SCR viewing in a mental health Trust in England

The benefits and experiences of implementing summary care record viewing in a UK mental health trust are examined

Katherine Delargy BPharm (Hons) MRPharmS DipPsychPharm 

Raj Parekh

Pharmacy Department,

North Essex Partnership University Foundation NHS Trust, UK

Summary care record (SCR) viewing has been available for English NHS trusts for around two years. It is an innovation that comes with many advantages most notably relating to patient safety and experience. In North Essex Partnership University Foundation NHS Trust (NEP), we have been using SCR viewing as a means of improving quality and speed of medicines reconciliation since July 2014. Medicine reconciliation in mental health settings can be a particular challenge but it is important that it is done accurately and effectively as harm may occur due to errors at the interface between care settings.1,2

The Health and Social Care Information Centre (HSCIC) are working to increase access to SCR viewing and have been working with mental health trusts in order to make sure this is rolled out to all NHS secondary care organisations. NHS organisations need to do some work in order to co-facilitate the introduction of this service. The HSCIC was established as an executive non-departmental public body (ENDPB) under the Health and Social Care Act 2012.3 The HSCIC have a duty to the public to ensure that health data is stored safely and used confidentially and work to ensure that health professionals can access health data to support safer patient care.

What is a summary care record?

An SCR is an electronic patient record: a summary of NHS patient data held on a central database covering the whole of England. The SCR contains details of medications prescribed, allergies and adverse reactions. The purpose of the database is to make patient data readily available anywhere that the patient seeks treatment. In a mental health setting this may be following inpatient admission, or when accessing community mental health services.3,4

In NEP there was an awareness of neighbouring acute trusts and other mental health trusts in England having access to SCRs. It was acknowledged that it was important to have SCR access to achieve our pharmacy department’s goals around improving the medicines reconciliation process.5 In the past we relied on faxed summaries sent from GP surgeries that were themselves requested by fax. This is not a smooth business process as it involves delays at each stage. The decision to proceed having been made, our information governance and business infrastructure representatives within our trust were approached and linked with our local implementation lead from the HSCIC.

The stages in the business process for NEP may be summarised as follows:

1. Contact was made with the HSCIC local implementation lead and a planning meeting between our pharmacy, business infrastructure and the HSCIC was arranged.
2. A standard operating procedure (SOP) detailing the practicalities of SCR viewing, paying particular attention to information governance requirements such as appointing a privacy officer, was written.
3. The SOP and a business case were presented to our information governance and security steering group and it was accepted.
4. Registration authority (RA) processes (permission levels on smartcards and NHS spine certificates) were checked.4
5. The HSCIC provided staff training for the pharmacy team.

SCR viewing by the pharmacy team was implemented and viewing figures and uptake of the service was audited. We have observed the following benefits and considerations. The allocation of the role of the privacy officer is something that trusts should consider when implementing SCR viewing.  The privacy officer ensures that there is always a legitimate relationship between the SCR viewer and the subject of the SCR. At NEP we chose the associate director of pharmacy (chief pharmacist). As the role can be somewhat time consuming it may be appropriate to delegate this to a member of administrative staff ensuring that they have a clear idea of the nature of the role’s requirements and they are aware of the way to escalate concerns and report variances and produce the necessary reports that are open to scrutiny by the information governance infrastructure in the NHS organisation.7

Benefits

SCR access is a valuable tool in medicines reconciliation and it should be viewed as a source of drug history information, but of course other sources should be consulted to build a fuller picture. Access through a secure N3 connection with the NHS spine is free of capital costs when done outside of a patient administration system or pharmacy computer system. Of course, IT system developers can make a charge to put this capability within their products. SCR access has utility in unplanned admissions and when the GP surgery is closed or cannot be contacted. It is also useful for patients admitted out-of-area or unknown to our service. When a record exists, access to records is quick and this reduces the time to get the required information to a few minutes rather than several hours waiting for the return of a GP surgery fax. Records are usually up to date and the date when the record was last uploaded is documented in the SCR. 

Considerations

Consent needs to be explored each and every time a SCR is viewed. When patients are first admitted to hospital they may not be able to discuss access with their healthcare professionals. Emergency access is possible and in the NEP SCR viewing SOP it is recommended that this is a multidisciplinary team decision. The information is currently limited. Often when GPs are contacted directly more details of medical history, information on past investigations and results are provided. This additional information may still need to be requested depending on the situation. A fax from the pharmacy often first alerts the GP practice that their patient has been admitted to hospital. This communication link will fall to other staff to implement and is still a requirement, as the trust needs to notify GPs of their patient’s admissions.

There are patients who have opted out of the SCR programme (1.4%). Negative publicity caused concerns but in fact there would be a great public benefit from expansion of the service and the information contained in SCR being made more extensive. Access to a patient’s SCR is strictly controlled.  Only staff with an NHS smartcard can view a record, and only then if they are involved with that patient’s treatment. Each time a record is viewed an electronic audit trail is made.

Future developments at NEP

Enabling staff from Crisis Response and Home Treatment Teams (CRHTs) to access SCRs when patients are first assessed is being developed. Medicines reconciliation within CRHTs is a challenge, as patients are often not seen directly by pharmacy staff. Also, exploring consent being taken from the admitting clinician and subsequently pharmacy staff viewing the SCR when present on the ward is being addressed. Other clinicians getting access to the SCR such as those working in Mental Health Liaison teams and medical staff is a future direction at NEP.

In NEP we plan to do an audit of medicines reconciliation on admission to hospital where SCR viewing is used and where it is not, the experience in other trusts6 has been that using SCR:

• Reduces the time taken to complete a drug history.
• Improves the timescales in which medicines reconciliations are completed.
• Reduces the phone calls/faxes to GP practices.
• Increases the medication discrepancies identified.

Conclusions

This has been a useful and important innovation for us, and it is really worthwhile to engage with HSCIC and gain the ability to view SCR.

Access to the SCR provides pharmacy with an additional tool to achieve 

level 2 (pharmacy involvement) medicines reconciliation targets within 72 hours of admission. It is hoped that roll out of SCR viewing to other teams and professionals will occur soon in our mental health trust.

References

1. National Mental Health Development Unit. 2009. Getting the Medicines Right. www.npc.nhs.uk/rapidreview/?p=393 (accessed 25 March 2015).
2. National Mental Health Development Unit. 2010. Getting the Medicines Right 2. www.cmhp.org.uk/wp-content/uploads/2013/02/Getting-the-medicines-right-2… (accessed 25 March 2015).
3. Health and Social Care Information Centre. HSCIC Board. www.hscic.gov.uk/article/2622/HSCIC-board (accessed 25 March 2015)..
4. Health and Social Care Information Centre. Information on Smart Card Access – Health and Social Care Information Centre. http://systems.hscic.gov.uk/rasmartcards/strategy/raoverview (accessed 25 March 2015).  
5. National Institute for Health and Care Excellence. Technical patient safety solutions for medicines reconciliation on admission of adults to hospital (PSG001. www.nice.org.uk/guidance/psg001/resources (accessed 25 March 2015). 
6. Health and Social Care Information Centre. The Findings. http://systems.hscic.gov.uk/scr/benefits/findings/index_html (accessed 25 March 2015).
7. Data Protection Policy NHS 2014 England. www.england.nhs.uk/wp-content/uploads/2013/06/dpa-policy-1.pdf (accessed 25 March 2015).