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									                           HEALTHCARE SERVICE

 Doctors, Nurses, Healthcare Assistants, Pharmacists, and

                                DECEMBER 2008

Crisis Services Manager:     Sandra Winnick
Document Author:             Jason Warriner, Healthcare Services Manager
Date of Next Review:         December 2009

The following information is in no way intended as a substitute for Crisis policies, they are
Healthcare Service specific and supplemental to current Crisis policies and procedures. You
will receive a Crisis Volunteer Handbook along with other literature regarding general
information about Crisis Christmas and volunteering

December 2008

Dear Healthcare Service Volunteer

Firstly, allow me to say a very big thank you and welcome for volunteering to spend time with
the Crisis Christmas Healthcare Service. Whatever your discipline or area of experience and
expertise you are a valued resource and a very welcome addition to the Team at this
pertinent time of the year.

The information within this document is intended to safe guard guests and volunteers alike
and answer some of the questions you may have regarding practising in an unfamiliar
environment and to give as much information as possible to allow you to get the most out of
your time spent in the Healthcare Service.

If you have any concerns, questions or wish to clarify any particular points. Please do not
hesitate to contact me. I can be contacted on the following email address: healthcare-

Jason Warriner
Healthcare Services Manager

Healthcare Services Team Deputy Managers:

Billy Boland
Jonathan Myers
Helen Barker
Karen Jones
Ann Page
John Anderson
Stewart Glaspole

British Red Cross:

Kieran Smith, Emergency Planning Officer

Please note all members of Senior Healthcare Team are volunteers for Crisis.

Shift Times & Location

Morning Shift – 8.00am to 3pm
Afternoon Shift – 1.30pm to 8.30pm

All Healthcare volunteers have been rota‟d to come to the centre where the service is based.
You will be receiving details of the location of this centre in the near future.

Shift Information

Each shift will begin with introductions and identification of areas of experience followed by a
handover from the previous shift leader and a detailed briefing from the Healthcare Service
Manager (or deputy).

The Healthcare Team will run daily or twice daily clinics across the Crisis Christmas centres
providing primary care and healthcare advice. The healthcare clinic will make appropriate
referrals to other services (both mainstream and CC services). Clinics will last 4 hours and
will be staffed by a full team of Doctors, Nurses, Pharmacists, Healthcare Assistants, and
Receptionists. There will be an abundance of knowledge and experience from different
areas; including mental health, sexual health, diabetes, and drug dependency, as well as the
knowledge and experience you are bringing yourself.

Once briefings are over with, teams for the clinics will be agreed and the teams will move to
their designated centre. Transport will be provided to this centre (and back again at the end
of shift).

The proposed times of the clinics are 9am – 1pm and 3pm – 7pm. Each centre will receive a
minimum of 2 clinics during the week.

The Healthcare base will have a small number of beds provided for observation. Guests will
be referred to these observation beds from the clinics or from emergency situations as they
arise. A guest requiring longer than three hours observation will be transferred to hospital.
The service will not provide an emergency call out service to respond to medical
emergencies across the event, although advice, guidance & support will be available 24hrs a
day over the phone.

Dress Code

The Healthcare team wear an orange badge with the letter „H‟ printed on it for identification
by green badges and all other volunteers and it will distinguish you from general volunteers.
The volunteer badge will be given to you on arrival.

When you are on duty we advise you to wear practical warm clothes.

Triage and Assessment

The first point of contact for guests will be a reception area where a receptionist will ask for
the guests name, age and gender only. The receptionist will enter these details on a
healthcare form. Each guest will be wearing a wrist band printed with an ID number. The
receptionist/assistant will insert the ID number in the appropriate place on the healthcare
form, then place the form in a tray marked „For Assessment/ Triage‟. In the event of a guest
not wearing a wrist band the receptionist/volunteer will inform the Healthcare Manager or
deputy on duty, who will liaise with the shift team running the centre. A nurse or doctor will
then carry out an initial assessment and complete the healthcare form with the guest. The
form will then be placed in a tray marked Nurses for nursing intervention/treatment, or
Doctors for medical examination/intervention/treatment. Once treatment is completed the
form will be placed in a tray for filing. The receptionist will place the form in numerical order in
the filing cabinet.

Functions of the Service

A Crisis Healthcare Clinic essentially offers a walk in health service. The functions of which
are mainly:

Medical/physical: -
      Symptom relief
      Pharmacological Intervention
      Basic wound assessment/dressing
      Health advice/promotion
      Referral to appropriate other services

The healthcare service does not offer:-
      Suturing of any kind
      Surgical intervention of any kind
      Intravenous therapy of any kind
      Invasive therapy of any kind
      All medical emergencies will be referred to the London Ambulance Service.

       Mental state examination
       Mini mental state examination
       Referral to appropriate other services (internal and external)
       Mental health promotion / advice
       Limited pharmacological interventions

The healthcare service does not offer:-
      Section under the Mental Health Act 1983
      Psychological, psychoanalytical, psychotherapeutic, or other therapies
      Rapid tranquilization by injection
      Detoxification programmes

All psychiatric emergencies will be referred to the local CMHT (Community Mental Health
Team). There will be qualified counsellors, as well as the Samaritans service based at as
many centres as possible throughout the event.

The British Red Cross first aid volunteers are an integrated part of our service. You will be
working closely alongside them throughout your shifts. Kieran Smith, Emergency Planning
Officer for the Red Cross is responsible for leading the Red Cross volunteers throughout the

Dependency Service

A number of our clients have drugs and alcohol issues. The advice, guidance, needle
exchange and referrals we make will help guests to start to transform their lives. This year
Turning Point will be leading this service to provide brief substance use assessments, harm
minimisation interventions and onward referral to appropriate services. The service will
primarily be aimed at guests who indicate that they would like to seek further advice,
information or treatment for a substance use issue but are not currently accessing treatment.
The service will also provide details of local support services for guests.

TB Screening

A Mobile X-ray Unit (MXU) will be screening guests during CC. The locations and dates will
be confirmed during the briefing session. All healthcare volunteers should refer each guest to
the MXU.

Professional codes of conduct and ethics

High standards of medical, pharmacy and nursing care, evidence based practice, codes of
professional conduct, morals, clinical governance principles and ethics, apply equally at the
Crisis Christmas Healthcare Service as they do in normal working practice. Each individual
qualified registered practitioner is responsible for adhering to their professional codes of
conduct and ethics during Crisis Christmas.

All volunteers will be asked to provide the following documentation at the briefing session on
December 11th 2008. Proof of professional registration and proof of ID. If you are still
working please bring along your work ID badge or if you are retired please bring along
another form of picture ID. If you are unable to attend the briefing please ensure that
you bring along this documentation to your first shift.

If the above documents are not seen and checked off by Crisis you will not be able to work in
the Healthcare Service. However you will have the opportunity to volunteer as a general

If any Healthcare/Dependency service volunteer has concerns regarding the practice of
another volunteer, they should report these concerns to the Healthcare/Dependency
manager immediately.

Standards of Record Keeping

You are just as responsible for accurate, legible, and comprehensive record keeping at Crisis
Christmas as in your every day practice. All entries should be legible and written in black ink,
to enable photocopying. Please date and time all entries, sign, print your name with your
designation. If you adhere to your normal record keeping policy, everything should be

Team Working

Ultimate responsibility for the safety of guests, volunteers, smooth running, management and
organisation of the healthcare service lies with the Healthcare Service Manager (Jason
Warriner) who reports to the Services Manager (Sandra Winnick). Each shift will be
facilitated by a shift leader and co facilitated by an assistant shift leader (where available).
Despite the inevitable hierarchical structure, the emphasis and key to efficiency, efficacy, and
safe practice is team working. The culture within the Healthcare Service is definitely one of
working together with an open and transparent communication system, where all volunteers
feel comfortable and confident to ask any questions (no questions are deemed silly or not
important enough to ask). All members of the healthcare team will be committed to a non-
judgemental, empathic approach to guests as well as each other and all members of the
healthcare team.

Health, Safety and Infection Control

There will be no mechanical (or other) equipment for moving and handling at CC. In the
event of a guest requiring moving and/or handling use your own area policies and
procedures as a guide. If in doubt ask the healthcare manager, shift leader or assistant shift
leader. (Remember Team Working is the key) Never attempt anything you are not
comfortable with alone.

The venues of the centres are different to hospitals in terms of hygiene and cleanliness;
however Crisis has a strict cleaning policy. It is vital that all members of the healthcare and
dependency team use gloves and aprons (supplied) as appropriate, for example when
dressing wounds.

Good hand hygiene is essential and that you wash your hand before and after examining
each guest. Sleeves must be rolled up, wrist watches and bracelets must not be worn.

Please wear only one ring on you hands.

Support/Supervision for Volunteers

The culture of the healthcare service is one of team working, open communication and
support. If any volunteer requires further support and/or clinical supervision, please speak to
the healthcare manager. Many thanks for taking the time to read this document. I hope it has
given you some idea of what to expect on your shift. There will also be time to ask questions
at the handover and briefing. Although the work can be challenging at times, it is also an
enormously rewarding experience. The Healthcare Team look forward to meeting you.

                           The Pharmacy Service - practicalities

The pharmacy at Crisis Christmas is not a registered pharmacy, but is, in essence, a Doctor
dispensing practice, which happens to have pharmacists as part of its staff.

The responsibility for the dispensing and administration of medication therefore lies legally
with the prescriber, although this has not been tested in court. One can assume that since
all those that are involved in dispensing are either qualified pharmacists or nurses, the doctor
may expect that any medicines are dispensed within the practice that may be expected of
such professionals.
Drugs for dispensing will be transported with the team – where a pharmacist is present,
he/she will be responsible for the transport and security of the drugs box and restocking the
drug boxes at the end of each shift. If no pharmacist is present, a nominated team member
will take on this responsibility.

Prescribing of medicines
The guests will normally be seen by one of the Doctors, and if necessary, a prescription will
be written. All medication, even GSL and P medication, needs to be prescribed on the
guest‟s medication card. The standard prescription chart is an A4 sheet with spaces for
“once only” doses of medicines and courses of medicines to take away. We also have
available a sheet which is more like a hospital chart /M.A.R. sheet, with space for regular and
PRN medicines and where individual doses can be signed for on administration. This sheet
is designed for use with guests staying in the healthcare centre for observation. (Appendix
1, Prescription Chart).
Only registered medical practitioners may prescribe at Crisis Christmas – other professionals
with extended prescribing rights are not currently permitted to prescribe within our service.
The one exception to this is that standing orders have been agreed by which a nurse or
pharmacist may administer one dose of particular medications to a guest. For further details,
please refer to Appendix 2, CC 2008 Standing Orders policy.

The Dispensing Process
When a pharmacist is available, he or she should be responsible for dispensing medication.
In the absence of a pharmacist, a doctor or a registered nurse may dispense from CC stock.
Upon receiving a prescription, the pharmacist/dispensing doctor or nurse should locate the
appropriate drug. At the healthcare centre base, drugs will be dispensed from the central
stock. For clinics at other centres, drugs will be dispensed from a pharmacy box. This
locked box will be transported with the team. Where a pharmacist is present as part of the
team, he/she will be responsible for the transport and storage of the pharmacy box. If no
pharmacist is present, a nominated team member will take on this responsibility. Upon the
team‟s return to the healthcare centre, the box will be restocked and the usage of drugs
during that clinic recorded.

Having located the appropriate drug, the dispenser should obtain the correct quantity. There
are three ways in which we will give out prescribed medication:
   A “stat” or one-off dose
   One dose at a time, signing for each dose as a nurse would for a hospital inpatient
    (usually only appropriate for guests under observation at the medical centre)
   An entire course, as for an outpatient or community supply (most commonly).
If a single dose is to be given, best practice is to ask another member of the team to check
against the prescription and the original pack that the correct dose of the correct medicine is
being administered. This should then be given to the guest with a drink of water where

Medication dispensed to “take away”, such as short courses of antibiotics, MUST all be fully
labelled according to the Medicines‟ Act requirements. We will attempt to label all medicines
in advance in such a way that only the guest‟s name and the date will need to be written onto
the label. For the occasional unlabelled item, a stock of blank labels will be supplied.

By law, the label on any medicine that is given to a guest must contain the following:

Name, form & strength of the product
Quantity in the container
Patient‟s name
Full directions
Course length if antibiotics
Date of dispensing
Cautionary warnings (can be found in the BNF)
Place of Dispensing (“Crisis Christmas”)
All liquids should be labelled “Shake the bottle”
All items for external use should be labelled “Not to be taken”

Best practice when dispensing courses of medicines is to ask another member of the team to
check against the prescription and the original pack that the correct quantity of the correct
medicine is being administered, labelled appropriately.
No glass is allowed to leave any pharmacy/healthcare area. This may prove problematic for
patients prescribed items such as simple linctus or Gaviscon®. However, Gaviscon® tablets
should be available, and we have managed to obtain a supply of plastic bottles for liquids.

There is normally a separate needle exchange service at the Dependency Centre. Guests
requiring this service should be discussed with the Healthcare Manager (or Deputy). There
is a CC policy for the storage of Guests‟ own medication, including methadone and other
controlled drugs. This service is not provided by the medical centre, but rather by the lead
volunteers (“green badges”) at each centre.

No FP10s (prescriptions from GPs) or private prescriptions can be dispensed - these must
be taken to a local community pharmacy. After medication has been dispensed, the guest‟s
notes should be filed in accordance to the procedure in place for that centre.

The proposed formulary is included at the back of this booklet (Appendix 3). It is likely that
we will run out of some medications by the end of the week. If this should happen, the
preferred option is to substitute. It is worth bearing in mind the question “What would the
guest have done if they were not at CC? Is the treatment essential to start before the guest
can visit their own GP?”

If substitution is not practical, then we will need to send a written order to a local pharmacy.
The shift leader for the healthcare team will be able to provide appropriate headed stationary
and we will have a list of open pharmacies.

Appendix 1: CC 2008 Prescription Chart

Guest‟s Name                      ID Band Number               Allergies/Sensitivities

Once Only Medications:
Date    Time     Drug               Dose     Route    Prescriber       Dispensed/Administered
                                                      (name and        by
                                                      signature)       (name and signature)
24/12   14.25    paracetamol        1        oral     M. SHAW          L. COLLINS
                                    gram              Martin Shaw      Lewis Collins

Treatment Courses to Take Away:
Date: 28th December 2007                      Date:

Drug:   Amoxicillin                           Drug:

Dose:   500mg t.d.s.                          Dose:

Duration:    7 days                           Duration:

Prescriber (name and signature)               Prescriber (name and signature)

Martin Shaw

                                              Dispensed by (name and signature)
Dispensed by (name and signature)
Lewis Collins

CC 2008 Prescription Chart

Guest‟s Name                          ID Band Number                     Allergies/Sensitivities

Regular Medications (administered on site):
                                                     December 2007
                                                     23    24      25          26    27     28     29   30
Drug    Ibuprofen      Dose 400mg           06.00              Lewis
Special                                     12.00    Lewis     Lewis
Instructions                                         Collins   Collins
WITH FOOD                                   18.00
Date           Name and Signature
28/12/07       M. SHAW                      22.00    Lewis     Lewis
               Martin Shaw                           Collins   Collins
Drug                   Dose                 06.00

Special                Route                12.00
Date           Name and Signature

Drug                   Dose                 06.00

Special                Route                12.00
Date           Name and Signature

As Required Medications (administered on site):
Drug Metoclopramide            Dose        Date     25/12
Max Frequency                  Route       Time     19.15
Every 8 hours                  P.O.
                                           Dose     10mg
Date           Name and Signature
25/12          M. SHAW                     Given    Lewis
               Martin Shaw                 by       Collins
Drug                           Dose        Date

Special Instructions           Route       Time

Date           Name and Signature

Appendix 2: CC 2008 Standing Orders

It may on occasion be appropriate for a registered nurse or pharmacist to administer one
dose of the following medicines to a guest without a prescription.

A record of administration must be clearly made in the guest‟s medical notes.

Medicines which may be given without a doctor’s prescription:

Paracetamol 1g for pain or fever

       ONLY IF
       Max daily dose (4g) not been reached,
       Last dose more than 4 hours ago
       No concerns about guest‟s liver function

Lemsip® (or equivalent) for symptoms of colds or flu

       ONLY IF
       Max daily dose has not been reached,
       Last dose more than 4 hours ago
       No concerns about guest‟s liver function
       No history of increased blood pressure

Throat lozenges for sore throat.

       ONLY IF
       Maximum daily dose not been reached (check individual packets)
       No concerns re glucose control

Gaviscon® (or equivalent) for dyspepsia

       ONLY IF
       Maximum daily dose not been reached
       No concerns re underlying GI/cardiac disorder

Appendix 3: Formulary

Amoxicillin        500mg      capsules          21
Cefalexin          500mg      capsules          21
Co-amoxiclav       375mg      tablets           21
Erythromycin       250mg      tablets           28
Flucloxacillin     500mg      capsules          28
Metronidazole      200mg      tablets           21
Penicillin v       250mg      tablets           28

Domperidone      10mg         tablets           28
Gaviscon                      suspension        300
Cinnarizine      15mg         tablets           counter
loperamide       2mg          tablets           30
Lactulose                     solution
Prochlorperazine 5mg          tablets           28
Senna                         tablets
Ranitidine       150mg        tablets           60
Omeprazole       20mg         capsules          28

Co-codamol                    tablets           30
Ibuprofen          200mg      tablets           12
Paracetamol        500mg      tablets           16
Paracetamol        500mg      Soluble tablets   100

Chlorpheniramine   4mg        tablets           28

Beclomethasone  100mcg        inhaler
Salbutamol      100mcg        inhaler
Salbutamol      2.5mg         nebules

Strefen                       lozenges
lemsip                        sachets           F
Simple linctus     200ml      linctus
Oxmetazoline                  Nasal spray
Difflan                       liquid            200ml

Anusol                        cream
Aqueous                       cream             100g
clobetasone        0.05%      cream
daktacort                     ointment
Clotrimizole       1%         cream             20g
hydrocortisone     1%         cream             15g
Canestan HC                   cream             30G
Aquadrate                     Cream             20g
Fusidic acid       2%         cream
Malathion                     liquid


Lyclear              5%                    cream                30g
Naseptin                                   cream                15g

Fucithalmic          1%                    Eye drops
chloramphenicol      1%                    Eye ointment
Gel tears                                  Eye ointment
Cerumol                                    Ear drops
Sod bicarbonate                            Ear drops
Locorten vioform                           Ear drops
Isopto alkaline                            Eye drops
Gentisone HC
Sodium cromylgate                          Eye drops
Lidcare                                    ointment

Cyclopentolate 1%                          minims
Proxymetacaine                             minims
Proxymetacaine                             minims
0.5% + fluorescein
Tropicamide 1%                             minims
Saline                                     minims

Daktarin                                   Oral gel             15g
Bonjela                                    Oral gel             10g
Flamazine                                  cream                20g
Permitabs                                  tablets              30
GTN                                        sprays
Thiamine             100mg                 Tablets              100
Prednisolone         5mg                   Tablets              28
Acyclovir                                  cream                2g
Cystopurin                                 sachets
Dioralyte                                  Sachets              20
Hypostop                                                        1x3x23g
multivitamins                              capsules             1000
Corsodyl                                   spray                60ml
Steripods                                                       25x20ml
unisept                                                         25x25ml
Epipen               300mg
Engerix B vac                              1ml prefilled

It is likely that we will run out of some of these by the end of the week.


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