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     Practice statistics
     logbook for ODPs
     Keeping accurate records of your practice is an essential part of
     professional development. John Gray explains how to use a practice
     development logbook within the rules of the Data Protection Act.

                                                    Introduction                                     though, this is just one of many
                                                                                                     examples, and a PSL can be extended to
                                                    What is a practice statistics logbook?           measure other aspects of practice, such
                                                    The central idea behind a practice statis-       as statistics for on-call , equipment use,
                                                    tics logbook (PSL) is to store information       extended roles and surgical speciality.
                                                    about an ODP’s daily practice – to gain
                                                    ‘real time’ statistical data. Using this data,   Why use a practice
                                                    an ODP can assess their own practice and         statistics logbook?
                                                    adjust it as necessary in order to improve       Before ODPs contemplate diversification
                                                    their standards of care and in turn benefit      of practice, they should look at their
                                                    the end user (the patient).                      fundamental practice shortfalls and
                                                      Some ODPs may believe they don’t need          concentrate on keeping their skills in
                                                    to update skills in certain areas and if         these areas updated. A PSL can help to
        John Gray ODP                               they have to carry out duties in areas           show up immediate shortfalls in such
        John Gray has been an ODP for 24            where they don’t usually work then they          fundamental practice areas. The ODP can
        years. He is an anaesthetic practitioner
                                                    can ‘get by’. Surely patients deserve            then use this information to prioritise
        at Sunderland Royal Hospital,
                                                    better than just ‘getting by’ – they deserve     ironing out these shortfalls. Setting prece-
        Sunderland, Tyne and Wear. He is
                                                    the best practice we can give them.              dence for continuing professional
        working currently in obstetrics, having
        recently moved from ophthalmics. He           A PSL would normally be stored in              development (CPD) activities will not be
        has an interest in CPD and is the CPD       electronic format and can be used to             as flexible, but it will give a more efficient
        co-ordinator for HPC- registered ODP’s.     measure any number of aspects of                 system to update these base skills.
                                                    practice. For the purpose of this paper
        Abstract                                    and to avoid over-complicating matters,          The Data Protection Act
        This paper discusses the reasons for an     just one aspect of practice will be              1998 – the principles
        ODP to maintain a practice statistics       discussed: an ODP’s intravenous (IV)             All healthcare professionals have a duty
        logbook (PSL) of their practice and what    cannulation failure rate. Do bear in mind        to maintain patient confidentiality, we
        data should be stored in it. It examines
        what a PSL is, and what information can
        be gained from it. Compliance of the
        PSL with the Data Protection Act 1998
        is covered, as is the question of how a
        PSL can contribute to an ODP’s continu-
        ing professional development by meeting
        the Health Professions Council’s
        standards as a form of evidence for
        continuing professional development.
        Key words
        Practice, statistics, logbook, CPD, Data
        Protection Act, anonymity


        Reference
        Gray J (2007) Practice statistics logbook
        for OPDs. Technic ?(?): ?-??.

                                                    Fig.1: Screen grab from the practice statistics logbook spreadsheet using Microsoft Excel



24   TECHNIC | VOLUME 4 | ISSUE 9 | APRIL 2007
                                                                                                                                  Feature



also have a duty to comply with the             contains personal data. If the informa-       again. The ODP would set their own
provisions of the Data Protection Act           tion within the PSL cannot be minimised       percentage limits based on their current
1998. It has eight principles (Pt 1. Sch. 1),   to non-personal data, then the compiler       practice. This of course will benefit end
which we have to comply with when we            should comply with the other seven            users, as they will be cannulated the
are storing or manipulating personal            principles of the Data Protection Act         absolute minimum number of times
data. The only principle we are going to        1998. They should also inform their           necessary and at minimum resource
deal with is principle three, because if        employer of their intentions and notify       cost. Without this information, the ODP
you can avoid using ‘personalised’ data         the Information Commissioner’s Office         would probably continue their practice
then the other seven principles do not          (ICO – see below) because the PSL             as if nothing was wrong. Not only would
come into effect. Thus, the intention is to     would be regarded as CPD activity and         the ODP be putting patients through
minimise the data to such an extent that        so to a certain extent out of the working     added unnecessary trauma, they would
it is no longer classed as personal data.       environment and you may not be                also be contributing to the added costs
  In order to comply with the third             covered by you employers jurisdiction as      of running the health service.
principle of the Data Protection Act 1998       a data controller.                              Most statistical information only
(Part 1. Schedule.1):                                                                         requires very simple calculations and
  ‘Personal data shall be adequate,             The Information                               should be within the reach of most
relevant and not excessive in relation to       Commissioner’s Office                         ODPs. Using the right computer
the purpose or purposes for which they          ‘The Information Commissioner’s Office        programs to set up the PSL alleviates
are processed.’                                 is the UK’s independent authority set up      the problems of calculations. To find the
  It is necessary to establish what             to promote access to official information     IV cannulation failure rate, the overall
personal information (if any) would be          and to protect personal information.’         cannulation rate is required – this is
required as an absolute minimum to              (ICO n.d. a)                                  easy. Every time the procedure is carried
achieve the results required by a PSL.            The ICO (n.d. b) states that ‘Under the     out the relevant information is logged in
  The Data Protection Act 1998 (Pt 1. Sect      [Data Protection] Act [1998] every organ-     the PSL: size of cannula, age group of
1.) states that: ‘“personal data” means         isation (data controller) that processes      patient, site of cannulation, success or
data which relate to a living individual        personal information (personal data)          failure and reason for failure. With this
who can be identified–                          must       notify      the    Information     information, three statistical events have
(a) from those data, or                         Commissioner’s Office, unless they are        been produced: overall rate, success
(b) from those data and other informa-          exempt. Failure to notify is a criminal       rate and failure rate. From this addition-
tion which is in the possession of, or is       offence.’                                     al information it can be established if
likely to come into the possession of,            The ICO (2001) gives the definition:        enough IV cannulations are being
the data controller, and includes any           ‘Personal data means data which relate        performed to keep skills up to par.
expression of opinion about the individ-        to a living individual who can be identi-       Keeping a running log of practice
ual and any indication of the intentions        fied from those data or from those data       enables the ODP to investigate the
of the data controller or any other             and other information which is in the         reasons behind any increase in failure
person in respect of the individual;’           possession of, or is likely to come into      rate, because the reasons for failure
  Gathering statistical data about one’s        the possession of, the data controller.’      have also been logged. For example, is
practice should be limited to practice            If the reader is in any doubt if they are   there a pattern of events that can be
details rather than patient details. Since      exempt from notification, then they can       linked to this increase in failure rate?
statistical data from the PSL is real time      use the self-assessment guide (ICO
and achieved over a period of time then         2001), which will clarify their position.     How accurate is
the date of the actual event is unimpor-        The ICO (2001) also states that ‘Data         accurate?
tant. The patient’s personal details, such      controllers who are exempt from notifi-       An important issue, particularly around
as name, address, date of birth and             cation may choose to notify voluntarily.’     anonymised data, is the question of
hospital index numbers, are all irrelevant                                                    verifiable authenticity. If your data
for the purposes of practice and because        Setting up the practice                       doesn’t require personal information in a
the example PSL is for anaesthesia-related      statistics logbook                            practice logbook, how can it be proved
practice, it can be regarded as unneces-        Imagine an ODP is trying to find out          that it has not been falsified? As a
sary to have the operation details.             what their IV cannulation failure rate is.    healthcare professional, an ODP is
  The Information Commissioner (n.d.)           Accurate collection of this information       considered trustworthy and honest and
states: ‘If data has been stripped of all       could improve the ODP’s practice over         on the basis of that one would expect
personal identifiers such that the data         time and also benefit patients. Suppose       ODPs to maintain an accurate and true
controller is no longer able to single          the failure rate for IV cannulation is 4%,    PSL. There is no point in falsifying infor-
out an individual and treat that individ-       but then suddenly over a short period of      mation to give yourself a lower virtual
ual differently, the data cease to be           time this failure rate climbs to 20%. With    failure rate. Nobody (apart from the data
personal data.’                                 this information the individual can start     collecting ODP) should be interested in
  The example PSL data provided in this         to investigate the reason behind the          the actual failure rate; the interest
article has been stripped of all personal       change and rectify the problem, and           should lie in whether or not the individ-
                                                                                                                                                    ,




identifiers and therefore no longer             hopefully lower their failure rate once       ual has changed their own practice to

                                                                                                       TECHNIC | VOLUME 4 | ISSUE 9 | SPRING 2007       24
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     lower the failure rate. Second-party             other two standards deal with the CPD       August 2006 a total of 294 cases have
     interest should only come about during           process as a whole.                         been carried out. The information stored
     continuing professional development                Standards two to four basically state     in this PSL (remember they may be
     (CPD) audit or the ODP’s individual              that your CPD must contain a mixture of     different for another ODP with a different
     performance review (IPR).                        learning activities, must contribute to     working role) is:
       To maintain an accurate PSL the                the quality of your practice and service    G Age group
     individual should be looking at updating         delivery and that the service user must     G Speciality
     it as soon as possible after the event.          benefit from your CPD activities. Table 1   G Anaesthetic,
     More time between the event and the              illustrates the HPC (2006a) standards       G ‘User-defined’ data
     recording leads to ever increasing inaccu-       and some of the reasons why a PSL           G ‘User-defined’ data
     racies of the facts. Leaving the PSL for         would meet the HPC (2006b) assess-          G Infusions
     days or even weeks and months will               ment criteria and be a major                G Airway maintenance
     lower the accuracy of the data that is           contribution to your CPD activities. The    G Rapid sequence Induction
     input. It will also lead to statistical infor-   PSL should be partnered with a              G Cannulation
     mation being available too late, which           summary of direct actions that have or      G IV cannulation failure reason.
     could lead to the stagnation of practice.        are to be taken in the future and entered   As you can see, there is no place to put
                                                      as evidence, cross-referenced on your       patient’s name, date, hospital number or
     Does a PSL meet HPC                              CPD profile with the three main             even the operation. This data is irrele-
     standards for CPD?                               standards for CPD.                          vant, because the statistics being
     The Health Professions Council (HPC)                                                         measured are total cases, whether adult
     has laid down five standards that have           A practice statistics                       or paediatric, airway maintenance, IV
     to be fully met in order to pass the             logbook example                             cannulation and failure of IV cannula-
     assessment criteria when your profile            Figure 1 illustrates a section of the       tion, surgical speciality mix and possibly
     and evidence of CPD activities is called         example PSL. It shows the statistics        two user-defined areas of practice.
     up for audit. As far as the PSL is               frame, which is situated, to the left of      Every time the PSL is opened the data
     concerned, we are only concerned with            the Microsoft Office Excel worksheet and    is automatically placed in alphabetical
     standard two, three and four, as the             a partial view of the input data. Since     order, so there is no true sequence of

      Table 1: The standards for CPD, published by the HPC – with indications of how
      a practice statistics logbook can contribute to registrants CPD
      CPD standard                                       Contribution to CPD
      One
      The HPC (2006a) states that a registrant           There is no reason why an accurate and true PSL cannot be used to
      ‘must maintain a continuous, up-to-date            create part of an ODP’s CPD activities, because it can form a good
      and accurate record of their CPD activities’.      portion of the CPD summary.
      Two
      The HPC (2006a) states that a registrant           The PSL can be classed as a work-based learning activity, which forms
      ‘must demonstrate that their CPD activities        a basis for one of the three activities required to fully meet standard
      are a mixture of learning activities relevant      two in the assessment criteria (HPC 2006b).
      to current or future practice’.
      Three
      The HPC (2006a) states that a registrant           A PSL, together with a written summary of it showing that the ODP
      ‘must seek to ensure that their CPD has            has reviewed and reassessed their practice to ‘improve the quality of
      contributed to the quality of their practice       their work’ (HPC 2006b), will fully meet the assessment criteria. If the
      and service delivery’.                             PSL has shown not to improve practice because it has not been
                                                         necessary or action needs to be taken in the future to improve their
                                                         practice then this will also meet the assessment criteria as long as the
                                                         ODP can show consideration for this in their statement. (HPC 2006b)
      Four
      The HPC (2006a) states that a registrant           By giving an explanation to the assessor of how the PSL has benefited
      ‘must seek to ensure that their CPD                service users, either directly or indirectly (HPC 2006b) the PSL will meet
      benefits the service user’.                        the assessment criteria for standard four.
      Five
      The HPC (2006a) states that a registrant           The ODP’s PSL can be an important part of a finished CPD profile and can
      ‘must present a written profile containing         give a good foundation on which to base future CPD activities.
      evidence of their CPD upon request’.


24   TECHNIC | VOLUME 4 | ISSUE 9 | SPRING 2007
                                                                                                                                              Feature



events. This is to ensure complete               improve the ODP’s standard of care then               become an integral part of an ODP’s CPD
anonymity in order to comply with the            it is an even more worthwhile tool. End               profile for audit purposes. CODP
Data Protection Act 1998.                        users (patients) will ultimately benefit
  The left-hand column of figures in the         from this improvement. A PSL can also                 How to obtain a PSL
statistics box indicates the total occur-        be used as a useful reference tool during             A free copy of the example PSL, specifical-
rences, the right-hand column depicts the        the ODP’s IPR.                                        ly designed for anaesthetics, but which
statistic as an overall percentage. Looking        A PSL completed on a daily basis takes              can be easily altered to meet most
at the IV cannulation failure rate, it shows     very little effort to maintain and with               practice requirements, is available. Email
that no action is needed to adjust working       modern computer technology, auto-                     the editor, who will forward your details. It
practice. A 5% failure rate in IV cannula-       complete techniques used by computers                 is for general circulation, provided the
tion could be deemed an acceptable level,        means very little time is consumed in                 basic format is not changed. John Gray is
but it could be concluded that the mix of        carrying out this task.                               now designing a scrub practitioner’s PSL.
surgical specialities needs to be investi-         A PSL presented with evidence in the
gated. The on-call commitment requires           form of a written summary over the two-               Acknowledgement
skill in all surgical specialities and to keep   year       period     of    registration,             I would like to thank Dr Keith Fordy (Cons.
up the skills for the on-call commitment,        cross-referenced with the HPC’s                       Anaes.) and Dr Amir Rafi (SpR Anaes.) for
the statistics indicate that an update of        standards within the CPD profile, will                giving me advice on writing this paper.
skills in general, ENT, genitourinary and
vascular disciplines is required.                 References                                             alist_guides/data_protection_act_legal_guidance.
  The example PSL also includes a basic                                                                  pdf> (Accessed 04 January 2007).
                                                  Data Protection Act 1998. (c.29), London: The        Information Commissioner’s Office (n.d. a)
accuracy monitor determined by how                  Stationary Office Ltd.                               Information Commisssioner’s Office website
many times the PSL is altered over a              Health Professions Council (2006a). Your guide to      Index page. ICO: Wilmslow. Available from:
                                                    our standards for continuing professional devel-     <www.ico.gov.uk> (Accessed 04 January 2007).
period of time.                                     opment. HPC: London: 5. Available from:            Information Commissioner’s Office (n.d. b)
                                                    <www.hpc-uk.org/assets/documents/                    Notification under the Data Protection Act 1998.
                                                    1000119FShort_guide_to_cpd.pdf> (Accessed: 23        [online]. ICO: Wilmslow. Available from:
Conclusion                                          December 2006).                                      <www.ico.gov.uk/what_we_cover/data_protec-
A PSL that contains practice-based infor-         Health Professions Council (2006b). Assessing          tion/notification.aspx> (Accessed 4 January 2007).
                                                    your profile. HPC: London. Available from:         Information Commissioner’s Office (2001).
mation (rather than personal patient                <www.hpc-uk.org/registrants/cpd/                     Notification Handbook, A complete guide to
information) in order to gain real time             criteria/index.asp> (accessed 23 December 2006).     notification. ICO: Wilmslow: 30-8. Available from:
                                                  Information Commissioner (n.d.) Data Protection        <www.ico.gov.uk/upload/documents/library/data_p
data to find any shortfalls in an individ-          Act 1998 – Legal Guidance, pp14. ICO: Wilmslow.      rotection/practical_application/notification%20ha
ual’s practice can serve as a useful tool.          Available from: <www.ico.gov.uk/upload/              ndbook%20complete%20guide%20to%20notifi-
                                                    documents/library/data_protection/detailed_speci     cation.pdf> (Accessed 04 January 2007).
If the information can be used to




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