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Children and young people: reduce the risk

05 February 2019

Dr Rachel Birch, medicolegal consultant at Medical Protection, provides practical tips to ensure you have systems in place to treat children and young people safely.

Medical Protection’s Education team have undertaken around 1,400 Clinical Risk Self Assessment (CRSA) visits to practices in the UK and Ireland. They have helped practice staff to identify potential risks to patients and find safe solutions. 
 
The following advice – which is relevant to children and young people – has been gathered from these CRSAs and aims to help you learn from the experience of others, so that you can take steps to ensure that your practice is as child-friendly as possible. This advice is by no means exhaustive, but you may wish to use it as the basis for discussion within a staff training session.

1. Child protection
• Ensure that you have an up-to-date and regularly reviewed child protection policy and a nominated clinical child protection lead. 

• Familiarise yourself with the Children First guidance.1 Tusla have developed a free online child protection training module to complement this guidance.2 The Health Service Executive (HSE) has also clarified the roles and responsibilities of staff.3

• Arrange for all your staff to have up-to-date child protection training.2,4 

• Clearly display posters in consultation rooms and the reception area, with easy-to-find details of who should be contacted if there are child protection concerns. 

• Ensure that all new staff have the appropriate pre-employment vetting checks, where indicated.

2. Appointments
• Allow young persons under 16 to see a clinician without the presence of an adult if requested.  

• Consider displaying a poster to let young people know that they may request to be seen alone. Unwillingly attending with an adult could potentially prevent a young person from asking for help. 

• Consider offering teenage-friendly times for consultations, for example, over school lunch breaks. Young people are more likely to access help if it is convenient to them.

• Practice privacy notices, detailing how patients’ personal data is used, should be provided in a format that can be understood by children and young people.5 

• Children under 16 can consent to medical treatment if they understand what is being proposed. Clinicians should encourage the young person to involve their parents in such decisions, however if the young person refuses, then the Medical Council outlines a list of factors to consider before proceeding with treatment.6 

• You should ensure there are no child protection concerns, that the young person’s views are stable and reflect their core values and beliefs, and that their decision is not affected by physical or mental ill-health. Having considered these factors, and if a young person demonstrates the  maturity and intelligence to fully understand the nature of the treatment, the options, the risks involved and the benefits, and you feel it is in their best interests, then their wish not to involve their parents should be respected.

3. Confidentiality
• Young people who have the capacity to understand the implications of their health and treatment have a right to expect confidential healthcare. 

• Ensure that you have systems in place to protect their confidentiality. For example, a 14-year-old may not want his parents to know that he saw the doctor to discuss mild symptoms of anxiety; a 15-year-old may not want her mother to pick up her prescription for her acne cream.

• Develop clear protocols for test results and prescription requests to ensure that results or prescriptions are not given to parents without the consent of the young person.

• Because parents have legal rights to access medical records of their children until they are 18, the Medical Council advises that you should tell children and young people that you cannot give an absolute guarantee of confidentiality. This is a complex area of law. If a parent or guardian requests access to the medical record of a child who is capable of understanding their rights to privacy and data protection, and the young person refuses consent to disclose the information, you should seek medicolegal advice.

• Consider excluding children under 16 years old from your text messaging service, as there is a risk that their parent’s mobile number could be linked to their record. 

4. Health and safety
• Ensure that sharps bins are not located on the floor or within easy reach of children. These large bright yellow boxes may attract the attention of small children, who may perceive that they are part of the practice’s toy collection. 

• Consider a dedicated children’s waiting area – with toys – as this may encourage children to be more relaxed and potentially easier to examine once they are in the clinician’s room. 

• Organise a regular cleaning rota for any toys that the practice provides for young patients. It is accepted that soft toys are more likely to be a risk of infection than hard toys, therefore consider only providing hard toys in waiting areas.7 

• Conduct a regular safety check of toys and discard any that are broken. 

CRSA for General Practices improves the quality of patient care and reduces your exposure to unnecessary risk. This unique consultancy programme has been designed especially for primary care and involves the whole practice team. For more information visit: https://www.medicalprotection.org/ireland/education-and-events/clinical-risk-self-asssessments/ire-clinical-risk-self-assessments-for-gps


References

1. Department of Children and Youth Affairs. Children First: National Guidance for the Protection and Welfare of Children. 2017. Available from: dcya.gov.ie/documents/publications/20171002ChildrenFirst2017.pdf
2. Tusla. Children First E-Learning Programme. Available from: tusla.ie/children-first/children-first-e-learning-programme/
3. HSE Children First National Office. Putting children first: roles and responsibilities of HSE staff under Children First. 2017. Available from: hse.ie/eng/services/list/2/PrimaryCare/childrenfirst/resources/staffrolesandresponsibilities.pdf
4. Health Service Executive. Children First Training. Available from: hse.ie/eng/services/list/2/PrimaryCare/childrenfirst/training.html
5. Irish College of General Practitioners. Processing of Patient Personal Data: Guideline for General Practitioners. V1.2, 2018. Available from: icgp.ie/go/in_the_practice/data_protection
6. Medical Council. Guide to Professional Conduct and Ethics for Registered Medical Practitioners. 8th edition, 2016. Available from: issuu.com/mcirl/docs/guide_to_professional_conduct_and_e?e=12642421/35694606
7. Merriman  E et al. Toys are a Potential Source of Cross-infection in General Practitioners' Waiting Rooms. British Journal of General Practice 2002;52(475): 138–40.