“I know the Cheshire Care Record is safe”
“At the click of a button, any of the doctors I go to, can see my notes from years ago. For example I had back problems a few years ago and I had injections for that – the information about this is on my Cheshire Care Record so I don’t have to worry about recalling when I went and what I had done. This is a relief for me – I see different health professionals for different reasons, so the fact that they have all the information to hand, without me having to go over things is a good idea.
“I know the Cheshire Care Record is safe and that no one outside the health and social care sector can access it. I know it won’t be passed on to a third party; it’s confidential and I trust it.”
“You don’t have to remember everything and repeat it at each appointment”
“I think that some people think that access to data in this way is a concern but I have had no worries about my data and how it is shared between my GP, consultant and hospital.
“When I see my consultant now he doesn’t have to ask me what has happened since my last appointment , he just pulls up my Cheshire Care Record and all my history is there, including information from my GP, most recent blood test results and my prescriptions.
“I’m now in and out of my appointments fairly quickly – and all my appointments just run as normal, I have noticed that I no longer have to go over any of my medical history or repeat myself. I can tell the consultant was very enthusiastic about using the Cheshire Care Record and he was able to see all my information at the touch of a button. I don’t have to go to hospital anymore now which is a benefit.
“If you are on a lot of medication it’s a really great tool for hospitals, GPs and other health professionals so that they can see what you are taking and ensure the combination is right. You don’t have to remember everything and repeat at each appointment as it’s all there on screen.
Advanced Nurse Practitioner
“A patient was confused so I was able to find out about all his medication”
Out of Hours Triage Nurse
“We went through the patient’s symptoms and medical history but they didn’t mention something important that I found out from the Cheshire Care Record. The Doctor on call later told me that we had saved the patient’s life.”
“As a triage nurse in the Out of Hours service, my job is to collect as much information on a patient to give to a GP on their way to a home visit.
I generally find that the Cheshire Care Record is most helpful for elderly patients who can’t easily recall their medications and I am able to type up this information and pass to the Doctor.
It definitely helps me to highlight a past medical history or previous health issues and eliminates a lot of guess work when we get phone calls from people who are ill.
Just recently I spoke to an elderly patient who was suffering from abdominal pain. We went through their symptoms and medical history but they didn’t mention something important that I found out from the Cheshire Care Record. The patient had had an umbilical hernia, but had forgotten to tell me about it.
The Doctor later told me that we had saved the patient’s life because the hernia had strangulated. Without that historical information we wouldn’t have made the decision to send an out of hours doctor and the patient could have died.
In our job when compiling a note history, it’s very important not to miss anything to aid an accurate diagnosis. The Cheshire Care Record can assist us in compiling a detailed set of notes on a patient.”
“Access to the Cheshire Care Record is helping me to ensure that diabetes patients are on the correct medical regime for them, which is vitally important for this group of patients whose wellbeing depends on their medication”.
“I do outpatient clinic sessions, including patients who come in for their annual check-up and often they don’t have a list of full medication with them. It is really helpful for me to access the Cheshire Care Record while the patient is there and see what treatment they are on.
“Using the Cheshire Care Record cuts a massive amount of time for me and can be really beneficial to patients too.
“One of my patients who has some learning difficulties came to see me recently – he thought he was on one type of insulin regime, but it turned out when I looked on the Cheshire Care Record he was actually on something very different.
“The insulin he was on wasn’t suitable for his diabetes diagnoses and was actually putting him in danger of unstable bloody sugar levels. We were able to correct that straight away and switch him to a more suitable regime. We reduced the risk of a potential hospital admission immediately because we were able to access all that information straight away, instead of having to wait whilst we got the information from the GP Practice.”
“Using the Cheshire Care Record makes my job slicker, it makes the information I need on a daily basis more accessible and it’s all there for me on screen”
“I came across the Cheshire Care Record when it was first introduced to us at Cheshire East Council to help the Social Care team access medical information.
“I used it initially to find out what clients’ medication was or what medical conditions they had, but more recently I have been using it to provide clinical reasoning and medical evidence to funding panels for equipment. Having access to all this information helps me add necessary detail to funding bid for a client who needs equipment to support their needs.
“The Cheshire Care Record works really well, before I started using it I’d be back and to between GP and client trying to get their medical information and background to support their assessment and needs, but with this system the evidence is all there to back up the clients’ requirements.
“Using the Cheshire Care Record reduces my admin time and the time spent phoning round gathering information from GPs and hospitals. I no longer have to wait for a fax from their Doctor – so it’s quicker and more secure as well. It makes things easier for the client and I find I can get decisions for them quicker.
“Some people have been seen by various hospitals in the area over the past few years and the Cheshire Care Record ensures that all their historical information is collated in one area. It definitely makes our job easier and it saves us time in assessments which means we can see more people.”
Accident & Emergency Doctor
On the Emergency ward round handovers between night and day duty Doctors, a review of the CCR for two patients was highly beneficial.
For the first patient it helpfully reinforced clinical assumptions as being accurate in particular where the Doctor had a feeling that there were previous mental health issues. The CCR provided robust detail of what Mental Health details were.
For the second patient there was an electrolyte imbalance contributing to the patients attendance-again the CCR showed that there was previous electrolyte issues therefore facilitating improved clinical decision making with accurate and robust information.
Using the Cheshire Care Record has reduced the number of home visits we do because the whole picture is available before the visit.
The team offers home based physiotherapy services for patients who have limited mobility following a fall or surgery.
The physiotherapist (PT) conducted a home visit assessment for a 50 year old patient who had fallen causing multiple complex fractures in their legs. The patient had surgery to insert supporting metal pins and plates.
Upon assessment the PT would have very limited visibility of the patient’s surgical details and supporting documentation. This lack of information severely limits how the PT could progress the patient as it involves the PT having to chase up the information they require. This is usually done by liaising with the surgeon’s medical secretary in order to request the patients’ last-letters, X-rays images and results.
This team has now revised its working practices to the following:
Now the PT utilises the Cheshire Care Record and goes through a pre-visit checklist reviewing GP Practice/mental/social/hospital interactions and last letters, x-ray results, discharge summaries for each respective patient. The PT is now aware of all relevant interactions and takes this information to each respective home visit. This has radically reduced the amount of time the PT is waiting for documentation to be sent by the Hospital.
The impact on the patient
The PT stated that using the CCR and having access to GP last letters/hospital last letters, associated x-rays results and discharge summaries, is a great advantage, as it actually lessens the amount of home PT visits. Information that if undisclosed and not discovered could lead to the patient receiving the wrong type of therapy, which may worsen the patient’s physical state.
Accident & Emergency Doctor
A patient presents at A&E following a procedure at a hospital elsewhere and the details of what was done can be instantly viewed on the Cheshire Care Record.
A patient presents at A&E because unwell following a procedure that they had at either another local acute or tertiary unit. This is an increasing problem, especially now that patients can use the Electronic Referral Service (e-RS) to select where they are treated and may choose to get treatment outside of the usual catchment area.
However, an ambulance on an emergency call for a West Cheshire patient will always take them to Countess of Chester. This means the receiving clinician has no access to the details of the recent procedure that they have had and often therefore makes decisions about their care with very limited information. If they could access the GP record the details of the procedure, outcome and medication would be provided and the clinician would be better able to assess the patient’s “normal state”.
An 85 year old was found wandering late at night in a local town centre.
A passer-by rang 999 and the emergency services then dispatched an ambulance. The paramedics noted that the patient was dazed, confused and in pain. Upon further investigation the paramedics obtained some basic personal details and noticed the patient had fallen and injured their leg, the paramedics also noted the patient was finding it difficult to remember their own personal details.
Upon arrival at the A&E Department the above information was handed over to the attending team. A&E’s initial diagnoses of the patient were a physical injury to the leg and delirium with early on set dementia.
There was a lack of any social and mental health information.
The provision of Social Care and Mental Health information through the Cheshire Care Record will radically reduce the amount of time clinicians take in chasing down patient information and substantially improve the amount of time they spend with each patient in order to plan the most suitable method of discharge.
The Integrated Discharge Team would find the CCR invaluable within the meet-and-greet aspect of their service. The Integrated Discharge Team can utilise the meet and greet to access their patients’ records and elicit the accurate mental/social care patient information to facilitate speedier discharge planning. It would also lessen the burden of trying to track down the relevant mental/social care information.
The impact on the patient
The impact on the patient was significant because they stayed in hospital for five nights, when they didn’t need to. The patient became frustrated with people asking the same questions again and again with respect to their patient history. If the CCR had been used it would have changed the outcome of this journey quite dramatically on two points. Firstly, it would have prevented an admission in the first instance as the correct and accurate patient information from across all areas GP/mental/social care providers, would have been available. Secondly, and given the patient was admitted, it would have facilitated speedier discharge for the same reasons as in the above sentence. It would have shown that the patient did not have early on set dementia.
“The CCR contained valuable information on medication, psychiatric letters and most importantly whether the patient was vulnerable or a risk to themselves or others”
A patient in their 20s, recently registered with the GP, moved into assisted living accommodation.
The patient says they are known to specialist mental health services but doesn’t have any further appointments. They stopped taking their medication it because it made them feel unwell. The patient is asked to make a further appointment and bring the medication list along, which they don’t do. It is clear that the patient’s mental health has deteriorated.
The mental health team and the previous consultant were then both contacted and information obtained.
The patient re-attended with a member of staff, but unfortunately there had been several incidents at their accommodation involving the police in the intervening period.
The CCR contained valuable information on medication, psychiatric letters and most importantly whether the patient was vulnerable or a risk to themself or others.
The impact on the patient
The delay in restarting medication caused unnecessary risk to the patient, several incident occurred with the police which may have been prevented by medication. No incidents have occurred since it has been restarted.
Patient Admitted to Hospital
It was day three of the patient’s inpatient stay before the full medical history was compiled and the correct medication prescribed
A 28 year old patient presented to A&E at 7:20pm on a Friday night. They were open to CMHT, had a break up in their relationship and was feeling suicidal. The patient has two children from a previous relationships but is not in contact.
There is a diagnosis of depressive disorder, but the patient not been taking their medication regularly and has habitually been using alcohol.
Days earlier the patient had been for a CT scan and blood tests at the CoCH then was referred by their GP, following the development of swollen lymph nodes.
The patient is assessed by the psychiatry team and the admission to Bowmere is arranged due to having suicidal plans and intentions. They are transferred at 10:20pm.
The patient received psychiatry treatment two years previously but at another Trust prior to moving into West Cheshire.
On admission it would have helped the ward to know:
- The results of the CT scan and blood tests taken three days earlier.
- A contact in Social Services to establish if there are safeguard issues with regards to the two children
- A history of A&E attendances to establish frequency of presentation
- Previous GP appointments, medication and treatment.
The impact on the patient
It was day three of the patient’s stay before the full medical history was compiled and the correct medication prescribed. Once their medication was stabilised the patient was discharged.
“I use it for the majority of my patients! When a patient comes into hospital, often if they’re really unwell they are unable to tell me what medication they are on, what type of diabetes they have and how long they have had it.
“It’s important for me to know all of this information and I find that everything I need to know is at the touch of a button on the Cheshire Care Record including blood sugar levels, repeat prescriptions and review dates. It’s cut my time down massively. In the past I would have had to contact their pharmacy to get a list of medications they are on and GP surgeries to find out their medical history and this took a lot of time.
“I now get all of this information at the start of the patient journey which means I can deliver the right care more quickly which often means I can keep a patient out of hospital because I’ve been able to resolve their issues there and then.
“I have a lot of young adults and the information they give you can sometimes be inaccurate and patchy. One young patient I was working with was getting ill quite often and spending a lot of time in hospital and we couldn’t work out why from what he was telling us.
“On looking on the Cheshire Care Record it transpired that he wasn’t looking after himself quite as well as he had told us – he had missed a few repeat prescriptions and had not been taking his blood sugar levels as often as he should. Armed with this information we were able to explain to him why he was getting ill so much and re-educate him on self care. This resulted in a reduction in his admissions.
“Patients are noticing how the Cheshire Care Record has improved care for them too as we are able to talk about their healthcare needs in a more joined up way, thanks to information from all the professionals involved in their care.”
“I hope that the Cheshire Care Record is used in future by a lot more professionals especially when seeing people with complex conditions”
“I think that our clients benefit from us using the Cheshire Care Record as they will have talked to numerous health professionals already. Some people have sensitive things or life limiting illnesses that they don’t want to talk about every time they see a different care professional, especially when they’ve just met you for the first time. It’s different to talking to their family doctor who they’ve known for years but access to the Cheshire Care Record helps overcome this when you first meet someone.
“We have to have accurate information with regards to people’s medical conditions, medications and medical history to put a case for funding to our Community Care Board. Using the Cheshire Care Record makes getting that information easier and quicker, as you’re not having to wait for a reply from doctors’ surgeries or other healthcare providers. It not only reduces our workloads in Social Care, but also other colleagues in health who would normally have to spend time getting back to us and providing us with historical information.
“In particular, the Cheshire Care Record has been of benefit to one client I went to see recently, where the information I had on the referral form was incorrect.
“The form said this the client had been diagnosed with dementia. When I went to see them, I thought from experience that although there was some word finding difficulties, the client didn’t appear to display many symptoms of dementia. I checked back on the Cheshire Care Record and it revealed that there had not yet been an assessment for dementia. It turned out the client didn’t have it after all and we were able to correct the misdiagnoses quite quickly.
“Another client I went to see had terminal cancer and was receiving palliative care. Although I suspected this was the case from the medication they were taking, before meeting her I was able to look at the patient history on the Cheshire Care Record and find out everything I needed to know. This meant I didn’t have to ask the client to recount their experience, which can be very distressing for some people and their family members – especially on their first meeting with us.
“It’s very quick to access the Cheshire Care Record – it’s a click of a button and I can access a services users’ information instantly. It enables me to write better assessments using more accurate information in a faster way and takes the pressure off us and the client to discuss everything at once.”
“The Cheshire Care Record is a terrific opportunity that we as a social care function should be using. It’s a fantastic tool and we want to embed it and ensure all our social workers use it.
“I was a commissioner for mental health and learning difficulties in the NHS before I took on a role as Cabinet Lead at Cheshire West and Chester in 2015, so I completely understand that in adult social care, there is a clear desire to understand who has been in contact with other healthcare services. It is important for us as a social care team to be able to assess our service users’ individual needs.
“Having access to shared information on our service users can help us decide how best to signpost them to other services we feel would be beneficial to their mental and physical health. By doing this at their initial assessment we can save lots of time and make a quicker referral, as well as removing the frustration for service users around having to repeat themselves and answer the same questions at every meeting with a social worker or health professional.
“The Cheshire Care Record is designed to downsize the number of conversations people have with health and social care professionals. Our assessments can take up to an hour, so having that information on screen for the next person to access is going to save time and allow other services to gain faster access to support for the service user.
“With access to all this information we can all make fully informed choices over what services to refer onto.
“If the patient has several health conditions, having information from the Cheshire Care Record is really important to assist the health professional in making the right kind of decisions.
“The link between mental and physical health is becoming more apparent and people who suffer with poor physical health can also be affected by poor mental health and vice versa.
“The Council’s wellbeing agenda promotes people living independently and avoiding unnecessary hospital admissions and I feel that the Cheshire Care Record is a vital tool in helping us to achieve this.”
The PT stated that using the CCR in this way has a huge advantage, as it actually lessens the amount of home PT visits
The team offers home based physiotherapy services for those patients who have limited mobility following a fall or surgery and find it challenging to travel to clinic for therapy services.
The physiotherapist (PT) conducted a home visit for a 90 year old patient. Upon conducting the physiotherapy assessment, the PT noticed that the patient’s movement was noticeably challenged and it looked like the patient had fractured their hip bone. The patient did not disclose this at the assessment stage.
The PT completed the assessment and returned to the office where they accessed the Cheshire Care Record to see what the patient’s last-letters could reveal about her observations regarding the patients fractured hip bone. The last-letters from the both the GP practice and the Hospital confirmed that in fact the patient had hip replacement surgery.
The PT used this information at the second home visit to enhance and develop the therapeutic package. This saved the PT from having to chase up and escalate the issue through multiple calls and faxes to the patients respective GP and Hospital.
This team has now revised its working practices to the following
PT now goes through a pre-visit checklist reviewing GP Practice/Mental/Social/Oncology interactions and last letters for each respective patient. The PT is now aware of all relevant interactions and medications and takes this information to each respective home visit.
The impact on the patient
This scenario shows that patients are not always the most accurate source of information for their own healthcare issues and despite the patient’s lack of disclosure, they received the most suitable therapy. The PT stated that using the CCR in this way has a huge advantage, as it actually lessens the amount of home PT visits, because the therapy selected had an accurate baseline at the start i.e. it took into account that the patient had broken their hip, resulting in surgery.