Patient stories

Case studies

Joan

“I know the Cheshire Care Record is safe”

“Seven years ago I went to see my Doctor about some problems I’d be having for a while.  He prescibed me some medication but it didn’t seem to work so I’ve been seeing a specialist for some time now to try and get to the bottom of the problem. I’m going back to see him and trying different  medications because they don’t know what’s wrong.

“My doctor asked  me if I wanted to sign up to the Cheshire Care Record as it would help people involved in my care share notes with each other and see what issues I had experienced in the past and what medications I had been on.  I thought this could only be a good thing, especially as I can’t always remember everything I have taken in the past.

“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.”

Carol

“You don’t have to remember everything and repeat it at each appointment”

“When we moved to Cheshire upon joining our GP pratice I was asked if I wanted to sign up to the Cheshire Care Record.

”I’m a firm believer that any joined up working is better than not at all, so was happy to sign up to it. I had some very small initial thoughts about data protection – but I worked with computer systems in my old job and I know that access will be limited to only those who are authorised to see it and that it’s password protected too. It’s actually more secure working in this way.

“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.

“I can see how this would have worked really well for my Mother. She was quite forgetful and if she had been resgistered with the Cheshire Care Record, her admissions into hospital could have been a lot easier and the staff wouldn’t have missed anything that she might have forgotten to tell them.

“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.

“I would definitely recommend this to others  and ask them to speak to their GP  to make sure they are signed up to the Cheshire Care Record.”

Sue Blake

Advanced Nurse Practitioner

“A patient was confused so I was able to find out about all his medication”

We went through her symptoms and medical history but she 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 her 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.

Access is always granted when I ask if they will allow me to look at their record, I think people are more than happy for me to use the Cheshire Care Record because they understand it’s in their best interests.

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 lady who was suffering from abdominal pain. We went through her symptoms and medical history but she didn’t mention something important that I found out from the Cheshire Care Record. She had had an umbilical hernia but had forgotten to tell me about it.

The Doctor on call later told me that we had saved her life because it had strangulated. Without that historical information we wouldn’t have made the decision to send an out of hours doctor and she 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.”

Using the Cheshire Care Record cuts a massive amount of time for me and can be really beneficial to patients too

“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 accesible 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 initally to find out what clients’ medication was or what medical conditions they had, but more recenty 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 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, whether I’m with a client or writing assessments or funding requests.

“It 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.”

The CCR provided robust detail of what the patient’s Mental Health details were

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.

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 assessment for a female aged 50. The patient had fallen and her legs had received multiple complex fractures. The patient had surgery which left her with metal pins and plates supporting and reinforcing the acquired complex fractures.

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 she requires. 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. It also minimised the time the PT needs to chase up the Hospital Registrar to confirm patient information details.

The impact on the patient

The PT stated that using the CCR and having access to both 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, because the therapy selected had an accurate baseline at the start i.e. it took into account that the patient had complex breakages each with their own batch of therapeutic requirements. A fact that if undisclosed and not discovered would lead to her receiving the wrong type of therapy, which in fact would have worsened her physical state.

If the clinician could access GP record details, procedures, outcomes and medication would be provided and the clinician would be better able to assess the patients’ ‘normal state’

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 Choose & Book 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 patients “normal state”.

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

An 85 year old female was wandering the streets in Macclesfield town centre.at around 10.30pm. A passer-by reported this to the emergency services via a 999 call. The emergency services then dispatched an Ambulance to the patient. The paramedics noted that the patient was dazed, confused and in pain. Upon further investigation the paramedics elicited some basic personal details and noticed the patient had fallen and injured her right lower leg, the paramedics also noted the patient was finding it difficult to remember her 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 was a physical injury to lower right leg and delirium with early on set dementia.

There was a lack of any Social and Mental health information. The associated requesting of Social Care assessments and Psychiatric Liaison assessments again would be prevented.

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 obtain consent from the patient with respect to accessing 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 she stayed in hospital for a 5 nights, when she did not need to and she spent these days becoming frustrated with people asking her the same batch of questions again and again with respect to her patient history. If the CCR had been used it would have changed the outcome of her 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 he was vulnerable or a risk to himself or others

A male in his 20s, recently registered with the GP, moved into assisted living accommodation.

He says that he is known to specialist mental health services but doesn’t have any further appointments.  He has been taking medication but has stopped it because it made him feel unwell.  He is asked to make a further appointment and bring the medication list with him.  He makes another appointment but doesn’t bring the medication or a member of staff with him.  His mental health has clearly 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 has been several incidents in the accommodation and also involving the police in the intervening period.  His medication was restarted and staff will be aware and able to prompt him with this.

CCR contained valuable information on medication, psychiatric letters and most importantly whether he was vulnerable or a risk to himself 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.

It was day three of the patient’s inpatient stay before the full medical history was compiled and the correct medication prescribed

Mark is 28 and presented to A&E at 7:20pm on Friday night. He is open to CMHT and has had a break up in his relationship. He is feeling suicidal. He has two children from previous relationships but is not in contact. He has a diagnosis of depressive disorder, but has not been taking his medication regularly and has habitually been using alcohol.

days earlier he had been for a CT scan and blood tests at the CoCH as he has been referred by his GP following the development of swollen lymph nodes.

He is assessed by the psychiatry team and the admission to Bowmere is arranged due to having suicidal plans and intentions. He is transferred at 10:20pm.

He did receive psychiatry treatment 2 years previously but at another Trust prior to moving into West Cheshire.

List the information you needed but did not have

On admission it would help the ward to know:

  • The results of the CT scan and blood tests taken 3 days earlier.
  • A contact in Social Services to establish if there are safeguard issues with regard to his children
  • A history of A&E attendances to establish frequency of presentation
  • Previous GP appointments, medication and treatment.

The time you took & method trying to track the information down

Due to time of admission none of the information can be obtained until the following morning and most would have to wait until 9am Monday morning.  The GP was successfully phoned 9am Monday morning and summary medication and details of previous mental health episodes obtained.  It took most of the day to track down the correct social worker.

The impact on the patient

It was day 3 of the patient’s inpatient stay before the full medical history was compiled and the correct medication prescribed.  Once his medication was stabilised Mark was discharged.

The patient stayed in hospital longer than they needed

A 82 year old female, falls and breaks her hip.  She is admitted as an elective admission for a hip replacement.  The hip replacement is done without complication but the patient suffers with COPD and is continually breathless.  She is transferred to a medical ward and treated with inhalers and steroids over a few days to try to get the right mix of medication to ease her symptoms.  She fails to show any improvement.

The impact on the patient

The patient stayed in hospital longer than they needed, more tests have been done and more medication prescribed, all to no avail.

Will lead to a faster patient diagnosis

A patient arrives at A&E feeling unwell, following a procedure they have had at Mid Cheshire Hospital.  This can often occur if patients use ‘Choose & Book’ to select where they are treated because some may choose to get treatment outside of the usual catchment area.

The receiving clinician has no access to the details of the recent procedure the patient had and therefore has to make decisions about their care with very limited information.  If they had access to the patient’s GP records via the Cheshire Care Record, the details of the procedure, outcome and medication would be provided along with the clinical discharge letter and the clinician would be better able to assess and diagnose the patient.

Provides instant access to medications history

An 82 year old female falls and breaks her hip.  She is admitted for a hip replacement.  The hip replacement is done without complication but the patient suffers with Chronic Obstructive Pulmonary Disease and is continually breathless.

She is transferred to a medical ward and treated with inhalers and steroids over a few days to try and get the right mix of medications to ease her symptoms but fails to show any improvement.

If her GP summary record had been accessible, it would have shown that the GP had already tried these medications.

You don’t have to keep repeating your health or social care history

An elderly lady was taken to hospital by ambulance. The paramedics noted that the patient was dazed, confused and in pain.

Upon further investigation, the paramedics managed to get some basic personal details and noticed the patient had fallen and injured her right lower leg. The paramedics also noticed that the patient was finding it difficult to remember her own personal details.

Upon arrival at the A&E department, the initial diagnosis of the patient was a physical injury to lower right leg and delirium with early onset dementia.

The patient stayed in hospital for five nights, when she did not need to and became frustrated with people asking her the same batch of questions again and again about her patient history.

If the Cheshire Care Record had been used, it would have improved her patient journey by preventing an admission because accurate patient information from across all GP/mental/social care providers would have been available.

It would have also allowed for a speedier discharge because it would have shown that the patient did not have early onset dementia.

Shared access speeds up patient's recovery and discharge

A 52 year old woman, morbidly obese with Type 2 diabetes, and treated with insulin, presented to her GP surgery with her carer.  Her speech was slurred and she appeared confused.  She was admitted via the stroke coordinator to the Countess of Chester Hospital via Accident & Emergency and discharged home 8 days later.

Later on the day of admission, staff at the hospital contacted the practice for information regarding her insulin dose.  She was known to the practice diabetic nurses, the hospital diabetic specialist team and had an insulin passport but they were unable to identify on her record how much insulin she used and directed it back to the ward, hospital diabetic team or carer. They accessed blood test results that had been taken during her admission, checked her last diabetic review at the practice and emailed back to the community matron.

Two weeks following discharge, the GP received an email from the community matron. The patient had been visited by the Stroke Association who had referred her to the community matron.

The community matron wanted to know when her last blood tests were done because the patient was not taking responsibility for her health. Ten minutes of GP time was taken looking at records and replying to the community matron.

The Cheshire Care Record has cut a lot of hassle and waiting out of my job

“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 especailly when seeing people with complex conditions

“When I meet someone for the first time, one of the questions I will ask is if they consent for me to talk to other professionals about their care and explain that sometimes it’s more beneficial for them if we share their information. As long as the client consents and is happy for me to do that, I would look at the Cheshire Care Record so that I can clarify what they say to me in their assessment.

“At the first meeting clients may be nervous and they might not want to talk to you about all their health conditions or they may have memory problems. The Cheshire Care Record allows you to verify the information you get from an assessment. Sometimes, no matter how good an assessor you are – you might miss something important that can be picked up on the Cheshire Care Record.

“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 lady I went to see recently, where the information I had on the referral form was incorrect.

“The form said this lady had been diagnosed with dementia. When I went to see her, I thought from experience that although she had some word finding difficulties, she didn’t appear to display many symptoms of dementia. I checked back on the Cheshire Care Record and it revealed that she had not yet been assessed for dementia.  It turned out she didn’t have it after all and we were able to correct the misdiagnoses quite quickly.

“Another lady I went to see had terminal cancer and was receiving palliative care. Although I suspected this was the case from the medication she was taking, before meeting her I was able to look up her 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 her 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 as long as I have consent 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 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

“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 an older female aged 90. Upon conducting the physiotherapy assessment, the PT noticed that the patient’s movement was noticeably challenged and it looked like the patient had fractured her hip bone. The patient did not disclose this at the assessment stage.

The PT completed the assessment and returned to the office where she utilised the Cheshire Care Record to see what the patients 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

Now the PT 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 show that patients are not always the most accurate source of information for their own healthcare issues and despite the patients lack of disclosure, she 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 her hip and had surgery. A fact that if undisclosed and not discovered would lead to her receiving the wrong type of therapy, which in fact would have worsened her physical state.

Using the Cheshire Care Record would minimise the risk of inaccurate mediations prescribed by offering a fuller picture across all care settings

There are 20 Pharmacists within the (ECH) Pharmacy Team. Their primary role is to care for patients, through ensuring the best use of medicines and providing information about medicines to both patients and to the professionals who treat them. There are two areas where the Pharmacists would find benefits in using the Cheshire Care Record.

Firstly, the Pharmacy service operates on the wards and conducts a medicine-reconciliation service. For example, if a patient has emergency surgery and is then admitted to a ward. There is often a lack of medications history for the Clinicians and Pharmacists to view. Secondly, the Pharmacy service operates an on-call service.

This is where the Pharmacists work on a rota and deliver an out-of-hours service to Nurses and Doctors who require medication information about their out-of-hours patients admitted into wards. Currently the on-call Pharmacist takes calls from the ward at home then travels into the hospital to check Hospital based systems for that patient current GP medications lists.

The CCR is a web based application and can help deliver speedier patient information from anywhere in the Hospital or home to the Pharmacist, who can then update the wards in both instances.

The impact on the patient

Medication reconciliation is recognised as a major intervention tackling the burden of medication discrepancies and subsequent patient harm at care transitions. Using the CCR would minimise the risk of inaccurate mediations prescribed by offering a fuller picture across all care settings and deliver accurate and safe medications to each respective patient.

(Being able to see test results on the CCR) would have saved test costs and freed up half a bed day

A 80 year old man presented at A&E with chest pain. He was noted to have abnormal liver function tests and therefore was sent for an urgent liver ultrasound.  The patient was admitted overnight to await the results of the ultrasound. The ultrasound reported as being abnormal, suggestive of a cancer deposit.  The patient was discharged with an appointment to come back to the Ambulatory Care Unit to have an outpatient whole body CT scan.  This showed that not cancer, but cirrhosis of the liver.   The patient is reassured and discharged back to the GP.  The GP subsequently wrote to the consultant to inform him that these tests had been done 2 years ago but at a neighbouring hospital.  The GP was monitoring blood tests (which were also sent to a neighbouring Trust) and reported that there was no progression, so there was no need to redo the tests.

If the consultant had seen that an ultrasound and CT test had previously been done he would not have redone these tests and he would have discharge the patient.  This would have saved test costs and freed up half a bed day.

The impact on the patient:

The impact on the patient was significant because he stayed in hospital overnight, when he did not need to and spent a few days getting anxious about the possibility of cancer whilst awaiting the test result.  He also made a second, unnecessary visit back to the hospital for the second test.

I was unable to identify on her record how much insulin she used and directed it back to the ward, hospital diabetic team or carer

A 52 year old woman, morbidly obese with Type 2 DM, treated with insulin, presented to her GP at a Monday morning surgery with her carer.  She had a 4 day history of symptoms and signs consistent with CVA. (mainly speech and upper limb impairment). Her speech was slurred and she was dazed / confused.

She was admitted via the SPA and stroke coordinator to COCH via A&E.  She was discharged home 8 days later.

2 weeks following discharge the GP received an email from the community matron.  The patient had been visited by the stroke association who had referred her to the community matron.  The community matron wanted to know when her last blood tests were done/due e.g. HbA1C as patient ‘not taking responsibility for her health’ and bms fluctuating.

Later on the day of admission staff from ACU contacted the practice for information regarding her insulin dose.  She is known to the practice diabetic nurses, the hospital diabetic specialist team and has an insulin passport but I was unable to identify on her record how much insulin she used and directed it back to the ward, hospital diabetic team or carer.

Blood results taken during her admission were accessed as well as checking her last diabetic review at the practice and emailed back to the community matron.

Just 10 minutes of GP time was taken looking at records and replying to the community matron. The GP also entered details of the dialogue with the community matron in the patient’s EMIS medical record.

The impact on the patient

Safety to patient in managing her diabetes/safe administration of insulin.

Unnecessary time by myself and staff on ACU in managing the patient which may have caused a delay in discharge.

The community matron is not able to see the patient’s follow up/review dates which is important especially in vulnerable unreliable patient who need reminding of when these appointments are.

The GP reception staff spent at least 1 hour on the phone to the laboratory at the Countess Hospital trying to get in touch with the ward

A gentleman was discharged after a period of treatment at the Countess of Chester. He has a complex medical history including diabetes, stroke, atrial fibrillation and ischaemic heart disease. 3 days post discharge his summary was not available.

He had an INR taken by the nursing home as advised by the Countess Hospital staff (usually he is dosed by the Wirral WACS system).

The nurses at the home were confused as to how to proceed with his warfarin and sent his yellow book with the blood test. The GP was contacted at 5pm on call with the INR result.

The GP had no discharge summary, no latest readings of INRs apart from the one taken, which was 3 and no recent dosing from the hospital, just the home telling the GP that he had taken 4mg yesterday.

The information you needed but did not have

The GP needed the INR results and instructions from the ward re: previous dosing so that the nursing home could safely organise switching back to the WACS system.

The GP needed the discharge summary to contain all the above information sent on discharge from the ward.

The time you took & method trying to track the information down 

The GP reception staff spent at least 1 hour on the phone to the laboratory at the Countess Hospital trying to get in touch with the ward. In the end after all the chasing we had no further information and the GP had to dose the patient without the information, which involved unnecessary risk. The GP organised an INR for after the weekend, which may not have been needed.

The impact on the patient

A clinical decision was made based on limited information so more risk was associated with the decision.

Possible inappropriate testing.  The patient may not have needed the INR so soon.

Limited information provided late in the day – almost impossible to obtain further information after 5pm so delayed patient care by hours.

If the results were available to the clinician at CCC, the patient would be able to have the tests completed in primary care

This patient is a 55 year old, kidney cancer patient on long term Variant Oral Therapy.  The cancer is well maintained.  Monitoring of his blood pressure and bloods is done at CCC.

List the information you need but did not have

Blood pressure and blood test results needed from primary care.

The time you took and the method of trying to track the information down

Due to issues accessing the blood results and blood pressure taken in the community/primary care, the patients are brought into CCC every month to have bloods/blood pressure taken at CCC in a clinic setting.  If the results were available to the clinician at CCC, the patient would be able to have the tests completed in primary care.  The clinician would review the results and physically see the patients every 3/12 months.

The impact on the patient

The patient attend CCC 12 times a year instead of four.  This is a longer journey for him than going to his GP, which costs more and means he takes more time off work, when he has already taken considerable time off work due to the cancer.

Importance of having patient consent with a full access to health records

Patients who use one or more health care service providers will benefit from opting in to the Cheshire Care Record because there will be instant access to your medical records between GP and hospital visits.

An 80 year old man arrived at A&E with chest pain. He was seen to have abnormal liver function tests and was sent for an urgent liver ultrasound.  The patient was admitted overnight to await the results of the ultrasound which came back as being abnormal, and indicated a potential cancer deposit.

The patient was discharged with an appointment to come back to the Ambulatory Care Unit to have an outpatient whole body CT scan which revealed that it was not cancer, but cirrhosis of the liver. The patient was reassured and discharged back to the GP.

The GP wrote to the consultant to inform him that these tests had been done two years ago but at a neighbouring hospital.  The GP was monitoring blood tests and felt there was no need to redo the tests and stress the patient again.

If the hospital had access to the patient’s records, as soon as the patient was admitted, he could have avoided an overnight stay in hospital and a long wait for the test results.

Can alert staff to serious mental health issues

A male in his 20s, who was registered with the GP was known to specialist mental health services but didn’t have any further appointments.  He had been taking specific medication but had stopped taking it because it was making him feel unwell and went to see his GP.

He was asked to make a further appointment and bring the medication list with him but on his return appointment, he didn’t bring the medication or a member of staff with him. His mental health had clearly deteriorated.

The mental health team and the previous consultant were then both contacted and information obtained. Following this, his medication was restarted; staff were made aware and able to prompt him with this.

The Cheshire Care Record could have provided details of medication, psychiatric letters, or most importantly whether he was vulnerable or a risk to himself or others.

Provide greater access to patient records for community staff

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 assessment for a female aged 50 who had fallen and her legs had received multiple complex fractures.

Upon assessment, the physiotherapist had very limited visibility of the patient’s surgical details and supporting documentation. This lack of information severely limits how the PT can progress the patient as it involves them having to chase up the information. This is usually done by liaising with the surgeon’s medical secretary to request patient’s previous correspondence, X-ray images and results.

They stated that using the Cheshire Care Record and having access to GP correspondence, associated x-ray results and discharge summaries would lessen the amount of home physio visits and enable the team to identify the best type of therapy.

Giving access to out-of-hours patient care

A patient arrived at A&E on a Friday night feeling suicidal. He had a diagnosis of depressive disorder, but had not been taking his medication regularly.

Three days earlier, he had been for a CT scan and had blood tests at the hospital as he was referred by his GP following the development of swollen lymph nodes.

He was assessed by the psychiatric team and an admission to the mental health hospital was arranged due to having suicidal plans and intentions.

He had received psychiatric treatment two years previously at another Trust and prior to moving to West Cheshire.

On patient admission, it would have helped the ward to know:

  • The results of the CT scan and blood tests taken 3 days earlier.
  • A contact within social services to establish if there were safeguarding issues with regard to his children
  • A history of A&E attendances
  • Previous GP appointments, medication and treatment.

Due to the time of admission, none of the information could be obtained until the following morning such as a GP summary medication and to obtain details of previous mental health episodes.  It took most of the day to track down the correct social worker. It was day 3 of the patient’s stay in hospital before the full medical history was compiled, correct medication prescribed and Mark could be discharged.

Meeting patient’s wishes for their end of life care

A patient with lung cancer had attended by ambulance with chest pain which they had experienced before.

The patient informed his Macmillan nurse that they did not wish to be hospitalised but the carer was not familiar with their end of life preferences and called for the ambulance.

North West Ambulance Service was not yet able to access end of life preferences and had not spoken to the hospital, GP or with the Macmillan nurse.

Once the patient attended A&E, the Cheshire Care Record raised an alert on his oncology records that the patient didn’t want to be resuscitated.  Once identified, his Macmillan nurse attended to him in resus and was able to update on his end of life preferences and we navigated a plan mutually agreeable for the patient, Macmillan nurse and A&E staff.