MedicAlert jewelry can speed assessment
Emblems identify patients’ medical conditions fast
If a patient has potentially life-threatening conditions such as hemophilia, diabetes, asthma, or allergies to medications, MedicAlert ID jewelry can speed assessment and avoid bad outcomes. "As part of your initial evaluation, you should always look for the bracelet," recommends Charlotte Yeh, MD, FACEP, medical director of Medicare policy at the National Heritage Insurance Company in Hingham, MA. "If it’s not part of your routine, it should be, because it can be invaluable."
When a patient with Alzheimer’s disease came to the ED with a complex medical problem, the MedicAlert emblem she was wearing made it possible to avoid hospitalization, recalls Yeh. "I was able to review her existing condition, find out who her primary care provider was, and contact that person. As a result, I was able to care for her in the ED, which shortened her stay," she says.
Nurses should encourage patients to be members of MedicAlert. "If you encounter patients with chronic conditions or who may have problems with communication, recommend this to them at discharge," Yeh advises. "Offer patients membership applications, or at least provide the 800 number." Here are some benefits of MedicAlert:
• Information is attached to patient (on a bracelet or necklace). "This is the one program where personalized information is attached to the patient," Yeh explains. "Other medical ID programs usually involve cards carried in the patient’s wallet. Those aren’t as useful, because they can be separated from the patient."
• The emblem lists medical conditions that could affect care. "This tells us immediately if a patient is allergic to insect stings and can immediately go into anaphylactic shock, or has implants such as a pacemaker or heart valve that could affect treatment," explains Yeh. "You can go to any drugstore and buy bracelets saying you are allergic to penicillin, but those are preprinted and don’t have detailed contact information."
• MedicAlert is also recognized internationally by the medical community. She notes,"In this day and age of global travel, it’s important that information be accessible at any time."
• The emblem adds to information provided by caregivers. One study revealed that caregivers often can’t adequately inform health care providers about children’s special needs, reports Alfred Sacchetti, MD, FACEP, an emergency physician at Our Lady of Lourdes Medical Center in Camden, NJ.1 "In the study, parents were interviewed when they brought their children to specialty clinics. They looked at whether they had enough knowledge to explain the child’s medical condition," he explains. "By and large, we found the majority of parents could not, in a consistent fashion, explain to a health care provider unfamiliar with the child what was going wrong with them."
One child had a complex cardiac problem, and the patient’s mother didn’t adequately explain the condition, Sacchetti recalls. "The mom didn’t know enough to explain that oxygen would make the child’s condition worse," he says. "Of course, everybody starts out getting oxygen, and it wasn’t until we got hold of a consultant that we were able to get that information."
Medical ID jewelry can be lifesaving in those situations, says Sacchetti. "It’s true that parents know more than most specialists do. But no matter how much parents are educated about their child’s problem, they can’t tell us everything we need to know. And if the parent isn’t there, the child can still be identified to all health care providers."
• A 24-hour medical database is available. A 24-hour emergency response center can be called to obtain additional information, which can be immediately faxed over or shared over the telephone. (For more information, call (800) 825-3785.)
"MedicAlert is not only for preliminary information. You also have access to the patient’s medical history and contact information for that individual," explains Yeh.
Nurses should use this medical database, urges Yeh. "MedicAlert is a two-part service. First, nurses should look at the emblem, and second, they should access the medical database," she says. "It’s not widely known that there is a national medical database available."
The 24-hour hotline number can be dialed collect from anywhere in the world. When ED staff call the number, they reach the MedicAlert Emergency Response Center. Within seconds, operators dispatch computerized medical information by voice or fax. Information includes the patient’s medical conditions, allergies, special needs, and the names of personal physicians and family members, and can be updated an unlimited number of times by members at no charge.
Like any data, however, they are only as good as the input, notes Yeh. "The process is when somebody signs up, he or she is given a detailed medical sheet to complete. If the person does not keep it updated, then the information can be outdated," she says. "However since contacts are listed, you will at least have information on who to contact to get the latest information."
• The emblem confirms identification of the patient. MedicAlert can also provide identification for patients who are unconscious, disoriented, or unable to speak when they arrive at the ED. "We’ve all had the embarrassing situation of having a critically ill or injured person and contacting the wrong family or misidentifying the patient, because his or her [personal items] did not accompany him or her to the ED," says Yeh.
• Identification of do not resuscitate (DNR) patients. "MedicAlert is an approved identifier in six states for DNR, which are Arkansas, Kansas, New Mexico, Maryland, West Virginia, and California," says Rose Marie Tantillo, JD, RN, advance directive DNR program manager at MedecAlert Foundation, based in Turlock, CA.
Upon receipt of DNR forms approved by the state, the MedicAlert emblem is engraved according to state requirements. "We keep a copy of the patient’s DNR order on file, which is in our database. When a health care worker sees that, they know there is a DNR order in effect. That emblem, in effect, acts as a DNR order, and they can withdraw or withhold resuscitative measures," Tantillo says.
• A copy of the patient’s DNR form can be faxed as needed. "Whether that is valid in their state or not depends on state guidelines," says Tantillo. "Some states require that they see the original, but anything can be used to show the intent of the person."
In Arizona, a patient had a DNR on file with Medic-Alert. "The ED nurse contacted MedicAlert and asked us to pull the order and read it over the phone. The physician verified it and called the code at that point," Tantillo reports. "In that case, the bracelet indicated the wish for DNR, and we verified that we had the order."
Reference
1. Carraccio C, et al. Family member knowledge of children’s medical problems: The need for universal application of an emergency data set. Pediatrics 1998;102:367-370.
Sources
For more information on MedicAlert, contact:
• Alfred Sacchetti, MD, FACEP, Our Lady of Lourdes Medical Center, Emergency Department, 1600 Haddon Ave., Camden, NJ 08103. Telephone: (609) 757-3803. Fax (609) 365-7773. E-mail: [email protected].
• Charlotte Yeh, MD, FACEP, National Heritage Insurance Company, Box 3033, Hingham, MA 02044. Telephone: (781) 741-3122. Fax: (781) 741-3211. E-mail: [email protected].
• A new training program for ED personnel is available from MedicAlert to enhance awareness and use of its emergency medical information service. The program includes a student participation manual, visual aids including PowerPoint presentation, CD, slides, case studies, and an explanation of how the MedicAlert identification emblem works as a DNR order. To order, contact MedicAlert, 2323 Colorado Ave., Turlock, CA 95382. Telephone: (800) 825-3785 or (209) 669-2436. Fax: (209) 669-2457.
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