Q We usually give our practice nurses written guidelines on flu vaccination, effectively repeating the indications and contraindications – and leave them to get on with the job. There are no written notes, but all the information is entered on the computer, along with the batch number, as part of the guidelines. There are no FP10s either – we use a bulk form.

This year, our regular nurse is on leave and we have a locum. She's very good, but she isn't happy with our protocol and insists on having written confirmation in the medical records that each patient may have the jab.

She will confine herself, reluctantly, to a computer-only record entry, but she'd be happier to have that information in the handwritten notes too.

My understanding has been that a blanket protocol, issued by a doctor, within a nurse's professional competence and in accordance with good practice (as defined here by the CMO's advice and the data sheet), is acceptable. We also feel that computer-only record keeping is adequate.

A There can be problems with locums because their experience of patients and systems may not be the same as that of the practice. It is important to make sure that a locum has a formal induction session, even if this is quite short. It gives you and the locum an opportunity to talk over any issues.

In the situation you describe, the problem is obviously of significance to both of you. You need to establish, if you can, the reason for the nurse's view. A discussion about your other views would probably be helpful. This should be kept quite separate from a meeting at which you formally request her to follow the protocol, if this proves to be necessary. You may find that the problem can be resolved by better communication. For example, the locum may:

Misunderstand some aspect of protocols in general or this protocol in particular, and talking to a senior nursing colleague in the health authority or at the UKCC may put her mind at rest
Be used to working in a more directed environment. Here you may find that confirming in writing that you continue to take clinical responsibility might help.

May object to being moved from other work or working as a locum. In this case, you might come to the conclusion that it would be better to part company.

I think that the UKCC's view of this would be that the nurse is not being asked to make clinical decisions in this instance, and that it is reasonable for her to be asked to follow the practice protocol. Your local health authority may be able to help, and you can contact the UKCC for specific advice.


Q Revalidation is soon to be introduced for GPs. Will knowledge and use of guidelines be part of the revalidation process?

A Revalidation is an important part of professional self-regulation. It reassures the GP and patient that clinical knowledge and attitudes are up to date in a rapidly changing world. Part of this will be making sure that a clinician engages in continuous learning, and in particular that he/she uses available evidence in making decisions that achieve the best outcome for the patient.

It is reasonable to expect a clinician to be able to demonstrate that he/she understands evidence-based practice, knows where to search for information, and receives regular information, and that there are satisfactory ways in the practice of making sure that the information is put to use.

Guidelines in Practice, December 1999, Volume 2
© 1999 MGP Ltd
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