise the patient they will need to resend the pictures. The reviewing clinician will need to re-request the pictures from the patient themselves using the above process.
The patient is only consenting to sharing their photos with Severnside when then reply. If a request is received from Public Health for access to images we hold in Adastra we should:
- ask if the request can wait until the next working day. If it can, advise an email should be sent to the governance team as a request for information via brisdoc.governance@nhs.net
- if the request cannot wait, a call should be made to obtain consent from the patient. This must be noted in the Adastra record, along with the outcome
- if consent is obtained to share the image this must be sent from the referral email account
- images must not be shared without patient consent
Receiving video clips
Occasionally, a patient or carer may have a pre-recorded video of episodic symptoms (eg possible seizures). Unfortunately, these cannot be sent via AccuRx. Instead, ask the patient for their email address. The operational team will then email the patient from the Severnside consultation email account, to request that the patient replies and attaches the clip. The operational team will then provide access to that account so you can view the footage. The videos are not saved in the medical record, so document your observations as you would in the face-to-face setting.
Logging out of Accurx
Please note: as Accurx is linked to NHS.net email, it is really important that you log out effectively. The following process describes the best way to do this to avoid others having access to your account.
Logging out of NHSmail takes longer than it used to because your NHSmail account now links across multiple Microsoft logins, including things such as Teams and office 365 online. When logging out it can take up to 60 seconds to fully sign you out. If you don’t wait for the sign out process to complete, you will likely leave your NHSmail account openly accessible for the next person who uses your PC.
When logging out of NHSmail, users should:
- Click on their profile in the top right of the screen and then click the sign out link that pops up below
- The screen below will show a message asking you to wait whilst you are being signed out of your NHSmail Microsoft Account (THIS CAN TAKE UP TO A MINUTE – YOU MUST WAIT)
- You must wait for the below message to show up before you close the browser window.
Appendix 1 – Video consulting in AccuRx
If there is a failure within Adastra meaning we cannot carry out video consultations, clinicians may use AccuRx to carry out the consultation.
Logging into AccuRx is as above in the SMS Texting and Photos section.
We recommend viewing the following videos as a guide to using this;
Video – how to use AccuRx on a smartphone
Video – how to use AccuRx on a PC
It is not possible to share a link for the video link to an email address if mobile reception is poor, or share attachments with the patient.
Monitoring
All incidents should be reported via the incident reporting portal and investigated in line with BrisDoc’s incident process.
IT issues
All technical issues should be reported via the IT reporting portal.
Monitoring will be by means of evaluation of incidents/ and complaints relating to this process
Related Documents
SOPS:
Standard Operating Procedure for failed contact with cases within the clinical advice queue
Call Handler Handbook
Change Register
| Date | Version | Author | Change |
| 10/03/2022 | 3 | N. Ryan | Addition of receiving video clips. |
| 09/02/2023 | 4 | N. Ryan | Update to text message content. |
| 28/03/2024 | 4.1 | N. Ryan | Full review and addition of Adastra video calling option |
| 08/07/2024 | 4.2 | N.Ryan | Addition of sharing photos |