Page 1 of 16
Assisting Care Navigation – Guidance for All Staff
What is this guidance about?
This guidance is to assist with the identification of families where communication and access barriers exist.
It is for everyone in the patient journey so that relevant information is captured and as needed alternative
approaches to invite and engage these families can be used. The aims are to:
 ensure uptake of services
 prevent DNA’s
 prevent inappropriate discharge.
 Assist staff when caseloads are transferred.
Who will record information?
Everyone!
What key information needs to be checked each time a patient contact occurs?
Check and update the following information every time:







Address and postcode
Contact information
GP
School attending
Parent and carer information.
Groups and relationships for other service staff involved in providing care.
Other family records that may need checking and updating.
What needs to be recorded?
The information recorded is not intended to label or categorise individuals but to assist our understanding of
their needs. Reminders for all staff will be used to signpost information recorded in the health record for
example:
Information
SystmOne –
High Priority
reminder
MaracisPatient Data
Sheet
Tiara
Rio
Care Navigator
involved, name
and contact
number.
Or
If there is a lot
of information
‘Check S1
reminders and
groups and
relationships’
Care Navigator
involved and
name and contact
number recorded
in history alert
To be
confirmed
(These are
displayed when
some appointments
are added)
That there is a care
navigator working with
the family. This may
include clinical forum
level involvement and
this will be recorded in
the child’s record.
Care Navigation –
see Groups and
relationships
Or
Care Navigation –
See groups and
relationships and
entry dated
DD/MM/YYYY
Guidance - Assisting Care Navigation V6 October 2014
Page 2 of 16
That an interpreter is
needed for the family
and the language
spoken.
E.G Slovak
Interpreter
needed.
Enter the
information in
fields ‘Main
Language’ and
‘Translator
Needed’.
Access issues – There
should be a reference to
an entry in the records.
Examples
 disability e.g.
child or parent is
wheelchair user,
blind, deaf etc.
Access barrier –
see entry dated
DD/MM/YYYY
and ensure that
any specialist
services that are
involved including
social workers are
recorded in
groups and
relationships.
Use the
Remarks field
or Mobile
Patient field.
Or
If there is a lot
of information
‘Check S1
reminders and
groups and
relationships’
Communication
barrier – see
entry dated
DD/MM/YYYY
and ensure that
any specialist
Use the
Remarks field
or Mobile
Patient field.
Or
If there is a lot
Some families may
have a Family
Facilitator or Key
Worker assisting with
co-ordinating their
care if they have a
disability. Check
groups and
relationships.
Interpreter alert is
added – this flags
up each time an
appointment is
booked to remind
staff to ‘book
interpreter’
Use the alerts
that are available
for
deaf/blind/partially
sighted or history
alert

temporary
problems e.g.
member of the
family is ill and
this is impacting
on attendance/
engagement.
 The family is part
of a vulnerable
group e.g.
homeless,
asylum seeker,
traveller etc.
 Moving between
addresses.
 Overseas visitor
– this may mean
that some
services cannot
be accessed.
 Preferred venue
for appointments
e.g. Healthy child
programme due
to being
registered with a
GP at a distance
from their home
address.
Communication barriers
–
 literacy,
 learning
disability, or
 physical
Guidance - Assisting Care Navigation V6 October 2014
Add to the history
alert
Page 3 of 16
disability that
impacts on
communication
e.g. sight or
hearing
problems.
Moving between
addresses may
also be a
communication
issue.
services that are
involved are
recorded in
groups and
relationships.
of information
‘Check S1
reminders and
groups and
relationships’
Multiple non-attendance
“Multiple missed
appointmentssuggest
additional
coordination”
Add to the
Remarks field.
Or
If there is a lot
of information
‘Check S1
reminders and
groups and
relationships’
Add to the
Remarks field.
Or
If there is a lot
of information
‘Check S1
reminders and
groups and
relationships’

This wording has been
agreed by IG as an
appropriate alert to add
to S1.
Significant Information or
Event
You may want any
others working with the
family to be aware of a
significant event or
information e.g. death of
a close family member.
Significant
Information or
Event – see entry
dated
DD/MM/YYYY
and ensure that
any specialist
services that are
involved are
recorded in
groups and
relationships.
Add to the history
alert
Add to the history
alert
NB Remember the parent and sibling records too and record information as necessary.
This information may assist others caring for the family in other services including adult
services.
What can be done in the meantime until this information is fully populated?


Check scanned or filed documents for information.
Pick up the phone to the lead professional, the Health Visitor or School Nurse. They may have a
wider picture of the family situation; any concern you may have could be relevant to care, including
safeguarding.
Where the information should be recorded?
On the patients electronic or paper health record. Administration staff should collect the specific
information from colleagues and agree with the clinician what should be recorded. This is to ensure
that there is compliance with Information Governance and Record Keeping standards.
SystmOne - If the record used is SystmOne staff should use the High Priority Reminder facility so that
the information is displayed to all users when the record is accessed. NB You need to ensure there is
no patient dissent to share for the information to be available. (See attached user guide to recording a
Guidance - Assisting Care Navigation V6 October 2014
Page 4 of 16
High Priority Alert). Groups and relationships should be used to record staff contributing to care and
family members. See guide attached.
Maracis
Staff using Maracis are able to enter the equivalent of the above alerts using the patient data sheet and
the ‘Remarks’ field.
The patient data sheet is added to the paper record.
Tiara
Use the ‘Alert’ functionality within the Tiara system. The alerts can be specific e.g. Interpreter, partially
sighted or the ‘history’ alert can be used.
Paper records
In paper records the information may be captured on a sheet at the front of the records.
When should the information be recorded or updated?
Whenever the patient record is accessed it needs to be part of your ongoing practice to review
information in the health record and if you are in contact with the family to update the information if it is
no longer accurate.
How should the information be used?
Appointment booking:








Ring to make the appointment rather than issuing a letter.
Consider the use of quarantined mail e.g. patient collects the post from an agreed place/ person.
Making sure the venue is suitable.
Making sure that an interpreter is booked to attend.
Make contact with the care navigator or specialist team before the appointment is made to
discuss the best methods and arrangements for the family/ child.
Consider if joint visits are needed.
Is transport needed?
Is there capacity in the teams to ring and remind families of appointments etc.?
Referrals:

The referrer should provide information to the service of all communication and access difficulties
that the team need to be aware of to ensure that the appointment and service arrangements made
for the child/ family are appropriate.
Non attendance
The information in the record should be used to inform actions in the event of non-attendance. The
clinician and the administrative team must investigate and agree the most appropriate course of action
before a further appointment is booked or the patient is discharged from the service.
Guidance - Assisting Care Navigation V6 October 2014
Page 5 of 16
Appendices
A – Adding a Reminder onto S1
B – Recording a relationship on S1
C – Contact with a family
D – Documents or Information received concerning a child or family.
E – Care Navigation Requests
F – Care Navigator contact Information
G – City Care Navigator Information
H – Voluntary Transport Criteria
Guidance - Assisting Care Navigation V6 October 2014
Page 6 of 16
Appendix A
Adding Reminders
1. To add a reminder to a patient record, right click on Reminders on the clinical tree, Select
Create Reminder
1
2
2. Create New Reminder box will appear as above, leave priority as ‘High’ and enter reminder
in Notes area
3. Click on OK
4. Save the record and record activity
Version 1.0
LPT SystmOne Team
Guidance - Assisting Care Navigation V6 October 2014
Page 7 of 16
Recording a Relationship
Appendix B
This Help Sheet will guide you through the process of adding a Relationship to a child record. This may be someone like a Speech Therapist, Child minder,
School Teacher or family member such as Grandparents.
1.
Ensure the child record is open, and right click on Groups and Relationships and choose the option of Record a Relationship.
2.
Alternatively, you can use the Record Relationship Icon (4th Icon in)
3.
The Select Relationship Type Screen will allow you search for the type of relationship. .
Guidance - Assisting Care Navigation V6 October 2014
4.
Enter the search criteria in the Search Box and click Search
5.
Select from the list and click OK at the bottom of the screen
6.
For a Childminder, choose the option of Other
Page 8 of 16
7.
The following box will appear. Always choose the bottom option (a textual relationship)
8.
Click on OK
9.
The New Relationship box will open.
10. If you are entering details for a Child Minder, please enter the days of the week the child attends in Comments and for what part of the day i.e. before or
after school or for the whole day.
11. Relationships can also be used for recording Dual Placements. The main school is added through the clinical tree, and the other school is added in
Relationships.
12. The Name of the Teacher can be added in the Person Details – title and surname is sufficient.
Guidance - Assisting Care Navigation V6 October 2014
Page 9 of 16
13. Click on OK
14. Once you have entered all the details in the child record, save in the usual way completing the Events Details Screen.
Ending a relationship
Staff members in the unit the relationship was recorded are the only people that can end it. When the patient is deducted from a unit other unit staff can end
relationships added by them.
If you need any further assistance, please contact the Service Desk on 0116 295 3500.
Guidance - Assisting Care Navigation V6 October 2014
Page 10 of 16
Appendix C
Contact with a child or family
Check information and update as needed:







Address and postcode
Contact information
GP
School attending
Parent and carer information.
Groups and relationships.
Records of other family members
Barriers or
significant
information
identified?
No
No additional
action needed.
Yes
Record the specific issue within the record
of the child or adult record.
Is the lead
professional
HV or SN
aware?
No
Yes
No additional
action needed.
Add a ‘High Priority Reminder’ to S1, the
information to the Maracis Patient Data
Sheet or an ‘Alert’ to the Tiara system.
Rio (TBC)
Guidance - Assisting Care Navigation V6 October 2014
Contact them
Page 11 of 16
Does the
child or
family need
services
now?
No
No additional
action required
Yes
Consider if you need to utilise the
Request for Involvement or Clinical
Forum arrangements. Appendix ‘E’
Do you need to
check the
appointment DNA
status?
Yes
Contact the administrative team in the first
instance to ensure that the child or family
continue to be offered services and any
alternative approach that may be needed.
Guidance - Assisting Care Navigation V6 October 2014
No other
services
involved
No additional
action
required
Page 12 of 16
Appendix D
Documentation or information
received concerning a child or
family.
Check information and update as needed:






Address and postcode
Contact information
GP
School attending
Parent and carer information.
Groups and relationships
Is a care
navigator, Key
worker or
family
facilitator
working with
the family?
No
Yes
Ring and discuss the
needs and approach
to provision of
appointments and
care. If the child has
DNA’d an
appointment, make
contact before
making further
appointments or
discharging.
Consider the
approach to
Yes
contact with the
family and any
appointment
arrangements
based on the
information
provided.
[Type a quote from the document or the summary of an interesting point. You can position
the text box anywhere in
Discuss
the document. Use the Drawing Tools tab to change the formatting of the pull
quotewith
text the
box.]
family or
No
clinician as
appropriate.
No additional actions needed
Are there reminders or
alerts on the system,
information on the
data sheet, records or
this document that
indicate barriers?
Guidance - Assisting Care Navigation V6 October 2014
Page 13 of 16
Appendix E
Care Navigation (CN)
Requests
Find their name and
contact information
in groups and
relationships of the
child’s record or
from the patient
paper record.
Is a CN
already
involved?
Yes
No
Ring CN and provide
the CN with the
current issue e.g.
child has DNA’d an
appointment etc.
and agree actions.
Identify CN based on child’s postcode
and the linked locality map for the
team.
Contact the CN by phone or if a S1 user,
send a Referral/ Task to them in the
HV/SN unit, requesting support with
engaging the family with service
provision due to multiple DNA’s despite
various approaches. (Record the
reason in the record not the task).
The Care Navigator will review the
record and consider the support that
can be provided and this may include
discussing and meeting the family
needs through:
 Their involvement.
 Requesting involvement from
resource within the
neighbourhood.
 Discussion of needs at a clinical
forum
Guidance - Assisting Care Navigation V6 October 2014
Page 14 of 16
Care Navigator Contact Information
Appendix F
Julie Adams
West, North West & South West Leicester
Tel: 07825976164 – [email protected]
Jo Houlston
South Leicester & Harborough
Tel: 07900914724 – [email protected]
Gemma Cole
North West Leicestershire & Hinckley & Bosworth
Tel: 07827449413– [email protected]
Steph Bates
Blaby, Oadby & Wigston
Tel: 07876710247 – [email protected]
Rebecca Thorpe
Melton & Rutland
Tel: 07827354999 - [email protected]
Anisha Jaiyeola
Central, East, North & North East Leicester
Tel: 07825976163 - [email protected]
Steph Squires
North and South Charnwood
Tel: 07827879700 - [email protected]
Guidance - Assisting Care Navigation V6 October 2014
Page 15 of 16
Appendix G
City Care Navigation Information
Guidance - Assisting Care Navigation V6 October 2014
Page 16 of 16
Appendix H
Voluntary Transport Criteria
The service must have written authorisation for all transport requests. Forms will be provided where required. All
requests are subjected to availability and arrangements will be made to confirm if requested.
Authorisation must be provided by:


A consultant within the Trust or the medical secretary on behalf of the consultant.
The ward manager or a member of staff on behalf of the manager.
The service user’s keyworker.
Voluntary drivers are unable to deviate from the authorised request.
Transport requests are usually for service user appointments within the Trust, but also:




Day centre activity arrangements.
Home day leave from wards.
Therapeutic reasons usually accompanied by staff escorts.
Group Therapy sessions approved by the service user’s consultant.
Occasionally, for a relative visiting a service user. This again must be approved by the Consultant.
The service will consider regular commitments on a weekly basis. i.e, UFN system (until further notice)
The voluntary transport service is operational weekdays only and covers the whole of Leicestershire, Rutland and
occasionally beyond.
All volunteer drivers are DBS (CRB) checked both in relation to adults and children.
They tend to be on the road from 9am, although sometimes beforehand. The latest returns from appointments are
at 4pm.
All volunteer drivers use their own vehicles and are unable to accommodate wheelchair friendly needs. Some drivers
are able to accept walking frames and occasionally fold up wheelchairs. The latter is provided that the service user is
able to mobilise into the vehicle on their own accord with minimal support, or an escort is present where required.
It is the responsibility of the user area requesting the transport arrangements to assess whether an escort is needed.
Any special instructions to provide transport must be provided on the request form e.g. communication needs (i.e.
hearing difficulties and language barrier) the need for male/female drivers only or issues mentioned above. Special
instructions also include the transportation of children. By law any child below the age of 12 or height of 135cms
should have either a child car seat (age 3 and below) or a booster seat, although there are exemptions.
Tom Pap
Guidance - Assisting Care Navigation V6 October 2014