Summary Care Records - Tattoo Needed?

I have an allergy – a significant one, potentially life threatening, to a drug used commonly in general anesthesia.  This was discovered during surgery as a child.  At the time I was given a small card with the name of the drug.  I don’t know where the card is now.

Fortunately I can remember the name of the drug.  Being a doctor helps.  I could tell anaesthetists about the allergy before operations, and hopefully give them enough time to find a suitable alternative.

That, of course, relies on me being in a fit state to do so.  I’d need to be conscious, need to be thinking straight, need to have a good memory.  The drug has a long name, is hard to spell and relying on family members to recall it in a stressful situation is unrealistic. 

So what are my options?  I could wear (all the time) a bracelet/necklace with the information on.  I’ve looked at the designs available and although I realise their importance I’ve always delayed ordering one.  I rarely wear a watch, and am a reluctant jewellery wearer.  I am wrong, but suspect I am not alone.  I could carry a card in my wallet, but I’m not convinced anyone would search my belongings before surgery.  Please tell me if I am wrong.

My hope, as a potential patient, is that any medication and allergies would be available to the hospital team, in real time.  I have the same concerns as many about the importance of privacy and confidentiality.  But, if we have the ability to improve safety, particularly with prescribing, we should have a duty to share.  Prescribing errors are known to be a significant issue, causing patient harm and longer hospital stays.  Yet they can be reduced.  The ability to share a Summary Care Record is here, and yet we do not yet have a culture where sharing is routine, where clinical teams routinely look for information before making treatment decisions.

An elderly patient, with an acute illness such as sepsis or a longstanding condition such as dementia, will often not be able to share medical details and allergies.  We should not be in a position where even a simple decision such as which painkiller to prescribe is made without a knowledge of potentially life-threatening allergies.  I wouldn’t want to prescribe in that situation, and wouldn’t want to have surgery without the doctor being able to access my Summary Care Record 24 hours a day. 

We are not at the point yet when I have confidence that would happen.  I'm not even sure what my own surgery's position is.  What would my anaesthetist want? 

Perhaps I ought to reconsider a tattoo….

Scrutiny

2012 has been quite a year. A year of personal scrutiny. What does that mean? The word apparently originates in Latin: scrutinium; from scrutari, meaning "those who search through piles of rubbish in the hope of finding something of value." A common definition is: 'to look closely (as for mistakes)'. Seems apt.

The start of the year (and the 2 years before that) saw our practice achieve the RCGP Quality Practice Award, a real team achievement and recognition of the focus on patient service, access and meaningful systems by the practice and its attached staff. The visit, following an enormous submission of 'evidence' included patient and staff interviews, observation and a nurse going through every drawer in my room to make sure all was in order and in date. That was a nervous ten minutes. We passed, and it has been a great experience for staff morale and a catalyst for patient engagement in the practice.

As a CCG Chair I then had an assessment to ensure I was able to fulfil the role, at least on paper. Maths and English tests and 360degree leadership surveys were followed by a visit to London where I was interviewed in great detail by the Hay Group and underwent a series of role play and written assessments. A full day later I had a stamp of approval and my first ever migraine. I also discovered that after a certain age writing for 30 mins in examination conditions is almost impossible. If the writer's block doesn't get you, the cramp will.

Next came authorisation. Armed with personal approval to be Chair, was the CCG up to it? We promised ourselves we'd take it as part of the day job, that we were doing the role, that we wouldn't get submerged in 'evidence.' We were wrong. To anyone who thought the process would simply be a formality, the fact that only 8 CCGs have been authorised without conditions (including Bassetlaw) will hopefully provide some assurance. We are a better CCG for having been through the process, but it's good to be focusing on quality and patients rather than process.

Finally, revalidation. My appraisal today was very similar to previous appraisals - a valuable opportunity to reflect on my clinical practice rather than policies and process. So what was different about a 'revalidation appraisal.' Mainly the surveys. Another 360 degree survey, but this time my colleagues in the practice, both clinical and managerial, including my secretary and other reception staff. This was followed by a patient survey. Both were done through an independent company (Edgecumbe) and the process was very smooth with clear reports afterwards. It felt much more personal than previous QOF surveys, and unlike previous 'leadership' surveys this was about my interactions with patients, my consultation skills, how I support staff.

So all my evidence has been submitted now for revalidation. The CCG has been authorised. The practice has the QPA for the next 3 years. A good year, with a focus on quality and assurance. 2013 should be easier. Wait, what's this on everyone's twitter feed? 35 outcomes for CCGs? A new planning framework? More scrutiny by the Local authority?

Better start collecting evidence.