Continuously working for a safe service delivering clinical excellence.

ENT Referrals Limited

Clinical Governance
​

Ear Clinic

**Section Under development**

INTRODUCTION:

Ear Clinic was originally established as part of a charitable partnership following an ethical low-profit service model, to treat retired and serving Civil Servants, Police Officers, Fire Fighters, Forces and other members. Since the reduction in availability of NHS earwax removal treatments it was decided to make this service available to everybody.

As with all clinical service provision governance is an essential element of the provision of a safe service that meets all the requirements of clinical excellence.

DEFINITION:
​
“Clinical governance is the system by which the organisation, managers and clinicians share responsibility and are held accountable for patient care, minimising risks to consumers and for continuously monitoring and improving the quality of clinical care.”

The main components :


1. Objectives

• provision and maintenance of high quality care
• provision of the service on a routine and regular (and possibly emergency) basis
• consultation and co-operation with other health care professionals concerning the  provision of the service
• conduct of professional activities in accordance with the standards set by relevant professional organisations
• compliance with all relevant health and safety regulations
• provision of a courteous and considerate service to patients including the need to respect privacy, confidentiality, diversity and human rights.

2. Strategic capacity and capability;
including planning, communication and governance arrangements and cultural behaviour aspects:

• Whilst the overall direction of the organisation will be the responsibility of the directors, the robustness of clinical governance and the ability to provide a safe and effective clinical service must be considered before any changes are made to the size or structure of the company.

3. Staff management and performance;
recruitment, workforce planning and appraisals:

• Any professional performing microsuction will be a:

• A medical practitioner, registered with the GMC and on the performers list
• An audiologist who has completed a foundation degree in audiology approved by the Health and Care Professions Council (HCPC) and registered with the HCPC
• A state registered nurse registered with the NMC

• All staff will have undergone specific training and been assessed as competent to undertake ear assessment and examination and give advice regarding  management options and the administration of ear drops as appropriate
• All registered nurses are expected to develop and maintain their competence in accordance with the NMC Code (2015) and follow Record Keeping (2009) guidelines.
• All healthcare professionals must exercise their own professional judgement when using these guidelines. However, any decision to vary from the guideline should be documented in the patient’s records to include the reason for variance and the subsequent action taken.
• All staff conducting clinical work will be covered by a company indemnity

4. Clinical effectiveness;

Clinical audit management, planning, monitoring and  learning : All staff will follow the agreed guidelines, and their clinical records will be audited on a regular basis:

• History taking and Assessment

Prior to examination of the ear it is essential to talk to the patient and / or their carer to obtain a detailed history and provide explanation of any examination or procedures. The service user should be fully informed of possible complications of the procedure and effects of ear irrigation and/or microsuction, to ensure that the patient understands and gives consent.
Document the assessment and relevant history on the Ear Care Nursing Record

•  Assessment Form  (See Appendix ).

The form should include patient’s personal identification details, including name, date of birth,address or NHS number.
Past medical history should be documented, including existing long term conditions, current medication, allergy status and present or previous occupation.
Detailed ENT history should be taken to include the following:

•  Grommets
•  Cleft palate
•  Recent ear infection 
•  Mastoid problem
•  Any ear surgery
•  Perforated ear drum
•  Ear pain
•  Ear discharge
•  Tinnitus
•  Vertigo
•  Itchy ears
•  Hearing aid
•  Hearing loss
•  Previous ear irrigation
•  Previous microsuction

 Details of the current presenting problem and any symptoms being experienced by the patient should be documented.
 

• Examination and Treatment:

The examination and treatment will be documented as per the retained medical record (see appendix)
 

• On-going patient advice:

• Give advice to patient regarding on going ear care and provide written patient information leaflet (see Appendix).
• Patient should be advised that the only reason for carrying out ear irrigation is when hearing is reduced due to wax impacted on the eardrum. Regular or routine irrigation is not recommended.
• If wax has been removed due to the presenting complaint of hearing loss, they should check whether good hearing is restored after treatment or would they benefit from a formal hearing assessment by the audiologist.
• Advise patients that wax protects the ear and that the ear is self-cleaning and does not need poking with flannels and direct streams from the shower head or cotton buds or keys.
• Ear candles are not a safe option of wax removal as they may result in serious injury.
• To prevent build-up of excessive wax, if this is a recurrent problem, it may be helpful to instil olive oil in to the ear canal once or twice a week and wear ear plugs when in water.

5. Cleaning, Disinfection and Sterilisation

​Clear guidelines will be in place to maintain a safe and clean environment (see Appendix)


6. Patient, public and carer involvement;

to include analysis of patient /professional involvement and interaction, and strategy, planning and delivery of care:

• All patients will be asked to fill in a questionnaire after treatment, and a record will be kept enabling the staff to change and improve service delivery.
• Compliments and complaints:

A record will be kept of all compliments and complaints:

• Complaints Process:

Good complaints management is an integral component of good governance and
quality management. See here for details of our complaints policy.

ENT Referrals Limited is a member of The Independent Sector Complaints Adjudication Service (ISCAS), and follows its code of conduct (see appendix - ISCAS Subscribers Code of Practice for Managing Complaints June 2017)


7. Risk management

ENT Referrals Limited will meet the Level 1 requirements of risk management, which in broad terms focus on the following areas:
• risk management strategy, and framework for implementing risk management policies;
• risk assessment and prioritised risk action planning;
• monitoring and review of performance management;
• processes for managing, recording and analysing complaints, comments and adverse events;
• information on the risks and benefits of treatment and informed consent;
 • operational risks – clinical and non-clinical;
 • record keeping – clinical and non-clinical;
• human resources, recruitment, induction and lifelong learning.


8. Team working within the service;

working with senior managers, clinical and multi-disciplinary teams and across organisations. Independent practitioners have a professional responsibility to interact with other health care professionals and to seek feedback.


9. Governance Board:

ENT Referrals Limited will have a governance Board which will:

• Include clinicians, and managers
• meet on a regular basis (at least once every 3 months)
• Monitor and maintain the governance standards outlined above

“Clinical governance is the system by which the organisation, managers and clinicians share responsibility and are held accountable for patient care, minimising risks to consumers and for continuously monitoring and improving the quality of clinical care.”