I called one of my diabetic patients this week to see how she was doing. She said she was better after her fall and trip to the ER. She elaborated: She'd gone for a walk with her dog. She has severe neuropathy in her feet and so tries to use a trail near her home because it has an even surface. Anyway, in spite of her efforts, she took a fall and landed onto her shoulder. She was in extreme pain and feared she'd broken something. Somehow she managed to get up and get back to home where a kind neighbor took her to the ER. She said she knew they would ask her about what medicines she takes so she remembered to take her copy of the Shared Care Plan(SCP) with her. She said it was wonderful! All the nurses and doctors were so excited and pleased to have a clear, up-to-date copy of her meds. She was glad she remembered the SCP because it made it much easier for her while she was in pain. She did not want to take the time to find all her medicines and take them to the ER.
Yes, I'd call that a success! However, the situation highlights many problems as well.
1. I had no idea she'd had the fall and gone to the ER. Her primary care provider will no doubt get the summary via the hospital. However, as Clinical Care Specialists, we are not yet in the communication loop. I am not sure how to address this problem.
2. Since she received new medications to deal with her shoulder injury, her meds list is no longer accurate.I will need to revise her SCP and then get a copy to her. Logistically this can be a challenge especially as our case loads increase.
3. So far, there is no electronic method of up-dating patient information.
I am so very much looking forward to the electronic Shared Care Plan. It seems like such an obvious necessity and will improve patient safety and multi-provider communication. The logistics are challenging because it will require that the entire medical community embrace and implement this for it to work. The vision is compelling!
