Day 150: Back in Fastrack hospital. The infection came back, and they are pushing a more powerful antibiotic into my veins.
One of the clinical assistants leaves the folders of patients' "ward records" – a traditional folder of paper documents – on the beds, when he comes round to take temperatures. These are not part of the main patient records, which seem to be the domain of doctors, of which some of the contents find their way onto the hospital's computer system. The ward record is what the nurses fill in, shift by shift, with temperatures, blood-pressures and so on.
So I took a peek at my ward record, encased in a ring-binder. I am not sure whether patients are supposed to see their ward records. I assume that it is OK, as Fastrack has a very liberal policy about telling patients by letter everything about their treatment. I could, incidentally, very easily have taken a similar peek at the records of my fellow-patients on the ward, had I been feloniously inclined. Dr Ross Anderson (link), please note: paper records can be even more insecure than electronic ones.
The first thing that struck me was the sheer volume of bumph covering my stay in the hospital – with summaries of my previous two short stays. I counted 16 pages, which the nurses had to leaf through while locating the two or three pages that they had to fill in with the current readings and assessments that matter.
Four of these pages were guidelines on how to check for "infection", by which they presumably meant MRSA and C. difficile. Fastrack boasts that it is one of the two hospitals in the strategic health authority free of MRSA, so I understand its zeal to maintain that status. But is the ward record the proper place to get these messages across?
Other pages covered my basic details and history of my previous two stays in Fastrack, but my data seemed to be rather sparsely spread across the pages. Only two pages really mattered as the record of my stay on the ward. One was the recording of temperature and blood pressure.
The second was called the "ongoing nursing assessment", which was the ultimate tick-list. The nurses on the day and night shifts had to assess the patients' psychological state, their oral care, skin condition, nausea and vomiting, social roles and relationships, body image and self esteem.
Another set of boxes were for "sexuality and reproduction". The guy in the next bed commented, "what sort of a ward is this anyway?"
The nurses had to tick items if these criteria were OK, and cross them if they hadn't evaluated the patient. A "C" indicated that the patient had a "condition", and up or down arrows to indicate whether they were improving or deteriorating.
I was fascinated to find that they had ticked my oral care, nausea and vomiting, but I was not aware that they had checked any of these things. Even more fascinating was that I got a tick for the first day on "Body language and self esteem" and "social roles and relationships", but then got a cross for the remaining days.
I was surprised at this verdict, as I felt that on the ward I demonstrated rather too much self-esteem for all to see. I began to suspect that the cross did not mean that they had not evaluated me, but it was a code for "stroppy old git". The nurses were warning the next shift that I was indeed a patient from hell. I did note that they started avoiding eye-contact as they passed my bed.
It became clear to me that the contents of this record would never find its way onto a computer, but would join the pile of paper in the basement. I felt that if someone took a hard look at this ward record, they could strip out most of it, condense the date that mattered, and put it on a BlackBerry, iPhone or "mobile clinical assistant". Then, the data, much of it valuable, could find its way onto the patient record, and then into clinical research. And a lot of trees would be saved.
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